Wednesday, 1 December 2010

Disease or risk factor?

Picking up on a meems reblog, originating from a definatalie tweet about a study, goodness! Some words on the status of the term 'obesity'. As we know, this is a faux medical term for fatness or being (a) fat (person). Such is the privilege of defining reality invested in scientists/medical professionals that even though this is like a group of 4 year olds playing at reality and getting it laughably wrong trying to fill the gaps of their inexperience. We have to take it seriously purely because of the source, not the merit of the proposition.

The lack of brain engagement doesn't matter its all part of their droit de seigneur. What it posits is that there is or can be an objective criterion for fatness, which due to the nature of physical variety is inexact as a rigid measure, yet can mostly be easily identified by observation.

We all know people with round faces who are thin and folks with big angular heads who are fat in body. We know of those who are finely drawn, in terms or bone, but are rotund, yet smaller than others bigger who are nonetheless not fat as their bone structures are more sturdy, etc., This is the underlying fault is at the heart of what makes BMI contentious. It tries to make a science out of what is often better observed, without the benefit of observation.

 Fatness has been seen as a sign of possible worsening health for a while; previously it was seen as much as a symbol of richness of all kinds including wealth and fertility. Since its development as a field of scientific study, there has been a debate about whether it qualifies as a disease.

This would seem to be easy on the face of it, you cannot turn people into a disease and fat people are above all, people, without exiting science and medicine, for morality, which is what has happened to fat people. Attempts to make a science out of it becomes quackery-due to the unsuitability of weight for this kind of categorisation and purpose. Trying to get round this by making fatness a pile of associations does the same. It is clear in more than one way that those pursuing these lines are no respecters of science and have other agendas.

The way fatness is characterized and tends to be present means that it can be categorised as more of a risk factor because it tends to be a marker of other things when it is anything much at all. Although some, notably researchers and some fat activists claim it is a product of genes for physical characteristics.

I personally find this unconvincing. It is clear that there is a spectrum of susceptibility towards weight gain and/or fatness. And I cannot myself see the purpose of fatness, in itself, full stop. It tends to be performing varying and various kinds of functions, or having done so, or genetically speaking, the product of atypical or atypically functioning genes.

To that you must add varying triggers, IOW, it is possible that many people of at all levels of fatness would not be if they had a different environment or different even different experiences within the same environment.

Perhaps the underlying factor is provoking a certain amount or type of a) stress and/or even more b) a specific kind or kinds of alteration.

The overwhelming majority of people start off either slim or plump then get fatter, sometimes very early on, but not stopping there, going all the way in stages to virtually the end of one’s life, this seems to indicate that susceptibility is about certain level of alteration being reached, which then facilitates gain-some clearly can reach that point far more easily than others due to their genetic makeup.

So it is fair to say "it's genetic” just not that has direct genes for fatness itself.

It is reactive and rarely consciously chosen, it happens spontaneously and cannot necessarily be predicted to occur or not to occur at any given point. It has become falsely defined by what is associated with, mortal sin rather than what actually provokes it, which is unknown, although there is a widespread and overweening conviction that it is caused by those associations.

What also complicates defining it as a disease is the sad drift from meaning that has occurred with that previous well defined and excellent term, the first definition here is relatively clear.

1. A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms. 

There is the issue of prognosis, how does fatness play out as a disease in its own right? Its prognosis is not predictable, if you exclude factors such as ageing, left alone it doesn’t follow a particular course that can be separated from underlying triggers, causes or continued existence.

Human regulation of weight is really efficient in keeping us within a certain range-about 20-40 lbs of our weight at 20 years between that age and 40 years old on average (female), this variance is minimal when considering the amount we eat over that time.

Now we can become sensitized to weight and seek not to gain the weight of years, however it is a normal facet of living and the ageing of our systems, and is certainly enough to place most people either 'overweight' or obese categories.

In the end, it’s the fact that it always seems to be a product of something else, its indirect nature that marks it out for assessing associated patterns of difference which could be characterised as risk; focusing on it with the label disease obscures those underlying causes for surface distraction.

Reversing the fact that weight change may accompany other pathological changes, or can be a product of them, sounds more like superstition. You can associate fatness with X so if you get rid of that, you’ll get rid of / prevent X.

Weight is too general and indirect a category to be taken on its own for diagnosis of something else, let alone for the label 'disease' to be borne without confusion or being misleading, which is important.

That's so for other weight categories, for example, thin. Not in itself ‘unhealthy’ yet could be the product of someone dying. So whilst any particular weight could signal something, I daresay some say the healthiest category‘overweight’ could signal the onset of certain conditions to.

We must get to grips with the imperfections of life and ourselves, without the frame of religion and recognise that there is a gap in between perfect function, if that even truly exists and pathology. We must stop invoking the latter crudely because 'sin' is out of favour in certain circles. The momentum building to bolt the two together is getting out of hand and making medicine into something other than what it is or should be the treatment of disease.

It is becoming a quasi religious cultural marker of identity and self absorption. It is important that our health is a part of us and that it is recognized that our health rarely stands in isolation from our lives, however, allowing our lives and selves to become medicalised as a way of dealing with things that may not be exactly as we want them is not a good idea.

We have become used to all sorts of habits being labelled diseases-seems to be the influence of the vagaries of acquiring insurance coverage often lead by the US health industry. As well as movements to remove stigma associated with conditions being labelled, 'self inflicted'.

Ironically, using the term for fatness is meant to do the opposite, induce stigma,taking a medieval line-the more you think of this, the more you have to say this cannot be the product of scientific minds- undermining the meaning of the term (disease) even further. It is difficult to see how any state seen as undesired can avoid the tag as the definition has now become so loose.

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