Maybe I Wrote in Invisible Ink

Obesity Diagnosis: More Than Meets the Eye

One thing has been clear in the public discussion about obesity this week — everyone seems very sure they know what an obesity diagnosis is or isn’t. And they all disagree. That’s not to say they’re all wrong, but most seem to have a very incomplete picture that makes dealing with obesity as a health issue difficult indeed.

We’ll take the Obesity Society’s words as definitive on what obesity is:

Obesity is defined as excess adipose tissue. There are several different methods for determining excess adipose (fat) tissue; the most common being the Body Mass Index (BMI). A fat cell is an endocrine cell and adipose tissue is an endocrine organ. As such, adipose tissue secretes a number of products, including metabolites, cytokines, lipids, and coagulation factors among others. Significantly, excess adiposity or obesity causes insulin secretion, which can cause insulin resistance that leads to type 2 diabetes.

But in the public dialogue, we have a simplistic and problematic definition at work, something along the lines of: obesity is someone who is really big and heavy. If the dialog is a bit more sophisticated, it might involve BMI — a more specific way of labeling someone as big and heavy.

The problem is that this definition sets obesity apart from other diseases. Most people with a chronic disease have the privilege of privacy regarding their medical history. But too many people think that with obesity, you can size people up and label them obese. Worse, they feel free to make false judgments about what’s causing the condition they’ve visually diagnosed. Some even feel free to offer unsolicited advice.

Understandably, people with obesity take exception to such ignorant behavior. Some go to extremes to deny the health impact of excess adiposity.

Obesity is not defined by appearance. It’s defined by adiposity and metabolic health.

Arya Sharma and Bob Kusher pointed out four years ago that BMI and similar simplistic approaches to defining obesity are totally inadequate. Writing in the International Journal of Obesity, they proposed the Edmonton Obesity Staging System (EOSS) as an alternative. Sharma subsequently published data confirming that the EOSS might better predict health risks than BMI alone.

The EOSS has a lot to offer for diagnosing obesity. The sooner we let go of more simplistic approaches, the better.

Click here and here to read more about the EOSS.

Maybe I Wrote in Invisible Ink, photograph © Thomas Hawk / flickr

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