Extreme Obesity, And What You Can Do About It

Too much weight can take a toll on your body, especially your heart. The good news is that there are steps you can take to get healthier — and even losing a little body weight can start you on the right path.

Why lose weight?
If you’re extremely obese, losing weight can mean “less heart disease, less diabetes and less cancer,” said Robert Eckel, M.D., past president of the American Heart Association. “Metabolic improvements start to occur when people with extreme obesity lose about 10 percent of their body weight.”

Losing weight can reduce your risk of heart disease and stroke; risk factors like high blood pressure, plasma glucose and sleep apnea. It can also help lower your total cholesterol, triglycerides and raise “good” cholesterol — HDL.

Understanding Extreme Obesity
A healthy BMI ranges from 17.5 – 25 kg/m2. If your body mass index is 40 or higher, you are considered extremely obese (or morbidly obese.) Check out the American Heart Association’s BMI calculator for adults to determine if your weight is in a healthy range. (Note: BMI in children is determined using a different BMI calendar from the CDC.)

A woman is extremely obese if she’s 5 feet, 4 inches tall and weighs 235 pounds, making her BMI 40.3 kg/m2. To reach a healthy BMI of 24.8, she would have to lose 90 pounds to reach a weight of 145 pounds.

A man is extremely obese if he’s 6 feet, 2 inches tall and weighs 315 pounds, making his BMI 40.4 kg/m2. To reach a healthy BMI of 25.0, he would need to lose 120 pounds to reach a weight of 195 pounds.

Doctors use BMI to define severe obesity rather than a certain number of pounds or a set weight limit, because BMI factors weight in relation to height.

How to Get Healthier
If you’re extremely obese, taking action to lose weight and improve your health may seem overwhelming. You may have had trouble losing weight or maintaining your weight loss, been diagnosed with medical problems and endured the social stigma of obesity.

“The key to getting started is to find a compassionate doctor with expertise in treating extreme obesity,” said Dr. Eckel, who is also professor of medicine and Charles A. Boettcher II Chair in Atherosclerosis at the University of Colorado Anschutz Medical Campus in Aurora, Colo. “Bonding with your physician is the best way to get past first base and on the path to better health.”

If you’re extremely obese, Dr. Eckel recommends that you become more active, but not to start a vigorous workout program without getting physician advice and not until you’ve lost about 10 percent of your body weight.
“You can continue the level of physical activity that you’re already doing, but check with your physician before increasing it,” Dr. Eckel said. “Some people with extreme obesity may have health issues like arthritis or heart disease that could limit or even be worsened by exercise.”

Treatment Options
Talk to your doctor about the health benefits and the risks of treatment options for extreme obesity:

  1. Change your diet. You may be referred to a dietician who can help you with a plan to lose one to two pounds per week. To lose weight, you have to reduce the number of calories you consume. Start by tracking everything you eat.

    “You have to become a good record-keeper,” Dr. Eckel said. “Reduce calories by 500 calories per day to lose about a one pound a week, or cut 1,000 calories a day to lose about two pounds a week.”
     

  2. Consider adding physical activity after reaching a minimum of 10 percent weight-loss goal.
     
  3. Medication. Some people can benefit from medication to help with weight loss for extreme obesity. Keep in mind that medication can be expensive and have side effects.
     
  4. Surgery. If changing your diet, getting more physical activity and taking medication haven’t helped you lose enough weight, bariatric or “metabolic” surgery may be an option. The American Heart Association recommends surgery for those who are healthy enough for the procedure and have been unsuccessful with lifestyle changes and medication. Risks can include infections and potentially dangerous blood clots soon after the operation, and concerns about getting the right amount of vitamins and minerals long-term.

Get The Social Or Medical Support You Need
Although some people can modify their lifestyle and lose weight on their own, many need extra help. A social support system can help encourage your progress and keep you on track. Decide what support best fits your needs — either a weight-loss support group or one-on-one therapy.

Some people with extreme obesity suffer from depression. Talk to your doctor about the best treatment, as some anti-depressant medications can cause weight gain.

Learn more:

  • BMI Calculator
  • BMI in Children
  • 5 Goals to Losing Weight
  • Losing Weight With Life’s Simple 7 Infographic
  • Preventing Childhood Obesity: Tips for Parents and Caretakers
     

Obesity grips Australia: research shows 40% of adults are …

The obesity crisis in Australia is far worse than experts thought, with new evidence showing 40% of adults are dangerously fat.

The new figures are based on the waist circumferences of 11,000 people who were tracked for 12 years in the Baker IDI Heart and Diabetes Institute’s AusDiab study.

Previous estimates using body mass index were 25%.

“The results surprised us,” associate professor Anna Peeters, president of the Australian and New Zealand Obesity Society, said.

When measured around the waist, a man should not be more than 102cm and a woman 88cm, said Peeters, who will present the findings at the society’s scientific meeting in Melbourne on Thursday.

She is pleased about growing government momentum against obesity, but says parents need more support.

“It is important to intervene early in life. We need good programmes for parents from before their children are born.”

A lot could be learnt from the US, which had decreased childhood obesity.

A minority of Australian schools adhered to dietary guidelines, she said, and workplaces should revise their catering and what was allowed in their vending machines.

Obesity was a condition of an inactive, affluent society that consumed in excess, said Peeters, who is head of obesity and population health at Baker IDI.

However, people of lower education and income living in rural areas were most at risk because energy-dense, nutrient-poor food was relatively cheap.

“People don’t need to be thinking too much about weight loss when they are a little overweight, but they do need to be thinking about preventing weight gain,” she said.

“If you are a little overweight at 30, you are likely to be quite overweight by 50.”

One way to avoid children growing up to be obese was to limit sugar intake, said associate professor Tim Gill, of the University of Sydney, who will chair a session at the conference.

“We are burning so few calories that every calorie we eat needs to come from nutritious food,” he said.

Active children should be allowed two small treats a day at most, he said.

The biggest problem was sugary drinks, which should be limited to one glass a week.

“People are not aware how much sugar they are eating. A can of soft drink has eight to ten spoons of sugar, but children and teenagers typically drink double that in a serve. Foods that contain a lot of added sugar contribute little nutrition, but a lot of calories,” he said.

Overweight 10-month baby caught up in obesity epidemic sparks …

New figures yesterday showed almost 1,000 children were sent to hospital in the last three years over fears about their weight.

Shocking statistics show a fifth of four-year-olds are now overweight or obese – a problem estimated to cost the NHS £5billion a year for all ages. According to figures obtained using the Freedom of Information Act, 932 children under the age of 15 were admitted to hospital with a ­primary diagnosis of obesity.

They included 283 primary school-age children and 101 under the age of five.

Portsmouth Hospitals NHS Trust said it had admitted the 10-month-old for obesity in the past year, while Mid Staffs NHS Trust said a one-year-old girl was sent to it by a worried doctor.

At Central Manchester University Hospitals NHS Foundation Trust, there were 172 children diagnosed with obesity, while Great Ormond Street Hospital in London admitted 97 ­children.

Dr Mars Skae, of the Royal College of Paediatrics and Child Health, said: “I am increasingly being referred children as young as four years of age in our specialist obesity clinics.

“It is not unusual for me to see 18-stone teenagers in our clinic and this is extremely worrying.

“Childhood obesity is the foremost public health threat currently facing the young of this nation.”

Pregnancy Weight Gain Linked to Childhood Obesity | WebProNews

Pregnancy Weight Gain Linked to Childhood Obesity

Though recent data has shown that childhood obesity numbers are falling in a number of U.S. states, health officials in the country are still referring to obesity as an epidemic. This week, a new study has shown that expectant mothers may have more direct, biological influence on the size of their children than previously thought.

The study, published Monday in the journal PLoS Medicine, shows that high weight gain during pregnancy is directly linked to an increased risk of obesity for the children up until age 12. The study’s authors believe that helping women limit their weight gain during pregnancy could have an impact on the fight against obesity in the U.S.

“From the public health perspective, excessive weight gain during pregnancy may have a potentially significant influence on propagation of the obesity epidemic,” said Dr. David Ludwig, lead author of the study and the director of the Boston Children’s Hospital’s Obesity Prevention Center. “Pregnancy presents an attractive target for obesity prevention programs, because women tend to be particularly motivated to change behavior during this time,”

The study looked at 41,133 mothers and children in the state of Arkansas over 12 years, cross-referencing birth records and school BMI records. Statistical comparisons were then made between siblings, ruling out demographic, genetic, and environmental influences. Excessive weight gain in the study was defines as 40 or more pounds, which correlated to an 8% increase in the risk of a child being obese.

Though the difference in BMI from mothers who gained the least weight during pregnancy to those who gained the most is only one-half of a BMI unit, Ludwig and his colleagues believe this effect could contribute to hundreds of thousands of obesity cases nationwide.

Overweight and healthy: the concept of metabolically healthy obesity …

Plus-Size-Woman-Lifting-Weight

Carrying too many pounds is a solid signal of current or future health problems. But not for everyone. Some people who are overweight or obese mange to escape the usual hazards, at least temporarily. This weight subgroup has even earned its own moniker—metabolically healthy obesity.

Health professionals define overweight as a body-mass index (BMI) between 25.0 and 29.9, and obesity as a BMI of 30 or higher. (BMI is a measure of weight that takes height into consideration. You can calculate your BMI here.)

Most people who are overweight or obese show potentially unhealthy changes in metabolism. These include high blood pressure or high cholesterol, which damage arteries in the heart and elsewhere. Another harmful metabolic change is resistance to the hormone insulin, which leads to high blood sugar. As a result, people who are overweight or obese are usually at high risk for having a heart attack or stroke, developing type 2 diabetes, or suffering from a host of other life-changing conditions.

But some people who are overweight or obese manage to avoid these changes and, at least metabolically, look like individuals with healthy weights. “Obesity isn’t a homogeneous condition,” says Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health. “It appears that it doesn’t affect everyone in the same ways.”

Dr. Hu and three colleagues wrote a “Personal View” article in Lancet Diabetes and Endocrinology reviewing what is known about metabolically healthy obesity. They identified several characteristics of metabolically healthy obesity. These include a high BMI with

  • a waist size of no more than 40 inches for a man or 35 inches for a woman
  • normal blood pressure, cholesterol, and blood sugar
  • normal sensitivity to insulin
  • good physical fitness

BMI isn’t perfect

BMI is not a perfect measure of weight or obesity. It often identifies fit, muscular people as being overweight or obese. That’s because muscle is more dense than fat, and so weighs more. But muscle tissue burns blood sugar, a good thing, while fat tissue converts blood sugar into fat and stores it, a not-so-good thing.

“Further exploration of metabolically healthy obesity could help us fine-tune the implications of obesity,” says Dr. Hu. “It supports the idea that we shouldn’t use BMI as the sole yardstick for health, and must consider other factors.”

Genes certainly play a role in how a person’s body and metabolism respond to weight. Some people may be genetically protected from developing insulin resistance. Others are genetically programmed to store fat in the hips or thighs, which is less metabolically hazardous than storing fat around the abdomen.

The concept of metabolically healthy obesity could be used to help guide treatment. Currently, exercise and a healthy diet are the foundation for treating obesity. When those efforts aren’t enough, weight-loss surgery (bariatric surgery) is sometimes an option. Such surgery is appropriate for people with metabolically unhealthy obesity, the authors suggest, but for people with metabolically healthy obesity it might make more sense to intensify the lifestyle approach rather than have surgery. This idea, however, needs to be tested in clinical studies, says Dr Hu.

Don’t rest easy

Metabolically healthy obesity isn’t common. And it may not be permanent, warns Dr. Hu. Just because a person has metabolically healthy obesity at one point doesn’t it will stay that way. With aging, a slowdown in exercise, or other changes, metabolically healthy obesity can morph into its harmful counterpart.

It’s also important to keep in mind that obesity can harm more than just metabolism. Excess weight can damage knee and hip joints, lead to sleep apnea and respiratory problems, and contributes to the development of several cancers.

Bottom line? Obesity isn’t good, even if it’s the metabolically healthy kind.

<!–

–>

Share

Print Print

How to prevent obesity in our kids

Obesity is an epidemic in the Latino population and we need to take action because our kids may be the first generation to live a shorter life than our own.  NBC Latino’s Dr. Joseph Sirven walks you through the startling numbers and gives you ways to combat childhood obesity by increasing children’s physical activity and making better food choices.

RELATED:Obesity rates among low-income preschoolers dropping in some states

Dr. Joe Servin -nbc-final

Dr. Joseph Sirven is a first-generation Cuban-American. He is Professor and Chairman of the Department of Neurology and was past Director of Education for Mayo Clinic Arizona. He is editor-in-chief of epilepsy.com and has served U.S. and global governmental agencies including the Institute of Medicine, NASA, FAA, NIH and CDC.

Another Angle on Childhood Obesity — Empower the Child …

We know the statistics. Childhood obesity has become a national public health challenge, with rates of childhood obesity doubling in the past 30 years. (1) According to the Centers for Disease Control and Prevention, in 2010 approximately 1/3 of children were obese or overweight. (2) A study released by the American Heart Association just this month found 5 percent of American teenagers were severely obese.

With a national focus on childhood obesity this month, teaching children to manage their weight and eat consciously should play a significant role in empowering children to prevent obesity. Children are capable of learning about food, nutrition and movement. The American Academy of Pediatrics has found that children are starting to eat more vegetables and move. While these results are encouraging, significant gains are still needed to combat this national health crisis.

Having sent my own child off to school recently, I realize that access to the right food prevents children from making poor food choices, but empowering children with the tools and knowledge to make healthy decisions is a life skill that can be taught. Children can learn to budget calories, sugar and fat. We just need to teach them.

In our house, we budget sugar by creating our own system of sugar finance. The children are allowed so many “sugar dollars” per day and have learned to use addition and subtraction to decide if they can eat that second cupcake or lollipop. They think about the number of sugary drinks they may have had and they count their servings of fruits and vegetables. They actually treat the whole system like a game and are determined to win everyday by banking their sugar dollars for real money at the end of the week. They are, by the way, 5 years and 4 years of age, respectively.

I have seen many great initiatives trying to bring the concept of nutrition into the schools. Vending machines with healthy foods, improved food service, and community gardens are becoming a part of our children’s schools. While this is encouraging, I still do not see a national curriculum on nutrition that teaches children to budget and measure food, calories and sugar on a daily basis. We need a curriculum that empowers the child. Sugar dollars may be a start, but we need more creative tools to help kids help themselves.

In developing such a curriculum, children will also learn the more intangible lessons of self control, discipline and respect for one’s body. These are skills that will determine success later in life. Short term, self gratification does not lead to success of any kind. Strategic thinking, planning and impulse control will. Having observed my own children and many others, these are early learning lessons. They should begin in preschool and advanced through elementary education.

While we work on food deserts, movement and genetically modified food, lets include the child at the center of the childhood obesity concept. As a mom, pediatrician, integrative health expert and living healthy naturally M.D., I know that children can do this. They can beat the obesity crisis if we can create the right curriculum. We need to empower the child.

References:

1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. Journal of the American Medical Association 2012;307(5):483-490.

2. National Center for Health Statistics. Health, United States, 2011: With Special Features on Socioeconomic Status and Health. Hyattsville, MD; U.S. Department of Health and Human Services; 2012.

For more by Tasneem Bhatia, M.D., click here.

For more on obesity, click here.



Follow Tasneem Bhatia, M.D. on Twitter:

www.twitter.com/@drtazmd

Preventing Childhood Obesity: Tips for Parents and Caretakers

Balance is key in helping your child maintain a healthy weight. Balance the calories your child eats and drinks with the calories used through physical activity and normal growth.

Overweight and obese children and teens should reduce the rate of weight gain while allowing normal growth and development. Don’t put your child on a weight-reduction diet without talking to your health care provider.

Balancing calories: Help Kids Develop Healthy Eating Habits
Offer your kids nutritious meals and snacks with an appropriate number of calories. You can help them develop healthy eating habits by making favorite dishes healthier and by reducing calorie-rich temptations.

  1. Encourage healthy eating habits. Small changes can lead to a recipe for success!
    • Provide plenty of vegetables, fruits and whole-grain products.
    • Include low-fat or non-fat milk or dairy products.
    • Choose lean meats, poultry, fish, lentils and beans for protein.
    • Serve reasonably sized portions.
    • Encourage your family to drink lots of water.
    • Limit sugar-sweetened beverages, sugar, sodium and saturated fat.
       
  2. Make favorite dishes healthier. Some of your favorite recipes can be healthier with a few changes. You can alsotry some new healthy dishes that might just become favorites too!
     
  3. Remove calorie-rich temptations. Treats are OK in moderation, but limiting high-fat and high-sugar or salty snacks can also help your children develop healthy eating habits. Here are examples of easy-to-prepare, low-fat and low-sugar treats that are 100 calories or less:
    • A medium-size apple
    • A medium-size banana
    • 1 cup blueberries
    • 1 cup grapes
    • 1 cup carrots, broccoli, or bell peppers with 2 tbsp. hummus
       
  4. Help your kids understand the benefits of being physically active. Teach them that physical activity has great health benefits like:
    • Strengthening bone
    • Decreasing blood pressure
    • Reducing stress and anxiety
    • Increasing self-esteem
    • Helping with weight management
       
  5. Help kids stay active.
    Children and teens should participate in at least 60 minutes of moderate-intensity physical activity most days of the week, and every day if possible. You can set a great example! Start adding physical activity to your own daily routine and encourage your child to join you. Some examples of moderate-intensity physical activity include:
    • Brisk walking
    • Playing tag
    • Jumping rope
    • Playing soccer
    • Swimming
    • Dancing
       
  6. Reduce sedentary time. Although quiet time for reading and homework is fine, limit “screen time” (TV, video games, Internet) to no more than two hours a day. The American Academy of Pediatrics doesn’t recommend TV for kids age 2 or younger.12 Encourage your children to find fun activities to do with family members or on their own that simply involve more activity.

Learn more:

  • Childhood Obesity
  • BMI in Children
  • Making a Healthy Home

Can Bacteria Fight Obesity? Gut Bacteria From Thin Humans Can …

fat-mouse-bannerfat-mouse-banner

Why are some people fat? It’s not just a question that fat people ask themselves, but also one that drives much medical research because obesity increases the risk of serious illnesses including heart disease and diabetes.

A study recently published in Science adds gut bacteria to the list of possible causes of obesity.

The intestine is home to trillions of microbes that help the body break down and use food. The particulars of the mix have been found to vary significantly from person to person, even among identical twins.

Gordon-RidauraGordon-RidauraIn an effort to isolate the contribution of gut bacteria to weight, researchers led by Jeffrey Gordon, of Washington University in St. Louis took the bacteria from pairs of identical and fraternal twins, each with one obese twin and one lean, and put it in previously germ-free cloned mice. (We glossed tastefully over the matter of the fecal transplant.)

The results indicate that bacteria does in fact play a powerful role: The mouse that got the obese twin’s bacteria grew fat and developed metabolic problems linked to insulin resistance, even when fed only low-fat mouse chow.

The researchers then housed the fat and thin mice together, allowing their gut bacteria to mix. (Mice housed in the same cage typically eat each other’s droppings.) The thin bacteria beat out the fat bacteria in the obese mice, and they became thin again.

So is obesity purely a question of gut bacteria? No such luck. The “thin” bacteria, specifically a group called Bacteroidetes, was only able to triumph when the fat mice were eating low-fat mouse chow. When they were fed a higher-fat food meant to mimic a typical American diet, obese mice kept the obese twin’s gut bacteria — and the excess weight.

Bacteroides biacutisBacteroides biacutis

Bacteroides biacutis

“Eating a healthy diet encourages microbes associated with leanness to quickly become incorporated into the gut. But a diet high in saturated fat and low in fruits and vegetables thwarts the invasion of microbes associated with leanness. This is important as we look to develop next-generation probiotics as a treatment for obesity,” said Gordon.

It can’t be long before we see Bacteroidetes and other potentially thinning “probiotics” for sale in the supermarket next to green tea.

But, buyer beware, the mouse studies are far from conclusive. The next step for Gordon and his team will be growing microbes in the lab and mixing them to nail down which combinations have which metabolic effects.

“There’s intense interest in identifying microbes that could be used to treat diseases,” he said.

Especially diseases that make us fat.

Photos: Lexicon Genetics Incorporated via Wikimedia Commons; Gordon with graduate student and co-author Vanessa Ridaura, E. Holland Durando, Washington University of St. Louis; CDC via Wikimedia Commons

Does the process of diseasification hold any promise in obesity?

In a thoughtful, measured and well-reasoned blog post, Dr. Keith Ayoob recently discussed the AMA’s decision to classify obesity as a disease. As he concluded his post, Dr. Ayoob wrote: “I don’t care how obesity is categorized. I care about what’s being done about it … We need to stop talking about whether obesity is or is not a disease and start talking about preventing it altogether.” This got me thinking: does the process of diseasification hold any promise at all in obesity? And are there downsides to this approach that should cause us concern?

Diseasification is a funny and not entirely real word, but I didn’t make it up. Sure, if you look for it in an online dictionary, you won’t find it — but if you Google it, you’ll find over 6,000 hits. Most seem to focus on one of the most problematic aspects of diseasification: that of classifying all sorts of mental states and psychological issues as diseases, a tendency that has arguably contributed to our nation’s overreliance on pharmacology to ease the vicissitudes of daily living. But some of these Google hits refer to issues in prevention, including obesity. While I didn’t coin the term, I think its meaning is self-evident: labeling as a “disease” a condition that is typically not so construed. Clearly, the AMA’s action would fit under this intuitive definition.

Of course, this begs the question: what is a disease? A typical definition of disease provides guidance, if not absolute clarity: “any deviation from or interruption of the normal structure or function of any body part, organ or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology and prognosis may be known or unknown.”

In holding obesity up to this standard, its appropriateness could hinge on whether a body with a body mass index (BMI) greater than 30 would be considered a normal structure; this in turn depends on how we define normal. Ironically, if we refer to a standard statistical concept of outliers — usually, the most extreme 5 percent or so of a population — then the more widespread our so-called national obesity epidemic, the more “normal” obesity becomes. Currently, more than a third of the entire U.S. population is obese; in certain states and in some ethnic/racial groups, the proportion is closer to half. Clearly, these are not outliers.

But I think the annals of preventive medicine have demonstrated that diseasification has its place. Let us look at a reasonably successful story of diseasification: that of hypertension. Some readers might be surprised that I’m considering this diseasification: after all, isn’t hypertension clearly a disease? Well, no, it’s not. There are no symptoms, illnesses or dysfunctions related to hypertension per se. Hypertension refers to an elevated blood pressure, where elevated was established in a discretionary (though certainly not arbitrary) manner. Coincidentally, about a third of all Americans fit the definition of people with hypertension, so these are also not outliers in the traditional sense. But what we do know is that high blood pressure is a major, modifiable risk factor for things that are diseases — important ones, such cardiovascular diseases, of stroke and heart attack. Moreover, we know that pharmacological efforts to lower blood pressure below established cutpoints leads to a reduction in the risk of such diseases. So diseasifying hypertension has led to helpful treatments and to a reduction in disease outcomes.

Obesity, however, is a wholly different animal. First, while obesity has been shown to be a risk factor for certain diseases — indeed, many of the same diseases predicted by high blood pressure — its association with those diseases is neither so strong nor so direct as that with hypertension. Moreover, healthcare practitioners do not have the sorts of treatments in their toolkits to treat obesity that they do for high blood pressure, and even more significantly, there is no direct evidence that using treatments to lower BMI will in turn reduce the risk of the real diseases that are associated with obesity — the ones we really care about.

Thus, the presumed upsides of this new AMA-endorsed classification are hard to imagine. Given the lack of effective and proven therapies, what benefit do we seek? Prevention, as Dr. Ayoob indicated, is key — but our rapidly exploding national obesity prevalence isn’t caused by lack of adequate medical care; rather, it is due to wholesale changes in diet and lifestyle, largely promoted by corporate marketing, governmental policies, new technologies and changing norms of behavior. These are amenable (alas, not easily) to public health interventions and policy change, but not to increased doctor visits.

An open question is: if this relabeling of obesity has an impact on the stigmatization of the overweight, will it be for good or ill? On the good side, perhaps, is recognizing that it isn’t necessarily a sign of sloth or weakness of will, but something that may be beyond volitional control, much as classification as disease may have improved the situation for alcoholics or substance abusers. On the other side — do we really want to equate obesity with such things? I think we ought to heed lessons from the fat acceptance movement, and consider that the overweight seem to be the last social group that it is deemed acceptable to malign.

Certainly, there are many fat people comfortable in their own bodies; do we really want to say to them, “Sorry, it doesn’t matter what you think, you’re sick”? Not a necessary corollary of diseasification, I think, but a cause for concern.

Paul Marantz is associate dean, clinical research education and director, Center for Public Health Sciences, Albert Einstein College of Medicine. He blogs at The Doctor’s Tablet.