from an expert in the field:
Scott Kahan, M.d., is co-director of the george Washington Univer- sity Weight Management center and is on the faculty of the Johns hopkins University School of Public health.
MARCH DEBATE RESULTS:
Should air travelers be required
to undergo whole-body
OBESITY IS A DISEASE of energy (calorie) dysregulation, just as
hypertension is a disease of blood pressure dysregulation.
Unfortunately, many people dismiss obesity as a lack of willpower.
It makes no sense to say that the one-third of U.S. adults who are
obese—some of whom are our most successful leaders and scientists
and doctors and artists—lack adequate willpower. Willpower is not an
explanation. It’s a convenient excuse that minimizes a societal role in this epidemic.
Consider the similarity between hypertension and obesity. Both have genetic predispositions and multifactorial causes, both are associated with unhealthy diet and inactivity, and
both result in adverse health consequences that increase the risk of disability and premature
death. But we don’t minimize the disease of hypertension because it manifests only inside the
body; hypertensive patients don’t necessarily get fat.
What if obesity wasn’t associated with weight gain? That is, what if all the consequences
of obesity—hormonal changes, inflammation, elevated cholesterol, atherosclerosis, proliferation of cancerous cells, enlargement of the heart and so forth—existed without an overt and
outward gaining of weight? If we were blind to the aesthetics of obesity, it would be hard for
anyone to question it as a disease.
The problem is that we have a societal prejudice against obesity and obese persons. The
question should not be whether obesity is a disease. Rather, the key question is whether we
can move beyond our prejudices to mobilize a systematic societal response.
As our food environments become more and more skewed toward cheap, unhealthful,
aggressively marketed, heavily subsidized, processed foods and as labor-saving technologies
become ever more ubiquitous, obesity rates spiral upward. The situation is not unlike an
infectious disease outbreak in a community with an infected water supply. Ultimately, we
must address the toxic environment in order to manage the disease.
I hope that as we continue to raise awareness that obesity is a disease, we will move past
its mischaracterization and begin to address it systematically and scientifically as we do with
other diseases. C
Percentage reflects votes
received by March 16, 2010.
FEBRUARY DEBATE RESULTS:
Is civility dead?
YES: 84% NO: 16%
Percentage reflects votes received by
March 1, 2010. results may reflect
debate being picked up by blogs.
from an expert in the field:
J. Justin Wilson is the senior research analyst at the center for con-
sumer Freedom (
www.consumerfreedom.com), a nonprofit coalition
supported by restaurants, food companies and consumers to promote
personal responsibility and protect consumer choices.
TO CALL OBESITY a disease implies that its causes are out of our
control, or even that it’s contagious. It also replaces personal responsibility
with a defeatist attitude that we can’t lose weight once we put it on.
Fortunately, the vast majority of Americans reject this outlook. A
December CBS News poll found that 89 percent of Americans believe that
obesity can mostly be controlled with diet and exercise. Indeed, weight gain or loss is the result of
the number of calories in (what we eat) differing from the number of calories out (physical activity).
Our waist sizes have grown over the past three decades, not because of a contagion, but
because of major lifestyle changes that have occurred during this time. For one, food is now
cheaper and easier to get than ever before (which is hardly a bad thing). But food is not the sole
cause of obesity. Our daily lifestyles have changed over the past few decades in little ways that
have reduced our activity levels. Increasingly sedentary lives have enabled us to easily rack up
the pounds by not burning calories.
Consider the spread of labor-saving devices. We now have lawn mowers that we can ride on.
Laundry machines. Dishwashers. No one walks anyplace if a car can take him or her there. The
percentage of the population driving to work increased from 64 percent in 1960 to 88 percent in
2000. And each hour spent sitting in a driver’s seat increases one’s risk of obesity by 6 percent,
according to researchers from the University of British Columbia.
According to a commentary in the Mayo Clinic Proceedings, doing things the automated way
means we don’t burn up to nearly 300 calories per day that we would spend with an active
approach to daily tasks. While small actions don’t amount to many calories individually, they
add up. And after a year of 300 calories a day that we didn’t burn off, a few more pounds have
taken up residence in our bodies.
If obesity is a disease, it’s a disease of a civilized lifestyle and a high quality of life. If we want
to win the battle of the bulge, the best way is to recognize the multitude of causes and focus on
the personal decisions that affect weight. Every day. C
Opinions expressed are those of the individuals
or organizations represented and are presented
to foster discussion. costco and The;Costco
Connection take no position on any debate topic.