When we say disease, what comes to mind are infections, chronic conditions, from a simple cold to the most complex multi systemic medical conditions. However, there is an ongoing epidemic affecting millions, that is not always acknowledged as a disease - the disease of obesity. Even to this day, some medical professionals do not recognize it as a disease. In this blog post, I want to open the conversation on the disease and the dis ease of obesity. The burden, the lack of ease of carrying excess weight. The emotional journey of having life-long obesity.
Disease is defined as an abnormal condition of a living thing - human, animal or plant - that causes discomfort or dysfunction. It comes from the the old French word des aese or lack of ease.
When I'm taking my patient's weight history, it cannot be helped that they share the most intimate detail of their difficulties. The disease of obesity extends beyond the aspiration of a better health or a lower BMI. Treating obesity is about helping patients reclaim the simple joys and opportunities that are currently not available to them because they have that excess weight.
Often times, what they want beyond that lower number on the scale is quality of life. What they want is to simply climb a flight of stairs without shortness of breath, be able to walk a block without pain, to effortlessly cross their legs, fit into seats at a show, or hop on an airplane without worrying for the need for an extender belt. It's about having the energy to play with their kids or their grandkids and join in the fun rides at the amusement park. One patient particularly showed me how she actually tries to cross her legs, she picks up the hem of her pants and pulls her ankle and places it on her knee. Another shares that while she relished her promotion, it required her to travel more and she gets uncomfortable and embarrassed asking for an extender belt. Another relished in her successful weight loss journey that she was able to watch a concert without the discomfort of the arm seat digging to her side.
These things some of us take granted, but for someone with obesity- it is almost always on their minds. It affects their day to day lives.
Of course we already know that obesity worsens a lot of other medical conditions. From the chronic pain of arthritis, to heart disease, diabetes, fatty liver, sleep apnea, increased risk of stroke, of cancers. Again, like all of us, what they truly want is to be secure in their health that they could be around longer for their families.
The Weight of Blame
I've been helping patients with their weight for more than 10 years now. I've witnessed the burden of not just the mass effect of weight but the psychological toll and feelings of inadequacy. Many have tried everything - from fad diets, meal replacement programs, gym memberships, expensive home exercise equipment - only to find themselves trapped in a cycle of starting and stopping, losing and gaining, sometimes the same 30 pounds for decades. One patient ruefully told me, "over the years I must have lost the equivalent of 1 person with how much I've lost and gained." When in the past I have doubted their efforts, I have come to know that they truly are trying. They are trying their best with what they have. By the time they reach their 40s, they are just about to give up on themselves. They've attempted to manage their weight alone for so long that frustration and hopelessness become their constant reality. It's an emotional journey that I have come to understand intimately. A lot of the times most who suffer from obesity are not equipped with what they need to succeed - the knowledge, the support, the time and a lot of the times and most especially, the necessary medication.
As a physician who has evolved with the understanding of obesity, I admit that I too once may have unknowingly pressured my patients into losing weight. I may have gaslit their efforts, I too once believed it was just calories in and calories out. However, it's crucial to recognize that obesity is a disease, acknowledged as such by the American Medical Association (AMA) in 2013. Much like any other disease like hypertension, diabetes or heart disease. Somehow these other diseases are not taken as personal failures, unlike obesity.
The Obesity Medicine Association (OMA) https://obesitymedicine.org/blog/what-is-obesity/ defines it as a "chronic, relapsing, multi-factorial, neurobehavioral disease. It involves neurobehavioral aspects, adipose tissue dysfunction, and abnormal fat mass physical forces, leading to a cascade of adverse metabolic, biomechanical, and psychosocial health consequences. While this definition is a mouthful, it boils down to this -
Obesity is a complex interplay of factors that goes beyond mere willpower and discipline.
Relieving the Burden
One of the most rewarding aspects of my work is offering a sense of relief to my patients. Having an understanding of the disease of obesity, I can explain to them the root causes of why they have this medical condition. It's science. I reassure them that they are not alone and, more importantly, it is not their fault. Before obesity gained recognition as a disease, individuals struggling with excess weight were unfairly blamed and shamed by society, even by their own family members and doctors. The seemingly harmless ribbing from family members, bullying from peers, and even misguided advice from some doctors are all rooted in a lack of understanding. These stories stay with them. They are actually traumatic experiences that mold them and affect their decisions to otherwise live normal lives. For example, they may avoid seeing doctors altogether and forego treatment to avoid the weighing and the eventual talking down. Or resent family members and skip gatherings to avoid the jokes directed at them.
Breaking the Stigma
Thankfully, more and more people are recognizing it as a medical condition and not someone's failure. And thankfully, there are more and more effective medications to treat it.
It is about time to break the stigma associated with obesity and recognize it for what it is - a disease that requires compassionate, comprehensive care.
The dis ease of obesity is a journey that many have traveled alone, burdened by self-blame and societal misconceptions. My hope is that the conversations around obesity continue to shift from blame to understanding. To borrow from a recent speaker I heard the expression from, shift the conversation from blame to biology. For the medical community, government and our society in general - to provide support and guidance to those who have felt ostracized because of their weight. Obesity is not a result of personal failure; it's a complex disease that demands empathy, education, and a collective effort to dismantle the prejudice surrounding it.
DISCLAIMER: Lea Grace R. Famularcano, MD is a medical doctor, but she is not your doctor, and she is not offering medical advice on this website. Contents on this blog is pure informational only and should not be considered as professional medical advice. If you are in need of professional advice or medical care, you must seek out the services of your doctor or health care professional.