On obesity, healthcare and mincing words.
Posted on | April 7, 2010 | 2 Comments
Note: I am not a medical, economic, academic or political writer or expert of any kind, and I can be taught. Go on, have a go at my conclusions and shoddy research in the comments. I can appreciate being corrected.
Note 2: Obnoxious trolls will still be banned. There’s a difference.
Note 3: I do actually have plenty of time and money enough to exercise, I just don’t want to, preferring to blog and have fun instead. That shouldn’t distract from my point, though.
I suffer from eczema in my foot. It comes and goes. We’re not sure what causes it, except that the causes of eczema are usually external. I’ve taken time off work several times now to see a specialist during business hours to get the condition analyzed and treated. The consultations are covered by my health insurance and I receive full pay from my employer during these absences.
I’m also obese. This causes me probably about as much irritation as the eczema, and, unlike the eczema, could lead to developing other, serious diseases.
No prizes for guessing if treatment for that condition is similarly covered.
It seems to be the current popular rhetoric that obesity is a disease, an epidemic engulfing the Western world. This is no new development. See, for example, this 2003 Medical News article addressing then-current U.S. debate on the issue. In 2009, the jury’s still out. BBC calls it an epidemic.
The fun thing about the word epidemic, by the way, is that it suggests disease but could also mean “extremely prevalent; widespread” (see Online Dictionary). The reporting on obesity is wrapped in words that say “disease” without actually committing to it – my guess is because it’s still, unbelievably, a contentious issue.
The whole problem with classifying obesity as a disease is not, as I see it, actually grounded in it being partially caused by lifestyle choices. This seems to be the main argument against the classification, but the cause of a condition doesn’t, as I see it, make the condition any less serious. Whether you got lung cancer from smoking or some other unknown cause makes no difference: you still have a health condition that requires treatment.
So why is obesity denied the status of disease? One answer could be that it doesn’t necessarily cause the sufferer discomfort or pain. If this was the whole of it, then obesity would be a cosmetic concern at best, an individual’s personal matter, and that’s as it’s been treated so far. However, it’s been shown that certain types of obesity can increase the risk of developing other, serious diseases, and can diminish quality of life. It also has mild undesirable symptoms such as aggravating joint pain and/or back pain (for large-breasted women) or affecting mobility in extreme cases.
No one seems to be denying that obesity is a “health concern”. Why mince words about it? What’s the difference between a health concern and a disease?
No, really, if you know, let me know too. I haven’t been to medical school. I’m just a girl with a blog.
But you know what I think? I think the real problem is that, should the consensus finally be that it is indeed a disease, then governments of the world would have to allow obese people the same opportunities for treating their condition as they do other people with diseases.
I’m not hearing a lot of people suggest that obese people should receive healthcare coverage for gym membership. I’ve also not yet heard it said – though please let me know if this has been mentioned before – that obese people should be given fully paid time off work to go to gym to treat their condition. This sounds extravagant, but is a no-brainer as soon as you accept that obesity is a disease that, on its own, requires treatment. A lot of otherwise healthy people are obese. This represents a huge rise in healthcare costs.
So there you have it. Money. Somebody somewhere has figured that it costs less to treat people with diabetes than pre-emptively preventing diabetes by supporting weight-loss. They still want fewer people to get diabetes, hence national weight-loss campaigns and various projects trying to get fat people to lose weight without actually spending money to make it easier for them to do so. What you get is a fat-shaming culture that produces eating disorders and depressed fat people who may not be fully cognizant of how little choice they’ve actually had in treating their condition.
What’s that? They have a choice? Gym and healthy eating are more like individual responsibilities than treatments? I have a few counter-arguments for that.
First of all, obese people (never mind how they got that way; we’re looking at a condition, not to engage in anything as despicable as fat-shaming) have to spend more time in gym to lose weight than non-obese people do to keep it off. Some individuals don’t need to spend time in gym at all in order to maintain their weight in the normal range. Is it fair that a portion of the populace has to spend their own time and money on looking after their health, and yet receive no more benefits or support from the government than those who do not? If gym is a civic duty it should be, if not entirely free, then tax-free and government-funded.
Second, not everyone has a chance to go to gym in the first place, even if they can cough up the dough. Busy single parents and people with disabilities may not be able to do so, not to mention the majority of the world’s population that simply has no access to gyms.
Thirdly, though less so than gym, a healthy diet is also a privilege for those relatively well-off individuals who have both money enough to pay for healthy ingredients and leisure time to cook and prepare all their own meals.
Sure, some people are just lazy, or may choose to ignore their condition. I could ignore my eczema, too. What we’re talking about are equal opportunities for treatment for those who choose to have it.
I realize that including obesity treatment under healthcare may be beyond the economic capabilities of most nations. I realize, also, that paid gym time would have a negative impact on employers and likely cause discrimination against fat applicants to go through the roof. I don’t have solutions for those issues.
I guess I’m just tired of hearing people blame fatties for rising healthcare costs. Obesity is a health condition that is already excluded from receiving a lot of the benefits available to sufferers of other conditions despite the fact that logically it should be covered just the same. Fat people are the ones who don’t get choices, and yet we also seem to be bearing the blame, not only for our own health, but for the economy, too? Please. If I have a disease, if I am a carrier in an ever-expanding epidemic, I should be given the tools for beating that disease that don’t exclude me from rights enjoyed by others. That’s all. Until then, mind your own damn business.
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April 7th, 2010 @ 4:33 pm
I’ve actually seen plenty of argument against obesity being classified across the board as a “health concern” (much less a disease). The post that comes to mind immediately is this one of Kate Harding’s.
I wouldn’t deny that obesity can be a symptom, but it occurs through such a variety of causes, and doesn’t always indicate ill health … I’m pissed at people who blame fatties for health care costs too, and at all the hostility and prejudice, but having someone declare me “sick” would bother me too, and not necessarily fix the other stuff.
April 7th, 2010 @ 6:18 pm
I actually started writing this post with the intention to argue that obesity isn’t a disease and shouldn’t be labeled as such, but as I went on I realized that it’s at least as much a disease as my eczema, which is covered. Obesity doesn’t necessarily make your life worse, that’s true, and doesn’t necessarily mean a person is not healthy. I’m living proof myself, healthy as a horse at my high BMI. It does have some minor inevitable side effects, but nothing drastic.
When people say obesity is a disease, it has connotations of contagion and – somehow – comes off as “obese people are a disease”. If you know what I mean? I reacted negatively to that connotation and suggestion, too. But you don’t say “people with cancer are a disease”, even via connotation. It’s just one of the ways in which obesity – health concern or not – is a condition that usually isn’t chosen and yet gets blamed on the people who have it, with no solution on offer except mortification of the flesh (and paying top dollar to health clubs). The whole process seems like a religious sin-guilt-repent cycle which, while very human, isn’t necessarily a good way to live a happy life. Happiness comes first. If that’s threatened by having a job topped off with a costly exercise regime that leaves a person little time to enjoy her life, I say toss the regime.
It would be nice, though, if we didn’t have to choose between physical fitness and mental health.
Thanks for the link!