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.

Madonna New Film and She Still Denies Surgery – It’s the Kabbalah Apparently.

Doesn’t Madonna look fresh-faced these days all of a sudden, as if by magic? At the Venice Film Festival, the 53-year-old pitched up looking no more than five years older than the so-called chubby Madonna so desperate to be famous no matter what it took back in the early- to mid-eighties.

Her desperate need for attention has been unremitting, although she lost a pound or few from her frame along the years, but piled them onto her ego.

[adsense]Madonna is back in the public eye – which means she must want something from us. Oh yes, she is promoting her new film based on the relationship between Edward and Mrs Simpson called W.E. Which probably stands for ‘weak ending’, although it would certainly be on no surprise if it also had a W.B. and a W.M.

She arrived on a speedboat (LOL) wearing a gray frock with red butterflies on that some designer had made just for little old her, and teamed it with red shoes and red sunglasses (even though it was dark – the tit). All very newsworthy stuff.

But if us in our pedestrian gray office jobs didn’t have stars like Madonna and Lady Gaga to false idolize, imagine how insipid our pointless little lives would be. I don’t know about you, but if I don’t get my weekly fix of Hello! Magazine (which should be renamed ‘Why?’), the week just seems to drag on. I like nothing more than to look at all the pictures of glamorous people I don’t know wearing different outfits in foreign locations I’ve never heard of and will definitely never be able to afford to go, whilst I gorge myself on cheap custard creams and a fat coke before I start processing invoices. I mean… what a life!

Madonna before and after no surgery

Madonna before and after no surgery. I can't wait to look younger than I do now in ten years time.

Since the music industry spat Lady Gaga out through its disgusting and smelly vagina, giving egotistic celebrity haters a new false idol to anti-worship, it’s been easy to forget all about Madonna. And then she brought out another film, (we all know that Madonna and films is a bad mix) and up she pops again in the media, looking like she spent more time directing her own face than she did on the film itself.

Why people are surprised when a squillionaire who can only function when they are in the public eye looks good, when they have access to the world’s best cosmetic surgeons et al, is beyond me and my ilk. People shouldn’t say ‘doesn’t she look good for her age’, they should be saying ‘didn’t they do a good job on Madonna?’

Of course, Madonna knows that her fanbase consists of undereducated know-nothings who wouldn’t know a great piece of music if it got up and gave them liposuction sans anaesthetic, so she vehemently denies having had any surgery done at all. Instead she blames her stupid religion of choice – the kabbalah – for saving her skin and making her wrinkle free despite galloping towards 60 with a ten-year-old boyfriend.

Apparently the kabbalah teaches beauty from within. LOL. Kabbollocks more like. This coming from possibly the vainest woman on the planet (Lady Gaga [always happy to emulate Madonna] comes close second.) who has spent the last 25 years or more rubbing her desperate celebrity minge in the general public’s face and screaming ‘Look at me! Love me!’ (Possibly due to her diminutive size. Short asses are known for their massive compensatory egos and for not being able to reach the cookie shelf.)

Cosmetic surgeons generally concur that the material girl has had extensive surgery performed on her face. And photos abound on the internet that make face lifts look highly likely. In fact, she’s probably undergone more ops than Michael Jackson. Not that it matters. If she wants to spend all her money on kabbalah surgery that’s up to her.  Easy come, easy go,

Madonna has not had surgery.

Madonna Denies Having Surgery to Make her Look like Peter Cushing.

Madonna has a lot to prove with this second stab at writing and direction. Her first film ‘Filth and Wisdom’ was shit. But then Madonna and films have always been a mismatch. Her past acting attempts made Pinnochio look like he’d spent forty years under Stanislavsky’s wing. She must shudder as she remembers the awful Desperately Seeking Susan, the pathetic Who’s That Girl, and the utterly dreadful Body of Evidence. Oh and Shanghai Surprise which almost put an end to Sean Penn’s career. But she likes to try her hands at stuff does Madge – like a bored rich kid playing with her toys: Hollywood and the music industry. I imagine that Madonna has always wanted to capture the one thing she can’t have – an intelligent audience. Something she will never achieve with a back catalog of songs akin to aural Haribo.

I hope that this next foray into theatrics will pay off, purely because W.E. features the wonderful Andrea Riseborough (star of The Devil’s Whore). I hope she doesn’t become soiled by Hollywood and all its wretched demons. People with genuine talent should stay away from the pop music industry and Hollywood.

Has Madonna had more surgery than a patchwork quilt? Maybe she was born with it. Or maybe it’s the kabbalah.

Peter Cushing.

Personally, if I was really rich and intelligent, I’d avoid any organised religion that made me look like I’d just come around from an anaesthetic having just had extensive facial surgery.

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Jennifer Aniston to direct movie about breast cancer

Jennifer Aniston will be switching roles and this time getting behind the camera for her latest project which will see her, together with Demi Moore and Alicia Keyes, direct a collection of short films exploring the impact of breast cancer on people’s lives as part as a five-part series called Project Five.

Breast cancer is the second most common type of cancer after lung cancer and the leading cancer for woman in the US and the UK, with two out of three woman surviving the disease beyond 20 years.

“Our hope with Project Five is to entertain, inform and inspire dialogue, research and prevention. Otherwise, our goals are small,” Jennifer, who has previously directed a short film, told Us Weekly. “We want these films to move people and empower those affected by breast cancer to stand tall through this challenge, which impacts all of our lives, no matter who we are.”

The film will air on  the Lifetime channel later this year.

Read here about Kylie Minogue, who was recently given the all clear, and about her emotional interview about living with the disease.

Other celebrities who have suffered from breast cancer include:

Images: Wikimedia Commons and PR Photos