As a dog-walker, I live in a cloud of numbers. How many dogs today? What is the temperature? How many will cancel or go away for the weekend? How much money will I put in the bank on Saturday? How much can I pay Visa this month?
As a fat person, I eschew as many numbers as possible, even when I am a fat person who is working on losing weight. I don’t weigh myself because I tend to make the scale into a very scary nun who either berates me or puts me in the goody-two-shoes front row. I don’t give a flying Friday about how much exercise I get. I follow a food plan so that I don’t have to count calories or grams.
The only numbers about myself that I keep track of are on my calendar and clothing labels. I mark down my start date and lapses and, once a month, reckon up how many clean days I have. Because I’ve been clean for about six weeks now, I’ve had to look at labels to figure out what size shorts and a dress to buy for my summer vacation. The thrill is over quickly, especially when I’m feeling most cocky. That’s when I will catch a glimpse of myself or try a shirt on as I make the switch from summer to winter clothes and put it aside as too small.
Last week, the American Medical Association announced that it now considers obesity a disease, defining obesity as a BMI of 30+. According to the NIH BMI calculator, I would escape the disease label at a weight of around 190 pounds.
This shocks me, as everything to do with my weight and my body does. I consider myself really, really overweight and yet 190 pounds is a reasonable number. It’s an attainable number. It’s a size 14 or 16, a few sizes smaller than I am now.
The backlash from the AMA’s announcement astonishes me. Bloggers are screaming about how this will impact “responsible” (i.e., thin) people’s insurance rates and the American Denial of Personal Responsibility. Even one arm of the AMA, the Council on Science and Public Health, does not uphold the decision, and many doctors feel that the BMI of 30+ is arbitrary. Does a 5’8” woman (let’s call her Diana) of 200 pounds with a BMI of 30.4 with no metabolic co-morbidities (blood pressure, heart rate, cholesterol, blood sugar, etc. all normal) have a disease? Should Diane be reimbursed for seeking professional help in losing weight?
First of all, physicians have to have a definition. The AMA drew it at a generous 30.
Secondly, insurance companies have yet to follow suit and create billings for obesity treatment. If and when that happens, yes, if Diana wants it she should have it.
Diana didn’t get to that barely-fulfills-the-diagnosis state of 200 pounds/30.4 without having problems with food or metabolism or medication or some other influence. My guess is that Diana won’t remain 200 pounds forever. Next year it will be 205 or 220.
And that’s where I take umbrage with fat activists, who have begun a Twitter movement called “IamNotADisease” [sic]. Because while Diana may be as healthy as a horse today, she might be trying not to be a disease that’s waiting to happen: Diane-the-Coronary, Diana-the-Type-2 Diabetes, Diana-the-Knee Replacement, Diana-the-Polycystic Syndrome, Diana-the-Surgery Risk. Treating her obesity is preventative medicine, much more economical in the long run than any of those “real” diseases.
This “I am not a disease” thinking is faulty in any case. Is a woman with AIDS the disease? Is an epileptic epilepsy? Of course not. At the very worst, they are stigmatized by a disease in as much as anyone knows they have one.
EVERYONE knows an obese person is obese. The stigma is already there. The Dianas and Franceses of the world have endured years of people t’sking away about their pretty faces or despicable habits or how much room they take up on the subway. We can shake our fists and demand equality—and we deserve equality, don’t get me wrong—but we can’t control the way the world thinks of us.
This includes doctors who have been taught to treat high blood pressure but not obesity and who are biased against the obese patients who make up a third of their clientele. The American Medical Association’s decision to classify obesity as a disease might also mean that doctors will finally be educated about the complexity of overeating—but only if the AMA expands its study and treatment of obesity to the worlds of psychiatry and neuroscience, which have already opened up the billable frontier.