So today I want to go back to the basics. There has been a lot of debate around what is Obesity and how it is defined, etc. This is in part due to COVID-19 – I will get to this shortly in future blogs. However, I feel we need to look at clarifying a few things first!
WHAT IS OBESITY?
People often hear about it in terms of BMI (Body Mass Index). Other people deny that obesity is a disease and it is something that you do to yourself, it is a matter of eating less, and moving more. I hear it all the time from my patients: “if I can just find that perfect diet or spend more time in the gym THEN I will be able to lose weight.” However, it is not that simple!
Obesity is a chronic and progressive disease – which means it is a life long concern and can potentially worsen over time.
Obesity is defined as an excess or abnormal amount of adipose (fat) tissue that poses a health risk. Does everyone who has excess adipose tissue suddenly become unhealthy and need medical management? NO. Re-read my first statement and one of the key elements, ‘….poses a health risk.’ There are plenty of individuals who have excess adipose tissue but they are perfectly healthy. They don’t need medical interventions or need to lose weight. However, those who do have excess adipose tissue that is posing a health risk may benefit from medical management – which may include learning strategies on how to lose weight. Fundamentally, the goal should be to improve an individual’s lifestyle by engaging in healthier behaviours and this may or may not lead to weight loss.
Weight loss isn’t the goal, as weight loss is extremely difficult to achieve. This is in part why obesity is considered a chronic and progressive disease.
WHAT IS BMI?
Now, BMI or Body Mass Index has been a hotly debated area and certainly a driver in weight-bias and stigma. BMI is essentially a measure of bigness. It takes into account a ratio between weight and height. Nothing more – it doesn’t tell me anything about how healthy an individual is or if they run every day, etc.
BMI is simply a metric that is utterly useless when I am trying to assess the patient in front of me.
However, it is still around as medical professionals like numbers. BMI is tangible and if you can make that number smaller it makes us feel like we are doing our job. BMI was originally developed for population statistics, looking at a large group of people with similar characteristics and ascertaining that group’s bigness. A higher BMI has been associated with poor health outcomes. It is still used in that manner today and has SOME utility in determining the general bigness and health of a population. Is it perfect? No, and needs to be adjusted based on the population you are looking at.
WHY IS OBESITY CONSIDERED A CHRONIC DISEASE?
What we know is there is a complex interplay for physiological, psychosocial, and biomechanical changes that can occur in an individual who has obesity. Obesity has also been found to increase your risk of a number of other chronic diseases such as :
- heart disease,
- high blood pressure,
- certain cancers,
- sleep apnea,
- joint diseases, and more.
Now, some people will say correlation doesn’t equal causation. In plain language, just because there is a connection or overlap it doesn’t mean that obesity was the cause and that me calling obesity a chronic disease is promoting diet culture and that we all need to look to be lean and slender.
They are right, in one sense. Correlation does not always equal causation, but the associations that have been demonstrated in the literature are what we consider a strong association and they can’t be ignored. Obesity is very closely linked to the above chronic diseases, likewise with Diabetes. Diabetes is correlated with heart attacks but, we can’t definitively say diabetes CAUSES heart attacks there is simply a strong risk association.
SO, HOW CAN WE REDUCE THE RISKS ASSOCIATION WITH OBESITY?
What we know is through lifestyle modifications, medications, and surgeries we can help to reduce the risk of and manage the comorbidities associated with obesity. Again, our focus shouldn’t be on weight-loss. It must be on living a healthier and happier lifestyle! I would say this is something we all can work on regardless of how much adipose tissue we have.
What are you doing today to live a healthier lifestyle? One small step might be discussing your questions about obesity in a free online session with me. Book it now!
– Dr. Dan