Are you a Tony Soprano?

When I speak with people about the risks of an unhealthy lifestyle, quite often I’m presented with the argument that their uncle weighs 250lbs, drinks 4 shots of bourbon and smoke a pack of unfiltered cigarettes a day....and he’s 95 years old and still kicking up a storm.  We’ve all heard this story.  So, their uncle or aunt that is the exception to the evidence is what they hang their future health outcome on.  The exception to all clinical and scientific research is their excuse for being obese and living an unhealthy lifestyle. 

It was with sadness on a couple levels when I heard of the premature death of James Gandolfini.  First, I was sad because I really liked him as an actor, especially as his character, Tony Soprano. He will be missed on both the big and small screens.  And second, I was sad that he ignored all the research and science that indicated his lifestyle was directing him to an early grave.  Gandolfini was obese at a weight of 300lbs when he died at the age of 51and even though this is considered a young age these days, it didn’t surprise me that he died of heart attack.

And just like the person that hangs onto someone they know that lives a long life in spite of their poor lifestyle choices as how they model their own lifestyle, let’s remember that James Gandolfini represents the vast majority; those hundreds of thousands of people that die every year of heart disease, or some other chronic disease.  Dr. Oz was on CNN the other evening and was asked to comment on the death of Mr. Gandolfini and he said, “1/3 may have been genetics, but for sure, 2/3 or more, of what contributed to his death was of his own doing”.

I also thought it was interesting that on the day I heard about Mr Gandolfini’s death, the American Medical Association voted to classify obesity as a disease.  So instead of saying “you’re obese”, now you can say, “I have obesity”.  I wonder if this subtle difference in classification would have benefited Mr Gandolfini and the 100’s of millions of North Americans that are obese.  In Mr Gandolfini’s case, I don’t think it would have changed much as he often said he liked the feeling of being large and didn’t like losing weight for certain roles he played.

I have little doubt the decision to classify obesity as an illness will draw more medical and public attention, which I think is positive, but was it really the right thing to do.  Like any other form of illness, the public looks to our medical community for the treatment.  And in most cases, illnesses are treated with some kind of pharmaceutical solution and never really cured. Will all the obese people now take this change in classification and simply look to their doctor for some pill to fix them up?  As with many chromic diseases brought on by poor lifestyle choices, will the overweight and obese  take even less responsibility for their condition?  It’s not like it’s a mystery how they got that way.  Just look at what large people purchase at the grocery store and you’ll see the answer.

Unlike people that are ill and suffering from cancer, diabetes, mental illness, etc.; someone who’s obese may not actually be clinically ill.  So how will being told, “You have obesity” help these people in their fight against their size and self image. Will they retreat further and become more self conscience of their condition, which would be equally destructive.

I read a while back that our medical community is ill equipped to treat obese people with only ½ of primary care physicians qualified to treat them.  The fellow I coached this year and last who started out at 245lbs and is now a very healthy 165lbs through dietary changes and cycling for exercise, told me that when he was at his heaviest, his doctor still didn’t mention he was putting himself at serious risk.  With the AMA classifying obesity as a disease, have they passed the treatment responsibility to an ill trained group of doctors?

I’m also concerned how the major stakeholders will react to this decision. If obesity is classified as a disease, the attention will be directed towards medical treatment and even less towards prevention.  The obesity epidemic that affects any nation that eats a typical North American diet has four responsible parties, with a fifth waiting in the wings;

1. Big Food – who are responsible for the unhealthy food they produce, but are wildly profitable
2. The Citizen – who choose to make unhealthy food choices for themselves and their families even when they know it will have long term health consequences
3. The Government – that subsidizes unhealthy food producers, making healthy choices significantly more expensive for many people in low income brackets.
4. The Medical Community – that will now be saddled with treating yet another man-made disease that can be prevented for the most part through healthy lifestyle choices. 
5. And a new stakeholder will play a more prominent role.  Big Pharma – who will smell significantly more $$$$ because now that obesity is a disease, it will be treated like all other diseases...through some kind of prescription medication.

I’m sure the AMA meant well by changing obesity’s classified to an illness.  To be sure, weight management is a complicated issue that employs an entire industry of medical researchers that are trying to figure it out.  But I’m equally sure this decision will have a boat load of unintended consequences.  So to avoid the consequences of this decision, don’t take the path of “Tony Soprano” and ignore obesity, regardless of its classification.  Prevention is the cure, so shape your health outcome by making good lifestyle decisions today, because let’s face it who wants to die at 51. 

Enjoy the Ride....Rob

 

Comments

[John Kreamer]

I'm an American living in Singapore and am in total agreement with what you are saying. A few observations; What I hear most often from foreigners visiting the US is their their amazement in the large size of the food portions served at restaurants. Perhaps this would be a good place to start by getting restaurants to cut down on the portions (resulting in lower prices which works for everybody). When I visit the US shopping at Walmart is like being in a scene out of star wars where obese people are riding in motorized shopping carts because they are too big/lazy to walk the aisles. What are they buying? Five gallon tubs of ice cream and similar products. The whole food culture of the US needs to be changed/turned back before this "disease" is cured. To do this the general public needs to be educated. Not an easy thing to do, especially when overweight kids see their obese parents eating like there is no tomorrow, and sadly, for some of them there isn't one.