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Why Labeling Obesity As A Disease Is A Big Mistake<br><br>The American Medical Association's decision last month to label obesity as a disease<br><br>has provoked a good deal of commentary, much of it critical. In fact, the AMA's action went against the conclusions of its own Council on Science and Public Health, which had considered the issue over the past year.<br><br>While no analogy is perfect, in terms of the magnitude of a societal problem, the example of smoking offers a number of points relevant to the discussion of obesity.<br><br>Smoking is a personal behavior that waxed dramatically and then waned dramatically over the course of the 20th century. Smoking causes a wide range of diseases from lung and other cancers to cardiovascular disease and chronic respiratory diseases. However, no one ever proposed labeling smoking a disease.<br><br>In the 1950's nearly half of Americans smoked. Starting with the publication of the first Surgeon General's Report on Smoking and Health in 1964 the prevalence of smoking declined from 42% to 19% in 2010. This occurred in spite of the fact that smoking is a highly addictive behavior. Thus, over the past 50 years, we have witnessed a profound change in society's attitude toward smoking and this change has been accompanied by a substantial reduction in smoking prevalence.<br><br>The decline in smoking prevalence is the result of wide variety of actions, including public education, increased taxes on cigarettes, restrictions on advertising, warning labels on cigarette packs, ordinances and laws affecting smoking in public places, smoking cessation programs, and the consideration of smoking habits in setting health insurance premiums. In addition, importantly, as the proportion of smoking population dwindled, public attitudes have changed, and smoking has become "de normalized," not to say stigmatized.<br><br>The analogy with obesity is imperfect, first because one can live without smoking but everyone has to eat, and controlling what and how much one eats and how physically active one is in our sedentary society is a real challenge.<br><br>Second, in contrast to smoking, the definition of obesity  a body mass index, or weight in kilograms /(height in meters)2 of 30 or above  is a crude metric. An estimated 30 percent of those classified as obese are actually healthy in terms of their cardio metabolic profile, including such things as circulating glucose, insulin, and cholesterol levels. In this group of "healthy obese," prescribing weight loss may actually be harmful. Furthermore, in the most detailed analysis of data worldwide carried out to date, having a BMI of 30<br><br>Another aspect of the decline in smoking prevalence that should be borne in mind is that smoking has been reduced predominantly among those with more than a high school education. Thus, smoking has largely become a habit of those with lower socioeconomic status.<br><br>While the rates of obesity in men do not vary by SES, among women higher SES is associated with lower levels of obesity. As the many initiatives to reduce obesity develop, it will be important to ensure that they don't preferentially affect the more educated and the middle class, but are tailored to address the circumstances of lower income groups as well.<br><br>Defining obesity as a disease makes little medical sense, since, rather than judging a person's health based solely on his/her BMI, a physician needs to examine each patient as an individual, take a detailed history, and assess clinical parameters, such as blood insulin, cholesterol, triglycerides, etc. If these are somewhat outside of the desirable bounds, behavior changes may have the desired effect. If the values are more extreme and if behavior changes are less of a realistic option, then drugs can be considered. But the decision needs to be made based on the complete profile of the individual, not on some arbitrary cut point in a proxy variable.<br><br>All of these points argue against classifying obesity as a disease. Above all, however, labeling something as a disease is a way of excluding it from normal, everyday life. But the point is that obesity is totally normal and totally integrated into our way of life.<br><br>Furthermore, as has been pointed out, classifying obesity as a disease in a blanket fashion will stigmatize those so labeled and in some cases will add to the sense of lack of control over their health and to an attitude of fatalism.<br><br>This is not to ignore the role of individual responsibility, but it is wildly moralistic and unrealistic to assume that growing up in an environment with a super abundance of calorie dense foods, jobs that are largely sedentary, and neighborhoods unsuited to physical activity has no effect on the body weight of the population. We tend to over estimate and idealize what the individual can do by resisting the prevailing current.<br><br>If some one is obese either the system pays now or later with many costly complications.<br><br>A new FDA approved diet pill called Belviq just went on the market. People who take Belviq with diet and exercise were 2 times more likely to lose 5% body weight and 3 times more likely to lose 10% body weight than the people who just did diet and exercise alone. The label states that if you do not lose 5% of your body weight in 12 weeks then consider stopping. Those that do respond in 12 weeks go on to lose over 10% of their body weight in one year. Losing 22 pounds for a 220 pound man is life changing. So comments about average weight loss are misleading and incorrect since over 45% of the patients lost a significant amount of weight.<br><br>Belviq makes you more likely to succeed because it helps you feel full more quickly, reduces cravings, and helps control "food issues". It is not a 'magic pill', it merely helps people willing to diet and exercise more likely to succeed.<br><br>Belviq has a second mode of action to reduce blood sugar which may end up preventing diabetes in many cases. Diabetics and pre diabetics who took Belviq, regardless of weight loss, saw their blood sugar numbers drop by double digit percentages. IE HbA1c  0.9 to  1.2 and fasting glucose feel  27. The cost of medications to reduce HbA1c levels exceeds the cost of Belviq. (seeArena's BloomDM phase III trial) These reductions in diabetic symptoms plus the weight loss at the same time makes Belviq a medical bargain.<br><br>With an estimated 40 million new cases of Diabetes expected over the next 10 years at a cost of over $400 billion per year to the US Health Care System, and the associated heart disease,coach galaxy note 3 case, strokes, blindness and amputations, any tool that will prevent this preventable disease from ballooning is a good tool to have. People who are borderline diabetic may benefit a great deal from Belviq whether they lose a lot of weight or just a little.<br><br>I do not know how long term you want. Some of belviq's patients in the trial were on the pill for 2 years with no bad side effects.<br><br>The diabetic control that is independent upon weight loss seems to be associated serotonin regulation.<br><br>HERE is a synopsis.<br><br>Edit And from the University of Berlin a remarkable study demonstrating diabetic mice had impaired insulin secretion due to lack of serotonin in the pancreas. And not only that serotonin plays a role in insulin secretion from the insulin producing beta cells, but that it does so from inside the cells as opposed to its traditionally understood actions in the brain/Central nervous system where it signals/instructs cells from outside the cells:<br><br>"In this study, we identify the hormone serotonin as a new regulator of insulin secretion and thereby attribute a function to the co localization of serotonin and insulin in pancreatic  cells that was first observed 30 years ago but until now not understood<br><br>One issue that has eluded researchers for more than three decades concerns the role of serotonin (5 hydroxytryptamine; 5 HT) in  cells. We found that these mice are diabetic and have an impaired insulin secretion due to the lack of 5 HT in the pancreas.

Why Labeling Obesity As A Disease Is A Big Mistake<br><br>The American Medical Association's decision last month to label obesity as a disease<br><br>has provoked a good deal of commentary, much of it critical. In fact, the AMA's action went against the conclusions of its own Council on Science and Public Health, which had considered the issue over the past year.<br><br>While no analogy is perfect, in terms of the magnitude of a societal problem, the example of smoking offers a number of points relevant to the discussion of obesity.<br><br>Smoking is a personal behavior that waxed dramatically and then waned dramatically over the course of the 20th century. Smoking causes a wide range of diseases from lung and other cancers to cardiovascular disease and chronic respiratory diseases. However, no one ever proposed labeling smoking a disease.<br><br>In the 1950's nearly half of Americans smoked. Starting with the publication of the first Surgeon General's Report on Smoking and Health in 1964 the prevalence of smoking declined from 42% to 19% in 2010. This occurred in spite of the fact that smoking is a highly addictive behavior. Thus, over the past 50 years, we have witnessed a profound change in society's attitude toward smoking and this change has been accompanied by a substantial reduction in smoking prevalence.<br><br>The decline in smoking prevalence is the result of wide variety of actions, including public education, increased taxes on cigarettes, restrictions on advertising, warning labels on cigarette packs, ordinances and laws affecting smoking in public places, smoking cessation programs, and the consideration of smoking habits in setting health insurance premiums. In addition, importantly, as the proportion of smoking population dwindled, public attitudes have changed, and smoking has become "de normalized," not to say stigmatized.<br><br>The analogy with obesity is imperfect, first because one can live without smoking but everyone has to eat, and controlling what and how much one eats and how physically active one is in our sedentary society is a real challenge.<br><br>Second, in contrast to smoking, the definition of obesity  a body mass index, or weight in kilograms /(height in meters)2 of 30 or above  is a crude metric. An estimated 30 percent of those classified as obese are actually healthy in terms of their cardio metabolic profile, including such things as circulating glucose, insulin, and cholesterol levels. In this group of "healthy obese," prescribing weight loss may actually be harmful. Furthermore, in the most detailed analysis of data worldwide carried out to date, having a BMI of 30<br><br>Another aspect of the decline in smoking prevalence that should be borne in mind is that smoking has been reduced predominantly among those with more than a high school education. Thus, smoking has largely become a habit of those with lower socioeconomic status.<br><br>While the rates of obesity in men do not vary by SES, among women higher SES is associated with lower levels of obesity. As the many initiatives to reduce obesity develop, it will be important to ensure that they don't preferentially affect the more educated and the middle class, but are tailored to address the circumstances of lower income groups as well.<br><br>Defining obesity as a disease makes little medical sense, since, rather than judging a person's health based solely on his/her BMI, a physician needs to examine each patient as an individual, take a detailed history, and assess clinical parameters, such as blood insulin, cholesterol, triglycerides, etc. If these are somewhat outside of the desirable bounds, behavior changes may have the desired effect. If the values are more extreme and if behavior changes are less of a realistic option, then drugs can be considered. But the decision needs to be made based on the complete profile of the individual, not on some arbitrary cut point in a proxy variable.<br><br>All of these points argue against classifying obesity as a disease. Above all, however, labeling something as a disease is a way of excluding it from normal, everyday life. But the point is that obesity is totally normal and totally integrated into our way of life.<br><br>Furthermore, as has been pointed out, classifying obesity as a disease in a blanket fashion will stigmatize those so labeled and in some cases will add to the sense of lack of control over their health and to an attitude of fatalism.<br><br>This is not to ignore the role of individual responsibility, but it is wildly moralistic and unrealistic to assume that growing up in an environment with a super abundance of calorie dense foods, jobs that are largely sedentary, and neighborhoods unsuited to physical activity has no effect on the body weight of the population. We tend to over estimate and idealize what the individual can do by resisting the prevailing current.<br><br>If some one is obese either the system pays now or later with many costly complications.<br><br>A new FDA approved diet pill called Belviq just went on the market. People who take Belviq with diet and exercise were 2 times more likely to lose 5% body weight and 3 times more likely to lose 10% body weight than the people who just did diet and exercise alone. The label states that if you do not lose 5% of your body weight in 12 weeks then consider stopping. Those that do respond in 12 weeks go on to lose over 10% of their body weight in one year. Losing 22 pounds for a 220 pound man is life changing. So comments about average weight loss are misleading and incorrect since over 45% of the patients lost a significant amount of weight.<br><br>Belviq makes you more likely to succeed because it helps you feel full more quickly, reduces cravings, and helps control "food issues". It is not a 'magic pill', it merely helps people willing to diet and exercise more likely to succeed.<br><br>Belviq has a second mode of action to reduce blood sugar which may end up preventing diabetes in many cases. Diabetics and pre diabetics who took Belviq, regardless of weight loss, saw their blood sugar numbers drop by double digit percentages. IE HbA1c  0.9 to  1.2 and fasting glucose feel  27. The cost of medications to reduce HbA1c levels exceeds the cost of Belviq. (seeArena's BloomDM phase III trial) These reductions in diabetic symptoms plus the weight loss at the same time makes Belviq a medical bargain.<br><br>With an estimated 40 million new cases of Diabetes expected over the next 10 years at a cost of over $400 billion per year to the US Health Care System, and the associated heart disease,coach galaxy note 3 case, strokes, blindness and amputations, any tool that will prevent this preventable disease from ballooning is a good tool to have. People who are borderline diabetic may benefit a great deal from Belviq whether they lose a lot of weight or just a little.<br><br>I do not know how long term you want. Some of belviq's patients in the trial were on the pill for 2 years with no bad side effects.<br><br>The diabetic control that is independent upon weight loss seems to be associated serotonin regulation.<br><br>HERE is a synopsis.<br><br>Edit And from the University of Berlin a remarkable study demonstrating diabetic mice had impaired insulin secretion due to lack of serotonin in the pancreas. And not only that serotonin plays a role in insulin secretion from the insulin producing beta cells, but that it does so from inside the cells as opposed to its traditionally understood actions in the brain/Central nervous system where it signals/instructs cells from outside the cells:<br><br>"In this study, we identify the hormone serotonin as a new regulator of insulin secretion and thereby attribute a function to the co localization of serotonin and insulin in pancreatic  cells that was first observed 30 years ago but until now not understood<br><br>One issue that has eluded researchers for more than three decades concerns the role of serotonin (5 hydroxytryptamine; 5 HT) in  cells. We found that these mice are diabetic and have an impaired insulin secretion due to the lack of 5 HT in the pancreas.