Is Obesity Really the Problem?
Mark Haub, Ph.D.
Associate Professor
Department of Human Nutrition
Kansas State University
The talk about obesity and its medical complications has increased dramatically over the past 20 years. However, a confusing division exists between physicians on one hand and scientists on the other. Consumers are left scratching their heads in the middle.
Many in the medical field (along with the media) have tried to establish obesity as a disease, which would suggest that insurance companies should offer coverage for treatment. However, many scientists, scholars and consumer protection advocates believe that weight is not the real concern. From my point of view, they’re both right. How can that be?
From the medical perspective, it’s clear that obesity is associated with many and most chronic diseases and conditions under the sun – heart disease, diabetes, cancer, arthritis, low back pain, depression, and so forth. Therefore, many in the healthcare field want to treat obesity as a disease so they can better treat these harmful conditions. However, from the scientific perspective, the research and data indicate that body weight and amount of body fat clearly do not cause these health conditions.
So what gives? Well, we have to think about whether something causes something else, or whether they just happen to be associated.
For example, obesity is associated with various diseases, but associations do not mean that obesity causes disease. Here’s an example from another major health issue, smoking. Many health problems such as lung cancer and emphysema are associated with smoking. Many smokers have yellow-tainted fingers. Therefore, just by removing the yellow stains, the health problems from smoking would also go away, right? This, of course, is ridiculous, but it’s somewhat similar to the controversy about obesity. Think of obesity as the yellow fingers – something associated with health problems, but not necessarily the cause of them.
Let’s talk about how a person becomes obese. It’s not as if someone wakes up one morning to suddenly find the scales tipping 30 pounds heavier overnight. We gain weight gradually by taking in more energy (eating more calories) than we burn. As a society, we haven’t changed our energy-intake (eating) patterns much over the past 20 to 30 years, but we have become less active (burning fewer calories). If we take in the same amount of calories and burn fewer, we gain weight. Therefore, I see obesity as a side-effect of an inactive lifestyle, with that lifestyle being the actual cause of the diseases I listed above. Yes, it’s true that obese individuals also tend to be less physically active than less-fat individuals, just as smokers tend to have yellow fingers, but remember that the yellow fingers don’t cause lung cancer and emphysema. I don’t believe that obesity itself causes disease. (Adding even more credibility to this position is that there is a lot of research to show that inactive-but-lean individuals have a greater risk for getting a chronic disease than active-but-obese individuals do.)
Another issue that muddies the water is the research that demonstrates weight loss can be deadly. Huh?, you say. Some diseases (Type 2 diabetes, certain cancers, and hyperthyroidism) have unintentional weight loss as one of their symptoms – losing weight without trying can be an indicator that you have a disease.
However, even when a person loses weight on purpose, that doesn’t mean better health will result. Numerous studies have shown that when people enter the maintenance phase of their weight loss diet – the point where their weight does not change – many health indicators such as blood glucose, insulin, cholesterol and lipids return to their pre-weight-loss levels. This indicates that they got no health benefit simply from weighing less. The typical cause of that return to pre-weight-loss health problems is that they also returned to a not-as-healthy lifestyle, even though they may weigh 10 to 20 pounds less. This is also seen with weight loss treatments, especially liposuction. When weight and fat are lost by surgically removing the fat, as with liposuction, there is no improvement in clinical markers of health (such as glucose, blood pressure or blood lipids).
Many people start a lifestyle change only to become frustrated when their weight does not change. But the key to improving one’s health over the long term is to maintain the lifestyle change throughout life and not treat a diet/lifestyle change as a temporary fix! In other words, exercise and eat right without concern for how much or little weight you actually lose. I know, it sounds radical, but the purpose of a healthful exercise and diet routine should be to improve health, not change your wardrobe, although that’s something a lot of people want. If their weight or size doesn’t change, too many people give up on their good lifestyle changes, which is the worst thing they could do from a health perspective.
So what does all this mean? The weight loss and fitness industry is highly focused on weight loss efforts, but I believe they’re focusing on the wrong outcome, at least from a consumer’s perspective.