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Taylor Skinner Hepner ENG201 11/17/11 ObesityDisease? Exordium (Introduction) As the human race enters into the 21st century and attempts to make sense of all the new technology and medicines that have developed in the last hundred years growing pains are sure to follow. Healthy living and prolonging life are two subjects that have long fascinated people of all cultures and are or should be the central goal of medical research and development. A great deal of time and resources have been spent to put into place systems by which people can afford medical assistance and improve the quality of life of people all over the world. This is the reason that there is a great deal of attention given to the question, what makes an illness an illness? Obesity is described as "a condition that is characterized by excessive accumulation and storage of fat in the body and that in an adult is typically indicated by a body mass index of 30 or greater" by the Merriam-Webster Medical Dictionary online. Since there is some debate surrounding the cause of obesity there is hesitancy on behalf of government, citizens and large insurance companies to define obesity as a disease. Narratio (Thesis) Obesity should be officially recognized as a disease by the media, government and medical community.

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Divisio (Outline) The percentage of obese people is steadily rising and has been for the past decade as have the costs to treat the debilitating condition. While there is much debate over the definition of disease, obesity fills most of the requirements of many common definitions. Obesity impairs normal functioning of the body as well as decreases life expectancy. Many large organizations have already accepted obesity as a disease such as the Food and Drug Administration, the National Institutes of Health and the Internal Revenue Service. More energy and resources should be invested into preventing obesity among American citizens and this can be more easily accomplished if obesity is more widely known and accepted as a disease. The percentage of obese and overweight people in the world is increasing and something must be done in order to more efficiently treat and prevent the obesity rate from increasing any further. Confirmatio (Evidence) The alarming rate of the obese and overweight in the United States alone has been a cause of concern for many over the past two decades. Although all the different causes of obesity are still in debate, it is too clear that it is a major health problem in the world. Obesity has been around for longer than most people believe. Acceptance of obesity as a medical phenomenon has been slow. For thousands of years, overweight and obesity were exceptional, rarely seen and never studied. In some cultures, indeed, obesity was prized, indicating status and wealth. Only the richest had the means to become obese and girth advertised wealth more effectively than the richest clothing or jewels. The ancient Greeks were the first, however, to realize the dangers of obesity and its association with disease (Haslam 31).

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As far back as the fourth century BC Hippocrates was diagnosing and attempting to treat the ailment. Obesity is defined today by the World Health Organization as having a Body Mass Index greater or equal to thirty. Body Mass Index is found by dividing an individuals weight in kilograms by his height in meters squared or his weight in pounds multiplied by seven-hundred and three divided by height in inches squared.

The Body Mass Index(BMI) formula was developed by Belgium statistician Adolphe Quetelet (1796-1874), and was known as the Quetelet Index. BMI is also referred to as 'body mass indicator'. BMI is an internationally used measure of obesity. (The BMI formula) The World Organization of Health also gives this word of advice when considering BMIs, BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals. Keeping in mind that the BMI is not an exact measurement of fat percentage the rates of obese and overweight people are still staggering. The WHO has declared that worldwide obesity has doubled since 1980 and in 2008 there were 1.5 billion adults, age 20 and over, who were overweight with 500 million of those being obese. In the United States it is estimated by the Centers for Disease Control and Prevention Department that one third of adults and 17% of children ages 2-19 are obese.

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It is clear from these statistics that obesity is prevalent in todays society which may be fairly obvious to the observant individual who strolls through a local mall. However the real problem resides in the negative consequences that come with being overweight or obese. Obesity is connected with some of the most prevalent diseases found in todays society. The greatest risk is for diabetes mellitus where a body mass index above 35 kg/m2 increases the risk by 93-fold in women and by 42-fold in men. The risk of coronary heart disease is increased 86% by a 20% rise in weight in males, whereas in obese women the risk is increased 3.6-fold. Elevation of blood pressure, hyperlipidaemia and altered haemostatic factors are implicated in this high risk from coronary heart disease. Gallbladder disease is increased 2.7-fold with an enhanced cancer risk especialty for colorectal cancer in males and cancer of the endometrium and biliary passages in females. Endocrine changes are associated with metabolic diseases and infertility, and respiratory problems result in sleep opnoea, hypoventilation, arrhythmias and eventual cardiac failure. Obesity is not a social stigma but an actual disease with a major genetic component to its aetiology and a financial cost estimated at $69 billion for the USA alone (Jung 307). According to a study published by the Journal of the American Medical Association, in 1999 approximately 280,000 annual deaths are attributable to obesity among United States adults. The negative effects of obesity are clear but does that make it a disease? The Merriam-Webster online dictionary defines disease as a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms. The sign of obesity is excess fat and it impairs normal functioning of the human body in multiple ways.

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George Cheyne MD lived in the 18th century and was a top physician who also suffered from gross obesity. He described his feeling excessively fat, short-breathd, lethargick and listless. He required a servant to walk behind him carrying a stool on which to recover every few paces. Cheyne wrote of The Fat, unwieldy and over-grown, saying tis easier to preserve Health than to recover it, and to prevent Diseases than to cure them . . . without due Labour and Exercise, the Juices will thicken, the Joints will stiffen, the Nerves will relax, and on these Disorders, Chronical Distempers, and a crazy old Age must ensue (Haslam 31). The sufferings of Cheyne are shared by countless individuals across the globe. Breathlessness and joint pains are among the most common symptoms of obesity or being overweight. With so many health problems caused by obesity, the cost of treating obesity related illnesses has exploded. A study was done in 1998 in order to find the economic impact of obesity in the United States. The study took in to account, excess physician visits, work-lost days, restricted activity, and bed-days attributable to obesity were analyzed using the 1988 and 1994 National Health Interview Survey (NHIS). The study concluded that The total cost attributable to obesity amounted to $99.2 billion dollars in 1995. With the harmful effects and costs related to obesity continually rising, it is crucial that preventative measures be made to put a stop to the damage being done. David Haslam, an obesity expert, states one thing the battle against obesity does not need is new scientific invention (31) Effective preventative measures have already been found for obesity but they are in desperate need of being exercised. Galen, a well-known roman physician described his treatment of obesity: I reduced a huge fat fellow to a moderate size in a short time, by making him run every morning until he fell into a profuse sweat; I then had him rubbed hard, and put into a

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warm bath; after which I ordered him a small breakfast, and sent him to the warm bath a second time. Some hours after, I permitted him to eat freely of food, which afforded but little nourishment; and lastly, set him to some work which he was accustomed to for the remaining part of the day (Haslam 37). Diet and physical exertion are the most common and effective treatments for being overweight or obese. Although the solution seems very simple there are many other variables that play a role in obesity. Since the treatment for obesity itself has been established, the true problem lies in implementation and the spread of this knowledge. In some countries, health insurance companies pay for the treatment of obesity, but most insurance carriers in North America do not. Funding is a major consideration in the management of all chronic diseases, but this is complicated further in patients with obesity, a disease that is still not recognized as such in many countries. This is an area that urgently needs public and governmental action (Bray and Macdiriamid 78). Confutatio (Refutation) There are many who see obesity as a crop reaped by those who have sowed unhealthy diets and poor exercise habits. Although it is true that obesity is very preventable there are more variables at work than the individuals laziness. Some would raise the issue of the definition of obesity and its discrepancies but these might not be as relevant as it may seem. Others would claim that wider acceptance of obesity as a disease will only enable those obese people and give them an excuse for their unhealthy lifestyles. Also, it is believed that spending more tax money on obesity would only be a waste of the peoples money in the end. Although there are many

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interesting points that draw the conclusion that obesity should not be treated as a disease, it is important to keep in mind the goal of that definition. It is true that the vast majority of the cases of obesity are due to overeating and little to no exercise but there are other factors that contribute to those causes. Some of the main factors responsible for obesity in industrialized countries are environmental. The World Health Organization states that one of the reasons obesity is on the rise is due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization (Pushka). Although personal responsibility is always first and foremost, changes in society as a whole are having a large impact on the health of the general public. The form in which obesity is measured is also a subject of debate. The BMI merely measures the size of a person but does not take into account the actual body fat percentage. This is a valid concern and could be seen as a major miscalculation. BMI can calculate if a person is overweight, not over fat. Thus it is possible that a highly trained athlete be technically overweight. But, research studies have shown that higher BMIs are associated with heart disease, stroke, diabetes and some cancers. The BMI formula may not be the most precise measurement for health risks but it is sufficient to prove that obesity is running rampant in the world. While excuses are common in everyday situations, it is not realistic to assume that all obese or overweight people would use its a disease! to excuse themselves for their unhealthy living habits. One must not assume that being overly fat is such an enjoyable thing and that people are fat because they like to eat and are lazy. Obese people suffer from many things other than the higher risks of disease like diabetes but psychologically and emotionally as well. Surely grossly overweight persons do not enjoy being limited by their weight in the places they can go

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and the things they can do. Any physical impediments are difficult to deal with not only temporally but emotionally as well. Many healthy individuals are appalled at the idea of obesity being considered a disease because they have spent time and energy staying healthy while obesity, to them, is an easily preventable condition. However the issue is not about as much about how it is defined than what it is called. Obesity needs to be taken more seriously which is reason to increase the severity of its title. Peroratio (Conclusion) Obesity has been considered an epidemic by many prominent figures like Former Surgeon General Dr. Richard Carmona. Research has shown strong ties between obesity and prominent diseases like heart disease and diabetes. Obesity is so prevalent in todays society that it is estimated that there are at least 300 million people who are obese. The problem with obesity does not lie in advancing medicine and finding a new solution but can be found in taking obesity seriously. The first step that needs to be taken in order to achieve this is recognizing and classifying obesity as a disease. This will force people, agencies and governments all over the world to change their views about obesity and recognize the serious consequences that are bound to catch up to the world and are already affecting millions of people.

Works Cited

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Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. "Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB." Obesity Research Center, St Luke's/Roosevelt Hospital Center, 27 October 1999. Bray, George A. and Macdiarmid, Jennie. "The epidemic of obesity" West J Med. 172.2 (2000): 78-79. Haslam, David "Obesity: a medical history," Obesity Reviews 8 (2007): 31-36. "How to Calculate Bmi - Formula - Body Mass Index Calculation." Independent Health Information | What Health. Whathealth.com, 21 Nov. 2011. Web. 21 Nov. 2011. <http://www.whathealth.com/bmi/formula.html>. Jung, Roland T. "Obesity as a disease," British Medical Bulletin, Oxford Journals 53.2 (1997): 307-321. Pushka, Dr. P, Dr. C Nishida, and Mr. D. Porter. "WHO | Obesity and Overweight." Who.int. Who.int, 2003. Web. 21 Nov. 2011. <http://www.who.int/mediacentre/factsheets/fs311/en/>. Walker, S. Carlos Poston II, Foreyt, John P. "Obesity is an environmental issue," Atherosclerosis 146.2 (1999): 201-209.