Eating Mindfully

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Fat

Why the AMA's classification of obesity as a disease is concerning

How are you feeling? On June 18th, 2013, approximately 1/3 of Americans woke up ill. They may not have had the usual signs of illness- fever, sore throat, aches and pains. These people didn’t even need to go to a doctor to diagnose their illness. Rather, based on your body mass index (BMI), which is a fancy term for a simple calculation based on height and weight, the American Medical Association, has diagnosed you with fat. “Obesity,” as fat is called in the medical community, has now become an illness.   

Call me skeptical, but I find the timing of this new diagnosis interesting. In the past year, two new weight loss drugs were approved by the FDA and released to the public. One drug, Qsymia, performed poorly in the market. Since obesity was not classified as a disease and drugs to treat obesity were not always seen as medically necessary, many insurance companies did not provide reimbursement for weight loss drugs and this affected sales of Qsymia. Another drug, Belviq, coincidentally went on sale just one week prior to the AMA’s decision to classify obesity as a disease. This makes me wonder if Big Pharma had any role in the AMA’s unusual decision to disregard the conclusions of its own Council on Science and Public Policy, which is a scientific advisory board that the AMA had designated to study the issue of whether or not obesity should be classified as a disease for the past year. The Council had concluded that obesity should not be classified as a disease, in large part due to the problematic nature of defining a disease based on no more than a calculation of height and weight.

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I am concerned about the designation of obesity as a disease for several reasons. Below are three.

1. People can be healthy at a wide range of body shapes and sizes. This means that- contrary to the AMA’s new decision- fat people can be healthy. What will happen to all of the healthy fat people who will now be designated as “sick?” I fear that they will be encouraged to go on a diet (or worse be prescribed diet drugs), which will consist of disconnecting from the healthy behaviors that they were engaging in, entering into a losing battle with their bodies, and joining the crowded world of disordered eating and body image dissatisfaction which, ironically, will likely lead to weight gain (in addition to taking a toll on emotional wellbeing).

2. Weight loss by any means necessary does not equate with health. The designation of obesity as a disease will likely lead to a continued preoccupation with weight loss in our society. Unfortunately, focusing on weight loss seldom leads to long-term weight loss. Usually it leads to dieting, which sometimes results in short-term weight loss predictably followed by weight gain. This pattern of “weight cycling” poses greater risks for our body than remaining at a stable weight.  In addition to the risks of dieting and weight cycling, people often engage in dangerous behaviors (like fasting, diet pills, and self-induced vomiting) when they feel pressure and desperation to lose weight.

3. Obesity is a red herring. Instead of focusing our time, efforts, and financial resources on helping all people (fat, thin, and anywhere in between) become more attuned with their bodies, eat more mindfully, and move more, we only see the number on a scale. If that number is low, than we believe we are healthy regardless of what we eat and how we move. Similarly, when we eat mindfully and are active but remain in the “obese” category, we are discouraged and deemed unhealthy by others.

Eating mindfully involves (gasp!) accepting your body at its current state and focusing on nurturing your body through eating what your body is calling for when you are hungry and stopping when you have had enough. Seems simple enough, right? Unfortunately, dieting and focusing on weight loss makes mindful eating as simple as walking across the Grand Canyon on a tightrope. Someone can do it, but most of us would fall into the chasm.

To learn more about mindful eating and Dr. Conason's practice, please visit her website at www.drconason.com

Alexis Conason, Psy.D. is a clinical psychologist in practice in New York City and a researcher at the New York Obesity Nutrition Research Center at St. Luke's-Roosevelt Hospital.

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