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A more complex view of obesity

Posted Nov 25 2009 7:16pm

So a few posts ago I said I would share some of my thoughts on Dr Sharma’s etiological assessment of obesity. You can check out his handy-dandy chart below:

This comes from the thought (outlined in the first link in the post) that the accumulation of excess fat is not in and of itself a disorder, but rather a sign that something is happening to upset the body’s energy balance. At first I was thinking that this distinction was kind of semantic, but the more I thought about it, I realized that an idea like this could have a profound effect on how doctor’s approach the treatment of obesity. If you’re not trying to treat being fat, but looking for factors that might be leading to changes in body fat, the constant haranguing to just ‘lose weight’ would have to cease. If you have a patient with persistent pain, you wouldn’t tell them to ’stop being in pain’ all the time, after all. (ok, I’m not the queen of analogy today, whatever.)

Ok so here is where I get hung up. Now, I don’t have a problem with acknowledging that gaining (or losing) weight has to involve some kind of energy imbalance, but what if you have a fat patient who is weight-stable? And what if this fat patient is also healthy with no conditions that are correlated to carrying a lot of body fat? Is it necessary to start analyzing the reasons for someone having an ‘unhealthy’ bmi if they’re not unhealthy and/or continuing to gain weight? I guess, what this comes down to is that I’m not sure how I feel about automatically classifying high weight as a symptom. Now considering some of Dr Sharma’s other ideas, I would assume this wouldn’t be an issue, but I’m not sure.

Obviously, I’m posting without having fully refined my thoughts so more on this may be forthcoming.

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