I was reminded of a very old movie recently, Don't Raise the Bridge, Lower the River (1968). The theme involves a con artist demonstrating the old adage "There is more than one way to skin a cat." In that vein, some have apparently finally found a way to address the growing issue of obesity in society. They have boldly . . . changed the definition of obesity.
The British Broadcasting Corporation (BBC) reports that Canada has overcome obesity by concluding Obesity should be defined by a person's health - not just their weight, says a new Canadian clinical guideline. This is inventive and novel, certainly.
The Centers for Disease Control in the United States has a clear definition of obesity:
"Weight that is higher than what is considered as a healthy weight for a given height is described as overweight or obese. Body Mass Index, or BMI, is used as a screening tool for overweight or obesity."
That is fairly simple to comprehend and to communicate to others. If my weight is above the standard, that is seen as problematic. I first confronted that fact years ago when I entered the world of workers' compensation. My early practice was focused on employer reimbursement claims against Florida's Special Disability Trust Fund, see section 440.49, Fla. Stat.
One of the criteria under that statute, constituting a "preexisting permanent physical impairment" is:
"Obesity if the employee is 30 percent or more over the average weight designated for her or his height and age in the Table of Average Weight"
That led me to those charts, which led me to calculate my own statistics, which led me to label myself "obese." The Government published an ideal weight range for my gender and height, and I was well above it. There were self-attempts at justification, at disbelief (in the standard, not the scales), at denial. But, the definition and the standard remained. I was obese.
We are an obese society. According to the American Cancer Society, many of us are obese, and the percentage is growing:
"between 2007-2008 and 2015-2016, the report says the rates of obesity rose significantly among adults, from 33.7% to 39.6%. Rates of severe obesity increased during this time from 5.7% to 7.7%."
Who can forget the tower scene from Airplane (1980) in which we learn "Leon is getting larger." In fact, recently it seems many of us are getting larger.
There are implications and problems. The American Society for Metabolic and Bariatric Surgery says there are potential health impacts:
"Obesity can cause a lot of damage to your body. People with severe obesity are more likely to have other diseases. These include type 2 diabetes, high blood pressure, sleep apnea, and many more."
Note that they say "cause." There are others who note various potentials for obesity to aggravate various maladies and conditions. But, also to "cause." Over the years I have seen a great many of those government standard height/weight charts in doctor's offices. My impression has been that there is general consensus that overweight can increase health risks.
Are we worried about obesity? (Alfred E. Neuman: "what, me worry?") Some conclude that we are, both individually and collectively. According to Thinkbynumbers.org, Americans alone spend vast sums on weight loss and fitness.
"Americans spend more than $60 billion annually to try to lose weight, on everything from paying for gym memberships and joining weight-loss programs to drinking diet soda."
The site claims that world hunger could be eradicated for half that amount. The news focuses on this topic. This year it noted the obesity rate is now over 40%, that weight may implicate COVID complications, and that obesity has implications for heart disease. Obesity is not a new topic or concern.
Canada's solution is interesting. According to the BBC, it is not suggested that "diet and exercise" be forgone, but it is now advising "doctors to go beyond simply recommending diet and exercise." The plan is to "focus on the root causes of weight gain and take a holistic approach to health." That may or may not be consistent with merely changing the definition. Without an objective standard like the charts, how does one decide if they are or are not a healthy weight?
Well, the Canadian Medical Association has determined that there is a potential for "weight-related stigma against patients," and it cautions practitioners against that. There are cultural assumptions, it notes, regarding "personal irresponsibility and lack of willpower." The result is "blame and shame upon people living with obesity," The Canadian approach seeks to remove the stigma attached to obesity, by redefining it, and thus purportedly empower clinicians to treat it.
The Canadian effort concluded that "many doctors discriminate against obese patients." There is a ""weight bias" that leads to practitioner behavior. The sense is that many have operated on a simple advice of less calories and more activity. The new guidelines continue to focus on a healthy and balanced diet as well as "regular physical activity" But, there is a significant focus on the mental aspects of both hunger and weight gain.
The new Canadian guidelines will continue to utilize the body mass index (BMI) ensconced in that government height/weight chart. The waist size will also remain as a measure. But, the focus will shift from attaining "ideal weight" essentially to attaining some improvement. Size will not matter as much as making some progress. The authors of the standard point out that small weight reductions can affect improved health.
The new guides specifically claim to not abandon the long-standing advice of "eat less, move more," but to shift focus to supporting the patient psychologically, medically (drugs), and even surgically (gastric bypass). Is it practical to conclude that surgery is the answer? Bypass surgery is nothing new. The Mayo ClinicMayo Clinic labels it a "major procedure" and notes it "can pose serious risks and side effects." And, it adds that "you must make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success." In other words, surgery is not apparently an independent, risk-free, solution to the issue.
The issue seems to be both complex and vexing. Vast sums are invested annually in addressing it, and despite that rates of obesity are increasing. We like sugar, convenient processed foods, eating out, large portions, and more. We tend to like exercise, activity, and self-discipline less. We are engaged in a societal battle of the bulge, and many signs indicate we are losing. Changing definitions may help. The path of the Canadian effort will be interesting to watch.
I for one hope they are proven correct and that weight loss can be more easily attained through their new redefinition and removal of stigmas. Clearly, something needs to change and obesity trends need to improve. Too much is riding on it for us personally and collectively. But, let's hope we are not just naively lowering the river. You think about it, I am going to get some breakfast.
