There are famous people in this world and they attract attention, for better or worse. The events in their lives can serve as ready examples because the press will spread the word of their achievements and failures. They draw attention, for whatever reason.
A 47-year-old singer passed away recently. The headline caught my eye because she died of obesity. I have struggled with the seemingly growing tendency to refer to fat as a disease. It seems more congruent that fat is a result or a choice. If you take in more calories than you use in a day, you will gain weight. If you burn more than you take in, you will lose weight. I struggle with this being calculus. I am striving to understand the recent trend of labeling it a disease.
The actual language used in the report is that she "died of complications from class III obesity." That is somewhat complex. Obesity comes in classes. That itself is not news, but the manner in which this story proclaims it is not common. It is simply novel for a headline to proclaim that fat caused death. More frequently, the conclusion is that weight causes or aggravates health conditions that cause death.
This story draws back to Body Mass Index (BMI), and the questions it raises. See How Can They Both Increase (February 2019), Monetary Costs of Obesity (December 2021); The BMI Conundrum (February 2022); Flying Disappointment and a Lawsuit (December 2022), and most recently Obesity- a Better Definition (June 2024). BMI is ubiquitous, imperfect, and criticized.
Nonetheless, it is the predominant standard that we use, despite its many critics. The main reason is likely its simplicity. With a scale and a tape measure, anyone with the internet or a calculator can determine if someone is obese.
Through definition, you can also determine how obese someone is. The recent article provides the following definitions from the Cleveland Clinic.
Class I obesity: BMI of 30–34.9Class II obesity: BMI of 35–39.9Class III obesity: BMI of 40 kg/m² or higher
Those are definitions, but they could be more helpful. The National Institute of Health has some handy charts for putting that in context. It depends on height and weight. For example, someone 6 feet tall (140 to 184 is "normal") would have to be over 294 pounds to be "Class III," which used to be labeled "morbidly obese." If the person is 5 feet 4 inches, then that threshold is 232 pounds (110-145 is "normal"). The crux here is that fat kills. The article strives to insinuate that many die of being fat.
That is not really supportable from the points made. The data supplied more readily supports that "cardiometabolic diseases like hypertension, stroke, and diabetes" kill many people. More simply, heart disease and cardiovascular issues kill many people. The chances of developing these health issues increase with increased fat in the body. This is true regardless of the source of fat, and the article strives to emphasize its theme of fat as a disease.
This vernacular and perspective change is for emphasis on treating fat and more critically on insurance treating fat. It is a characterization effort, a propaganda, to free the individual of responsibility. It excuses the overindulgence in calories and under-engagement in activity and labels their result "disease." It is an effort to normalize treatment and drugs as a solution to overconsumption of calories and under-exertion of activity. The authors want to convey that there is no fault for fat, that it simply happens. That is an unfortunate characterization.
Is cigarette smoking a disease? Is drug use a disease? Certainly, some arguments can be made that either could result from addiction, which is accepted as a disease. Addiction is a diagnosis, and possible it can be treated. But the (over) use of a substance does render the result a disease; drunk is not a disease; high is not a disease; speeding is not a disease. Like fat, they are each results of consumption. That is not to say that the compulsion to consume could not be an emotional challenge that could be treated. But drunk is still not a disease, it is an effect of overconsumption.
The math is not complex. To attack fat, consume fewer calories and increase activity. Either will help. Both together will work more rapidly. It is not easy, our worlds are full of temptation and antagonists. People not fighting the battle will bring doughnuts to the office. Restaurant workers will ply us with dessert options and other temptations. Too many of us will grab a corn-syrup-laden soft drink, energy drink, or worse.
But, in the end, it is a personal choice to consume or not consume. Whether you buy into the definitions of obese, the categories of obese, the criticisms of BMI, or the "disease" label that facilitates, enables, and normalizes drug use, the math remains the same. Consume less, move more. It is math, but it is not calculus.
And, it can be a journey. The singer who recently passed touted weight loss efforts. She enjoyed weight loss successes. She decried diets and advocated for life change. She recognized the threat of fat and she campaigned against it. Nonetheless, she died at 47.
Certainly, the singer's passing is tragic. But she did not die of obesity. Whatever caused her death was likely accelerated, aggravated, or exacerbated by body mass. There are a multitude of things that can go wrong with the body. While obesity is not easy to address, it is one of the few symptoms, factors, or aggravations that we can actually attack ourselves, that we can attack holistically. Drugs are necessary for a variety of medical conditions, but not needed to address fat.
That said, there is room for reform. Where can efforts rationally start? In a world of increasing obesity, the time has come for any program that supports, enhances, or provides food to exclude the challenges. Simply stated, if the government is paying for someone's food, that should never include sugary drinks, candy, cookies, chips, and other such irritants. Food subsidy programs should be limited to the necessities of life - proteins, vegetables, and fruit.
In allowing poor food purchases, government money is wasted. Tax dollars are wasted. Fat results. A great many of those people will then consult doctors or visit hospitals for the predictable complications and ailments to which fat contributes such as diabetes, heart disease, and more. Tax dollars (that is taxpayer's money) is buying the cause (chips, candy, soda) and then having to treat the result.
In that vein, the government has long been complicit in the failings of many. And, it is getting worse. In April 2024, rather than moving such programs toward health, there was a pronouncement that EBT cards (formerly food stamps) can now be used at restaurants. There are those who do not see a connection between prepared food and obesity, but those caloric encounters are not helpful to fitness. Do doughnuts enhance health? Does it make any more sense for EBT to be spent on french fries and milkshakes than on candy and chips?
Obesity is not a disease. It is an aggravating factor in many maladies and can be a predisposing factor as well. It can be changed by any person who chooses to change the math on either calorie intake or calorie burn. Programs that provide sustenance should be constrained and designed to prevent consumption of the high-calorie, minimal-nutrition, fat-causing products. It is anachronistic to do otherwise, and the results are troubling.
Mourn the singer. Know that the day she died of "complications" thousands more just like her did as well. They did not make the national news for their weight loss efforts or their passing. They were not famous, rich, or Internet-famous. But they were every bit as important as the singer, and everyone is capable of preventing such deaths.
