Obesity Becomes a Disease

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    • 00:05

      [Obesity Becomes a Disease]Hello.My name is Dr. Stephanie Medley-Rath.[Dr. Stephanie Medley Rath, Associate Professor, Departmentof Sociology, Indiana University Kokomo]And I'm a professor of sociology at Indiana University Kokomo.Since 1980, obesity rates have grown around the world.Obesity is described as an epidemic causing poor healthoutcomes by the Center for Disease Control and the World

    • 00:26

      Health Organization.How obesity is measured has changed, which contributesto some of the rate increase.Recently, the American Medical Associationbegan classifying obesity as a disease.This increasing medicalization of obesitymay pave the way for increased access to treatmentand possibly reduce the stigma associated with the condition.

    • 00:48

      I will cover the following points.Obesity-- the growing epidemic.But what's behind these statistics?Is obesity an epidemic?How is obesity determined?Obesity becomes a disease.Remember, correlation does not equal causation.And are there any benefits of recognizing obesityas a disease?[Obesity-- The Growing Epidemic]

    • 01:13

      More than one third of Americans over the age of 20 are obese.According to the Center for Disease Control,obesity rates among adults doubled between 1980 and 2000.Overall, about 60 million adults or 30% of the US adultpopulation are obese.Public health officials in the United States and globallyhave declared obesity an epidemic.

    • 01:34

      The World Health Organization reportsdoubling of obesity rates around the world since 1980to 13% of the world's adults.[Behind the Statistics-- Is obesity an "epidemic"?]But what's behind these statistics?Is obesity an epidemic?Part of the growth in obesity ratescan be attributed to a change in how obesity is measured.

    • 01:56

      In 1998, the National Institute of Healthrevised the measure of obesity and overweight,which lowered the threshold.In other words, Americans who were not considered obesein 1997 were now considered obese under the 1998 revision.This is not to say that obesity is not a problemor that describing it as growing or an epidemic is disingenuous.

    • 02:17

      What is important to understand isthat part of the increase in obesity ratesis due to the change in how obesity is measured.And one of our jobs as sociologistsis to uncover the reality behind the statistics.[How is obesity determined?]So how is obesity determined?

    • 02:38

      Obesity is determined by an individual's Body MassIndex, or BMI.BMI is calculated based on a person's height and weight.A BMI between 18.5 and 24.9 is considerednormal or healthy weight.A BMI between 25 and 29.9 is considered overweight.And a BMI of 30 or higher is considered obese.

    • 02:60

      This measure, however, is problematic.Scientists point out BMI is an incomplete measure of obesitybecause it cannot distinguish type of fat or where the mostharmful fat is located in the body,both factors which influence the riskiness of a higher BMI.The reality is that depending on where the fat is storedand the type of fat in question, a person with higher BMI

    • 03:21

      may be at no more health risk than a person with a lower BMI.[Obesity Becomes a Disease]In 2013, the American Medical Associationbegan officially recognizing obesity as a disease.This means that a person with a BMI at or above 30is not only obese but also has a disease.

    • 03:44

      This person is now marked as sickand in need of treatment regardlessof how risky the weight may actually be.Sociologist Peter Conrad argues that we should questionwhen normal human processes and conditions become medicalized,such as with the case of obesity.Medicalization refers to the process by which somethingmoves from not being a medical matter to requiring

    • 04:05

      medical intervention and surveillance.If obesity is a disease, it suggeststhat medical intervention is necessary in orderto treat or cure it and to prevent other negative healthoutcomes.[Correlation does not equal Causation]Obesity is a risk factor for negative health outcomessuch as type 2 diabetes, heart disease, stroke, and asthma.

    • 04:29

      But is this enough to make obesity its own disease insteadof a condition or risk factor for serious health conditions?Based on the American Medical Association's decisions,yes, obesity is a disease independentof other measures of healthfulness.Keep in mind that obesity has been establishedas a risk factor, not a cause of things such as type 2 diabetes.

    • 04:50

      In other words, correlation has been established, notcausation.It's important to remember that correlation does notequal causation.To establish causation, three conditions have to be met.First, correlation has to be established.Correlation exists in this scenario.There is an increased risk for type 2 diabetes and asthma

    • 05:11

      among people who are obese.Second, the time order must make sense.In other words, either type 2 diabetes or asthmamust occur after a person becomes obeserather than before they become obese in order for obesityto have contributed to those outcomes.And third, the explanation is nonspurious.

    • 05:32

      A nonspurious explanation means that there is nota third variable that has been overlooked.Is it possible that a third variable is causing obesityand also causes these other conditions?Is it possible that a person susceptible to obesityis also susceptible to these other diseases?Could it be in their genes, for instance,or caused by the same environment, such as diet

    • 05:54

      high in saturated fat?The point is that a BMI above 30 is correlatedwith negative health outcomes, but that does not mean obesityactually causes these negative health outcomes.[Are there any benefits of recognizing obesityas a disease?]Despite problems of how obesity is measured

    • 06:14

      and the way in which many treat itas a causal factor of negative health outcomes,there are at least two clear benefits of recognizing obesityas a disease.First, recognizing obesity as a diseaseincreases the likelihood that insurance companieswill pay for treatments, such as prescription drugsor surgeries for obesity.

    • 06:35

      According to Peter Conrad, medicalizationmay be the only way individuals can get the services they wantor need to be paid.Tellingly, obesity was designated as a diseaseafter doctors received limited reimbursementfor obesity-fighting surgeries andafter pharmaceutical companies garnered poor salesfor obesity-fighting drugs.

    • 06:56

      In other words, there's a much largerpharmaceutical and surgical market for obesity as a diseasethan there is for obesity as a riskfactor of other conditions.It is in the financial interest of pharmaceutical companiesand surgical providers to confuse correlationand causation in the public's mindand promote obesity as disease in its own right.

    • 07:17

      Second, recognizing obesity as a diseasemay serve to reduce the mark or stigma of obesity.By expanding a condition's definitionto disease as opposed to earlier understandings of obesityas an individual's personal failing,a person may be less stigmatized, thereby loweringthe harm caused by the problem.Research demonstrates a persistent stigma

    • 07:39

      against obese individuals in employment,health care, and education.For example, one study found that obese individualsare less likely to receive job interviews.Scholars, however, find that classifying obesityas a disease improves a person's body image,thereby reducing stigma.The potential of reducing stigma associated with obesity

    • 08:01

      is there through the further medicalizationof the condition.[Conclusion]Obesity is described as an epidemic and cause for concern.Sociologists are trained to illuminate those concerns.In particular, we raise questionsabout how obesity is measured and whether correlation

    • 08:23

      and causation are being confused.Sociologists also question medicalizingnormal human conditions but also emphasizethat medicalization can provide needed benefitsfor people who are suffering.I'll leave you with these questions to consider.What is the difference between correlation and causation?How are the two confused regarding obesity?

    • 08:44

      Should obesity be considered as a disease?Should it be medicalized?Does this reclassification pave the wayfor other risk factors of negative health outcomesto also be redefined as a disease?What are the benefits of recognizing obesityas a disease?Will obesity continue to be stigmatized as more people come

    • 09:05

      to recognize it as a disease rather than as a lifestylechoice?

Obesity Becomes a Disease

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Abstract

Dr. Stephanie Medley-Rath discusses obesity and the factors that played into its classification as an epidemic. Changes in measurement, market forces, and a desire to end stigma all had roles in the medicalization of obesity.

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Obesity Becomes a Disease

Dr. Stephanie Medley-Rath discusses obesity and the factors that played into its classification as an epidemic. Changes in measurement, market forces, and a desire to end stigma all had roles in the medicalization of obesity.

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