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David Katz: Obesity as Disease: Why I Vote No

(David Katz, M.D., Yale Prevention Research Center) There is a certain irony in the nearly immediate juxtaposition of the rare introduction of anew FDA-approved drug for weight loss (Belviq) to the marketplace and the recognition of obesity as a "disease" by the AMA. A line from the movie Jerry Maguire comes to mind: "You complete me!" Drugs need diseases; diseases need drugs.
And that's part of what has me completely worried. The notion that obesity is a disease will inevitably invite a reliance on pharmacotherapy and surgery to fix what is best addressed through improvements in the use of our feet and forks, and in our Farm Bill…
Our bodies, physiology, and genes are much the same as they ever were. Certainly these have not changed much in the decades over which obesity went from rare to pandemic. What has changed is the environment.
We are awash in highly-processed, hyper-palatable, glow-in-the-dark foods. We are afloat in constant currents of aggressive food marketing. We are deluged with ever more labor-saving technological advances, while opportunities for daily physical activity dry up.
We are drowning in calories. And that's how, in my opinion, we should make obesity medically legitimate: as a form of drowning, not as a disease…
The most important reasons for rampant obesity are dysfunction not within our individual bodies, but at the level of the body politic. We do need medicine to treat obesity, but more often than not, it is lifestyle medicine. Lifestyle is the best medicine we've got -- but it is cultural medicine, not clinical.
That's where our attention and corrective actions should be directed… If we look more to clinics and less to culture for definitive remedies, it will do net harm. If we fail to consider the power we each have over our own medical destiny, and wait for salvation at the cutting edge of biomedical advance, it will do net harm.
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Please do not give advice. We can best help each other by telling what works for us, not what we think someone else should do.