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• Should Obesity Be a 'Disease'?
  Joseph Ting
  Published on: 18 May 2017
• Should Obesity Be a 'Disease'? -Heavy and healthy: the latest take on obesity
  Joseph Ting
  Published on: 18 May 2017
• Force dieting may not be conducive to health
  Yvonne Lau
  Published on: 18 May 2017

• Published on: 18 May 2017

  Should Obesity Be a 'Disease'?

  • Joseph Ting, Clinical senior lecturer

  Obesity being designated a disease recognizes its adverse effects on physical and psychological health. Pleas on behalf of the corpulent to not being judged and regarded without compassion are timely. However, obesity's classification as a disease could devolve the self-control needed to assume personal responsibility for the unhealthy dietary and sedentary choices we make. Dieting, weight consciousness, anxiety about bo...

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  Obesity being designated a disease recognizes its adverse effects on physical and psychological health. Pleas on behalf of the corpulent to not being judged and regarded without compassion are timely. However, obesity's classification as a disease could devolve the self-control needed to assume personal responsibility for the unhealthy dietary and sedentary choices we make. Dieting, weight consciousness, anxiety about body weight/shape and widespread hostility to obesity are fundamental themes in contemporary life. There is tension between trying to control our body weight in the midst of unprecedented access to unhealthy foods. The impulse to ridicule and publicly monitor the body shape has its basis in the highly visible markers of overweight transgressing aesthetic standards and signalling pathology and disease. Seeing fatness leads to the negative reading of fat bodies. More than ever, judgements about our own and others' worth is based on the morphological body as compared to the ideal. Although there is psychological toil from discrimination meted out to the obese, being insulated from the externally-imposed assessment of our weightiness imposes the inertial foundation to stay as we are. There is indeed a fine line between a stern reprimand that could avert a burgeoning public health disaster and abuse and derision that debases the esteem of others. Aside from being susceptible to more serious iterations of a whole range of chronic medical problems, the obese sustain higher risks of anaesthetic, pregnancy and post operative complications. They are more difficult to resuscitate in trauma and critical illness. Life- sustaining procedures such as intubation and central venous access pose an anatomical challenge. Due to their thickset habitus, even the longest chest drains could fail to reach large clots pressing on lungs in major trauma. The treat of loss of life and limb with acute injury and serious illness could be far more effective message than low grade hazard spread over years to decades .

  pleas on behalf of the corpulent to not being judged and regarded without compassion by society. Dieting, weight consciousness, anxiety about body weight/shape and widespread hostilty to obesity are fundamental themes in contemporary life. There is tension between trying to control our body weight in the midst of unprecedented access to unhealthy foods. The impulse to ridicule and publicly monitor the body shape has its basis in the highly visible markers of overweightedness transgressing aesthetic standards and signalling pathology and disease. Seeing fatness leads to the negative reading of fat bodies. More than ever, judgements about our own and others' worth is based on the morphological body as compared to the ideal. Shriver rightly protests the psychological toil from discrimination suffered by the obese. On the other hand, being insulated from the externally-imposed assessment of our weightiness imposes the inertial foundation to stay as we are. There is a fine line between a stern reprimand that could avert a burgeoning public health disaster and abuse and derision that debases the esteem of others.

  Joseph Ting, MBBS MSc (Lond) BMedSc PGDipEpi DipLSTHM FACEM.

  Clinical senior lecturer, Division of Anaesthesiology and Critical Care, University of Queensland Medical School, Brisbane.

  Acute Care Programme, Mater Research Institute, The University of Queensland, and Division of Critical Care and Anaesthesiology, Mater Health Services, South Brisbane, QLD 4101.

  TEL : +61 07 3843 2541

  CELL: 0404 826 650

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 18 May 2017

  Should Obesity Be a 'Disease'? -Heavy and healthy: the latest take on obesity

  • Joseph Ting, Clinical senior lecturer

  It remains controversial whether overweight and obesity confer protection when one becomes afflicted with a chronic disease. The debate would benefit from a shift in focus from susceptibility to more serious iterations of a whole range of chronic medical problems, to the obese sustaining higher acute risks from anaesthetic, pregnancy and post operative complications. They are more difficult to resuscitate in trauma and...

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  It remains controversial whether overweight and obesity confer protection when one becomes afflicted with a chronic disease. The debate would benefit from a shift in focus from susceptibility to more serious iterations of a whole range of chronic medical problems, to the obese sustaining higher acute risks from anaesthetic, pregnancy and post operative complications. They are more difficult to resuscitate in trauma and critical illness. Life-sustaining procedures such as intubation and central venous access pose an anatomical challenge. Due to their thickset habitus, even the longest chest drains could fail to reach large clots pressing on lungs in major trauma. The treat of loss of life and limb with acute injury and serious illness could be far more effective message than low grade hazard spread over years to decades.

  On another note, society's obsession with physical apperance and attractiveness remains a fixture. Dieting, weight consciousness, anxiety about body weight/shape and widespread hostility to obesity are fundamental themes in contemporary life. There is tension between trying to control our body weight in the midst of unprecedented access to unhealthy foods. The impulse to ridicule and publicly monitor the body shape has its basis in the highly visible markers of overweight transgressing aesthetic standards and signalling pathology and disease. Seeing fatness leads to the negative reading of fat bodies.

  Joseph Ting, MBBS MSc (Lond) BMedSc PGDipEpi DipLSTHM FACEM.

  Adjunct associate professor, School of Public Health and Social Work

  O Block, Room O-D610 Victoria Park Road Kelvin Grove, Brisbane QLD 4059

  Queensland University of Technology, Brisbane

  Clinical senior lecturer, Division of Anaesthesiology and Critical Care, University of Queensland Medical School, Brisbane.

  Acute Care Programme, Mater Research Institute, The University of Queensland, and Division of Critical Care and Anaesthesiology, Mater Health Services, South Brisbane, QLD 4101.

  TEL : +61 07 3843 2541

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 18 May 2017

  Force dieting may not be conducive to health

  • Yvonne Lau, Medical doctor & PhD candidate

  In the article ‘Should we force the obese to diet?’, Giordano[1] drew similarities between the anorexics and the obese, suggesting that if people could accept it ‘ethical to force people to maintain “a proper diet” in the anorexics, there could also be similar justifications to force the obese to diet. There are problems with this premise. First of all, even though anorexia and obesity are both related to problems with e...

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  In the article ‘Should we force the obese to diet?’, Giordano[1] drew similarities between the anorexics and the obese, suggesting that if people could accept it ‘ethical to force people to maintain “a proper diet” in the anorexics, there could also be similar justifications to force the obese to diet. There are problems with this premise. First of all, even though anorexia and obesity are both related to problems with eating and diet, and that people with anorexia may share some symptomatic features with people who are obese, they are necessarily different problems attracting different strategies of intervention. Medline Plus defines anorexia nervosa as primarily an eating disorder (http://www.nlm.nih.gov/medlineplus/ency/article/000362.htm#Definition, accessed July 30, 2008). People who suffer from it are not uncommonly driven by ‘an intense fear of weight gain and a distorted body image’. Although the condition is complex and its cause multi-factorial, the mental component seems significant. On the other hand, obesity simply describes a condition of excess body fat (http://www.nlm.nih.gov/medlineplus/obesity.html, accessed July 30, 2008). Although it is often associated with over eating, its cause is also diverse with a strong socio-economic component. Unlike anorexia though, it is unlikely that most obese people have been driven to it as a result of a distorted body image.

  The predominant mental component of anorexia would appear to explain the rationale behind the provision for force feeding as an exceptional treatment strategy under the Mental Health Act 1983. Force feeding is reserved for those anorexics who have lost so much body weight that vital body organs stop functioning properly and death becomes imminent. That forced feeding is considered potentially and immediately life saving is not a sufficient justification in itself to override a person’s autonomy to refuse feeding. Many examples attest to this, for example society does not necessarily accept force feeding an individual with a terminal disease who refuses feeding, or an individual who chooses starvation as a form of peaceful political manifestation. Both Western ethical traditions and Anglo-American law uphold individual autonomy as a fundamental principle in human relations.[2] Individuals are recognised to be their own agents with the rights to pursue their own goals and interests in life free from external interference. In their pursuit, individuals may sometimes undertake actions that could endanger their health or even their lives. Nevertheless, this does not immediately provide cause for intervention.

  External interference may be considered justified when an individual lacks the capacity for self-determination. Competence depends on the person’s ability to understand basic information that will allow him or her to reason out his or her preferences in accordance with a relatively consistent set of values. Competence is task specific. A person who is incompetent to make one decision may be competent to make other decisions. Furthermore, decisions that have potentially serious consequences for the person often demand a higher level of competence while less significant decisions will require less.[3] An anorexic who starves himself or herself to the point of imminent death in pursuit of a distorted body image would not appear to be a person competent enough to make decisions concerning his or her own feeding needs. Many people would therefore accept temporarily overriding their right to self-determine, force feeding them under the circumstances. The urgency of the matter is also taken into consideration.

  Obesity is undoubtedly an important risk factor for serious diseases such as cardiovascular diseases and diabetes. Yet, the association is not straight forward and the development takes place over a prolonged period of time. While it may be true to say that over eating is an important reason for obesity, it is certainly not the only reason. Eating foods high in unsaturated fats or carbohydrates with poor nutritional value constitute other important reasons.[4] Nevertheless, even though it is possible to educate people to eat more healthily, personal responsibility is not the only nor perhaps even the primary determining factor for success. Indeed, considering that people live in complex social situations that can potentially limit their courses of action, long term health may not even be the individual’s priority concern in life.

  By stating that ‘the drastic measures needed to reverse the alarming pandemic are as yet purely voluntary’, Giordano situates the problem of obesity primarily on the individual. The implication seems to be that dieting will reverse the problem of obesity, and if individuals cannot be relied to undertake the responsibility themselves to eat a proper diet, they could be considered mentally incompetent providing justification for others to discipline them. The discourse reflects a reductionistic way of understanding the human condition. It ignores the intricate relationships between individuals and their social environments. By focusing solution on the individual, it distracts society from examining social realities and social practices that are potentially unhealthy and that could equally contribute to the obesity epidemic. It perpetuates the illusion that individual’s health is primarily and directly a result of individual appropriation through rational choice, and that ‘we can as individuals control our own existence’.[5] Thus, failing to conduct our lives according to predetermined standards is not only a reflection of personal incompetence but also of moral inadequacy. This opens individuals to moral blames and reprisals that justify the removal of their basic rights for self-determination since they are no longer regarded as equal moral beings.

  While there is no doubt that reducing obesity can reduce people’s sufferings from serious biological diseases, it is questionable as to whether draconian measures such as force dieting which remove people’s right for self-determination and render them inferior moral beings, will genuinely bring them improved health and well-being over time.

  The author acknowledges the support of the University of Otago Research Committee, by means of The University of Otago Postgraduate Publishing Bursary (PhD)

  References 1. Giordano, S. Should we force the obese to diet? J. Med. Ethics 2008;34:319 2. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. In: Mappes TA and Degrazia D, eds. Biomedical ethics. New York: McGraw-Hill 2001:97-102. 3. Buchanan, A.E. and Brock D.W. Standards of competence. In: Mappes TA and Degrazia D, eds. Biomedical ethics. New York: McGraw-Hill 2001:109- 114. 4. The Pan American Health Organization. Regional strategy and plan of action on an integrated approach to the prevention and control of chronic diseases. Washington D.C.: The World Health Organization 2007 5. Crawford, R. Healthism and the medicalization of everyday life. Int. J Health Serv. 1980;10(3): 365-388.

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  Conflict of Interest:
  None declared.

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