Rosie O’Donnell on a recent episode of “The View” shared her experience with a near fatal heart attack and its association with her obesity. Rosie has since had surgery to address her obesity, which she refers to as the disease that caused her heart problems, health problems and almost destroyed her life. However, is obesity a disease?
This is a tricky concept. The way Rosie and her doctor spoke about it on the show was a little off to me. That obesity causes heart disease and diabetes. I don’t think its quite that linear, direct or simple. And it begs the question what is causing obesity?
Of course many people would say over-eating and lack of exercise causes obesity. And yet, that alone doesn’t cause obesity, rather that causes weight gain and lack of muscle tone. What causes those things to become the metabolic disorder we know as obesity is when it crosses a threshold. That is a part of knowing stress thresholds and variability. Many different things can create this crossing of a threshold into metabolic distress. Excessive consumption of calories is the most obvious and the most intimately connected to energy balance and creating this stress. But you can have heart disease and diabetes without obesity and vice versa.
This is where obesity equaling unhealthy can be a bit fuzzy. This is why there is so-called “healthy obesity“. Because obesity is a symptom of resource stress. So too many calories not managed properly is one way for the system to go into distress. For some obesity is a reflection of this distress for others its a protective cocoon for this distress. It’s more than a math problem, its a complex communication and balancing problem. Some have a stress regulating system that provides a better “dam” for stress, others as they get obese are clearly showing the distress on their waists. This is where we can liken the experience of obesity to Autism spectrum disorders.
Obesity is also a spectrum. Obesity has multiple subtypes, causes and co-morbid outcomes, much like Autism. Because obesity is a symptom of stress regulatory issues it runs parallel and in tandem with many other stress related disorders like heart disease and diabetes, but it doesn’t “have” to. It is vastly more likely to.
The same is true for Autism. There are some on the spectrum whose medical measurements are perfectly healthy. Their body and minds have found ways to compensate for the stress amplified programming in ways that do not create drags on the other systems of the body, like sugar metabolism, cholesterol, immune or digestion. However, many on the spectrum do have these co-morbid conditions of a medical nature. Some have co-morbidities of an emotional nature. Because the stress amplified neurophysiology runs parallel with emotional and sensory amplification.
The same is true for obesity. Because it is caused by stress imbalances and in some cases early life stress programming those with obesity have troubles either regulating their intake or their intake is not being regulated internally in a more productive “output” way.
Imagine you were born during or an “emergency” state shortly after birth. Would it not make sense that the body would have mechanisms in place to trade-off energy to what it deems less important, ramp up function in faculties it does and store energy whenever possible?
Not everyone gets obese for the same reasons, just like not everyone gets Autism for the same reasons. There are “many roads to Rome”. Its a good idea to me, from a medical insurance and treatment point of view for it to be classified as a disease or a disability. It’s also important that we view it as a disease that is outside personal decisions and to some extent control. However, as my philosophy stands, I think that the “disease model” is an outdated framework in general, and needs to give way to a more inclusive and dynamic “stress model”.
In a way some obesity may reflect the system in distress. In others the obesity may actually be “protective”. That the extra weight is insulating from the stress. Either ways obesity is still a reflection of a bigger issue: Why are experiencing an increasing disregulation in stress balances? And why do we still lack a scientific framework to put this evidence together?