Culture of Obesity – Overeating vs. Undereating. Part I of II
Carolena Trocchia, MD1 Student at Geisinger Commonwealth School of Medicine
Carolena Trocchia, MD1, originally from Long Island, NY, is a first-year medical student at Geisinger Commonwealth School of Medicine. Carolena received an undergraduate degree in science from Stony Brook University and a Masters degree in public health from SUNY Downstate Medical Center. She has participated in research projects on obesity and the role of health equity on disease. She hopes to pursue a career in pediatric oncology upon graduating from GCSOM.
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It is no secret that the United States is currently suffering from an obesity epidemic. More than 1 in 3 adults (greater than 30%) and 1 in 6 children are currently considered obese. Obesity, in medical terms, is considered to be a form of hyperexia or a condition of overeating. Within the past 20 years (roughly 1995-2015), we have seen obesity rates more than double in most states, with some areas fairing worse than others. Some experts feel that obesity is a complicated condition that includes political, psychological, social, financial, and biologic factors. However, we still have yet to see a cultural shift in the perspective towards those who are obese. This is an issue that is shared from top ranking physicians, researchers, and healthcare providers, to the lay population. Thus this bias is not a matter of medical knowledge, but from a cultural belief that obesity is due solely to weakness of the individual. We have this notion that if you are overweight it is your fault for overeating or eating the wrong foods, and therefore is your problem. Ironically, when it comes to diseases of the other extreme eating disorders such as anorexia or bulimia, we tend to have more empathy for the patient and see them as a victim of a psychological barrier they cannot overcome. Yet, both diseases involve disproportional control and intake of calories. So, why do we treat one as damsel in distress, and the other as the villain?
Studies further demonstrate that treatment options available for both extreme disorders of hyperexia and anorexia vary greatly. For example, in patients with hyperexia or ‘over eating’ related issues, most physicians leave the treatment in the hands of the patient by suggesting diet and exercise. Pharmaceutical intervention is typically provided only for the obesity related complications such as hypertension or diabetes. In more extreme cases, bariatric surgery may be an option for those that require a more severe form of intervention. Some patients may work with a healthcare team which includes their physician, a dietician, a personal trainer and other specialists to help them reach their weight goals.
However, in the case of individuals with anorexia, a similar team of professionals (physician, dietician, psychologist etc) are provided, however, the psychological aspect of treatment is focused on much more directly and intensely. The patient is often referred for individual and family based therapy, psychotic medications and the strategy of care is typically more proactive in making sure the patient and their surroundings are working together to improve their weight.
This disparity is even more shocking in light of the fact that the rates of anorexic type eating disorders constitute roughly 2% of the population, whereas obesity affects greater than 30%! (This does not mean we should ignore anorexic diseases by any means, but shows how severely behind we are in terms of obesity management: limited resources and treatment, and narrow perspective). Clearly, one can see that all members of the medical professional team would be valuable for both conditions and require an individual and community approach to treatment to make a serious approach to treating obesity effectively.
Thanks to new research findings, we now understand that there are a host of factors related to obesity that move so much farther beyond the individual’s behavioral habits. Studies show that obesity is an issue of socioeconomic status, race, gender, and immigrant status has an impact on socioeconomic status, which effects obesity. Another major influence is an individual’s biological and genetic composition and the interplay between individual genetics and the environment, which will be discussed in more detail next week in Part II of Culture of Obesity..
Read Dr. Mackarey’s Health & Exercise Forum – every Monday. Next week: Part II of Culture of Obesity. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: email@example.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.