Obesity may seem like a weird topic, but it’s a conversation that needs to get started because some concepts are widely understood about the disease, that SHOULD also know about obesity, but are not. Here is a couple of thoughts for starters:
- These are both biologic medical conditions; neither cancer nor obesity is ‘chosen’ by sufferers.
- These diseases NOT DESERVED. There is a universal understanding that those who have cancer are victims of their disease, but many still believe that those with obesity bear responsibility for their condition.
- Both conditions need medical treatment, and the intensity of therapy should match with the severity of the disease. This is an obvious and established fact for cancer treatment, but for some reason, it remains common to withhold beneficial treatment from people with obesity.
There are numerous other similarities between cancer and obesity:
- Both diseases induce pain, disability, and organ damage.
- There are many subsets of each illness. We all understand that lung cancer is different from colon cancer, etc. Developing research shows that there are some obesity subtypes, each with different types of hormone imbalance. It’s important to understand the exact nature of each’s disease so that targeted/effective treatment can be selected.
- Both conditions shorten life, in a sense “stealing” life. Even those who continue to live alongside the disease have reduced the quality of life.
- Earlier stage intervention is more effective for both conditions. There is less damage from the disease and a better chance of living disease-free.
Some differences between obesity and cancer:
- Although both diseases affect people of all ages, obesity has it’s greatest negative impact on young adults and folks of working age. Although cancer is most common in older individuals, we all feel a particular sense of tragedy when cancer strikes children and young adults. We should feel the same sense of loss when we see those who lose the early years of their life to obesity.
- There’s a difference in timing and the sense of urgency between Cancer and Obesity Disease.
Cancer grows internally, invisibly. It has most often been present already for several years by the time it diagnosed, and the shock/dismay that comes with a new diagnosis of cancer leads to a natural sense of urgency. There is also an awareness that, until treatment begins, the disease gains ground and the patient loses ground every day. Thus, cancer treatment assumes top priority, and the best available treatment begins within days or weeks of diagnosis.
On the other hand, the obesity disease shows up gradually. Obesity diagnosis seems obvious because it shows up in full view and is easily measured, but it is subtle in the sense that it comes on so gradually that the threshold is separating “overweight but healthy” from “obese and becoming ill” is crossed with a whisper instead of the thunderclap that announces a cancer diagnosis. The gradual arrival of Obesity Disease makes it seem less important to treat, but this isn’t true. Every day that one lives with Obesity Disease means that pancreas cells do lose to insulin resistance, that joints deteriorate due to excess load, that the aging process accelerated, and that social opportunity lost due to fatigue and to stigma.
The bottom line is that obesity needs to have to been recognized as a disease and then needs to be treated using the same logical/statistical framework that has already accepted for every other disease such as cancer, cardiovascular disease, or diabetes. This means that treatment selected according to risk/benefit estimates and that potentially beneficial treatment is not withheld based on a question of “deserving” treatment. In general, earlier treatment of a disease is more successful, and the intensity of therapy ought to be scaled to match the stage of the disease.
This is not to give a “free pass” to patients who are suffering from Obesity Disease. Lifestyle heavily influences this disease, and every treatment plan including bariatric surgery builds on a foundation of healthy eating and optimized physical activity. In my experience no one seriously considers surgery without genuinely trying diet & exercise first; this is appropriate, but it is not appropriate to insist on many rounds of failed diet & exercise before moving on to more intense therapy.
People who choose to treat their Obesity Disease with surgery understand they aren’t taking “the easy way out.” They accept responsibility for continuing to work every day to keep their disease under control; they only look forward to having some biologic help (the bariatric surgery “tool”) so that their work will not continue to be wasted effort.
Write to me at DoctorJP@sagebariatric.com, if you’d like to continue the discussion.