“Should Obesity be a ‘Disease’?”
That’s the headline on a piece in the New York Times by Crystal Hoyt and Jeni Burnett, both of the University of Richmond. It irked me a little and I had to stop and remember that you can write as cogent a piece as you want and the headline writers will still do their work on it before it sees the light of day. You can see the piece here. Crystal and Jeni, (left and right, respectively) I apologize for my hasty and blaming thoughts.
Or, maybe I don’t apologize. I do have, after all, a personality disorder and that’s probably why I responded with anger. It isn’t my fault, really. And why should I change if it isn’t my fault to begin with.
And there you have it.
The headline is silly. Either it is a disease or it isn’t. That’s why they put “disease” in quotation marks. With the quotes, it reads, “Should obesity be called a disease or should it not?” That isn’t silly. It does force us into some difficult decisions, however and that’s why I prefer the language of “making” problems to “identifying” problems or even “formulating” problems. There seems to be a lingering sense that if I “made” the problem, I could have made it differently and that lingering sense is the payoff. It’s what you get for being careful about saying that a problem “really is there” or not.
What problem shall we make about the name we shall give to a “multi-metabolic and hormonal disease state?” That is, in fact, what the American Medical Association proposes that we call it. The AMA wants to call the natural effects of persistent overeating, a “disease.” Here is the way that problem would go using my own format for public problems. Point 1: Obesity should be called a disease, but Point 2, it is not (currently) called that, because, Point 3, people prefer to call it a moral lapse so they can condemn those who have lapsed.
But, the thing about problems is that if you make ‘em, you can make ‘em any way you want. How about this one? Point 1: Obesity should be called a disease, but Point 2: it is not (currently) called that, because, Point 3: consumers are fed up with the AMA inventing diseases and making money from them.
These two formulations suggest topics for our conversation. We could talk about the natural predisposition of people to criticize others. As Lord Finkle-McGraw says, in one of my favorite books, “people are naturally censorious,” and they will find things to disapprove of, no matter what. We could talk about that. Or we could talk about the persistent medicalization of persons, personalities, and social traits—every one of which turns something into a “disorder” that you can pay someone to treat. You get your choice of conversations, but your choice is based on what you want to talk about, not about “what the problem is.” And there is no way to talk about what the problem “really is” once you understand that you are free to make them yourself.
Authors Crystal Hoyt and Jeni Burnett did an interesting study about the effects of considering obesity as a disease. They found three clear effects. First, reading about the AMA’s decision to rename obesity “increased body satisfaction among obese individuals.” Second, it undermined the importance these individuals placed on health-focused dieting. Third, it led these obese individuals to make higher calorie food choices.
If you want to have a conversation about the effects of using MMHDS, you put the shaming response on the one side and the three behaviors listed above on the other side. Then you say, “Is this a good idea?” You could have that same conversation about cigarette smoking if you wanted. You could call persistent smoking a Nicotine Affiliation Syndrome. NAS, I suppose. I am quite sure that you would discover that it reduced feelings of self-blame among smokers; that it undermined the importance of quitting smoking, and that it led them to smoke more. That brings us back to “Is this a good idea?”
It is easy to say nasty things about people who say nasty things about people who are overweight. If you would like to bathe in this solution, I recommend the International Size Acceptance Association. You can find them at www.size-acceptance.org, but you will not find there any interest in reducing the public and private expenditures associated with obesity.
It is easy to say nasty things about people who are overweight on the grounds that they are costing themselves and their families and their insurance companies (and therefore, us) and the government (and therefore, again, us). What you really need to ask is whether saying official nasty things (hiring criteria that come perilously close to job discrimination) or unofficial nasty things (Who has to sit with the wubba in the cafeteria, today?) about obese people is going to help.
Here’s what would help.
1. Recognize that there is no single cause of obesity. If you are going to deal with the obesity of five people whose obesity is caused by five different things, you are going to have to come up with five different solutions.
2. Some of those causes will require that the person suffering from MMHDS take responsibility for his or her actions and begin taking action to remedy them. These people will not be aided in this project by being routinely disparaged by others.
3. Most of the causes are going to require infrastructure change. It’s going to be immediately expensive. The argument that it will save money in the long run is ordinarily resisted by people who run for office in the short run. I therefore recommend that the task be given to a faceless bureaucracy with a lot of money and ready access to jackbooted thugs.
4. Healthful, nourishing food needs to be cheap and plentiful and the places where you can buy this food need to be accessible to poor people. Stores that provide this food will not make a profit for pretty much the same reasons that the U. S. Postal Service doesn’t make a profit, and will need regular government support. Any questions about this predisposition to help the poor should be addressed by this graph.
5. Safe places to exercise, including safe places to commute to work on foot or by bicycle, will need to be provided. It will cost a lot of money, not only to provide the facilities, but to make them safe to use. Exercise programs need to be built into schools and the information that says how bodies work and why this is important needs to be a part of the program.
6. A fundamental distinction needs to be made between whether your body is fit and healthy and whether it is attractive. People on my side of this issue often make nasty remarks here about looking like models. Models come in weight classes, like wrestlers. I don’t see why we need to disparage what they do in order to make the point that obesity is a public health problem and not having the currently fashionable dimensions—which, by the way, I have never had in all my life as an athlete—is not a public health problem and is, in fact, none of anyone’s business.
Those are six really spendy solutions. You tell me which of them we can do without and I’ll eliminate it. Just one thing. Be sure that getting me to accept your suggestion is not going to raise your insurance rates and your taxes. Just a thought.
 We’re going to be considering the effects of naming, today, and I want to pause long enough to ask what an “ordered personality” would look like. That’s short for “properly ordered,” I’m sure, but even that requires a standard that defies consensus. We appear to be able to agree on “disordered” if it is unusual and we don’t like it.
 In time, that will surely become MMHDS and if they adapt it for TV commercials, they could have it pronounced “MEDS.”
 The metabolic processes underlying this effect were once a significant evolutionary advantage for our species. In our rush to condemn its effect in modern life, we ought to remember that.
 The Diamond Age. Equity Lord Chung-sik Finkle-McGraw in one of author Neal Stephenson’s lasting achievements.
 The thugs are not for the people who need to lose weight. They are for the governments, the insurance companies, and the food wholesalers who are reluctant to do what they have been given federal funds to do.
Pretty good take on the social side, it seems to me. There are problems on the medical and political sides, though. Lots of hormones are being discovered that affect fat storage and use. Just how they are regulated and what role they play in the obesity problem isn’t known yet, so there isn’t any public response to them. Politically, I’m furious that I’m paying taxes to subsidize high-fructose corn oil, one of the major factors in obesity. Eliminating that would save you money, which could be better spent on subsidizing high-nutrition foods, therefore making them more available to the financially challenged.
I’m familiar with the high-fructose corn syrup problem. We get hit when we pay for the corn and when we pay to store it and when we eat and drink it. The effect of the newly discovered hormones may make a big difference in the medical treatment, but they aren’t going to budge the political needle at all, more’s the pity.
PS. I recommend a book by Baumeister on Self-Control. Some useful ideas and some very clever experiments.
I’ve ordered Baumeister’s Will Power. It looks really good.