Obesity: A disease or a lifestyle

calivianya, BSN, RN · Mar 5, 2015

I've wondered this, too.

I have never been addicted to anything like narcs/nicotine/alcohol, so I don't know what those cravings feel like, but I will tell you I have been so miserable with sugar cravings that I have just eaten plain sugar packets out of the pantry because my cravings have driven me so nuts I can't take it anymore. Sometimes it's so bad I feel like I can't even THINK until I've had something sugary. Granted, I intervene and work very hard to lose weight any time I top over 135 lbs, so I'm not sure I really understand how people get to be 600 lbs, but I do know those cravings are awful and I can imagine, if you weren't that concerned about your image, how much easier it would be just to give in to the craving instead of forcing yourself to eat something you don't want.

enuf_already · Mar 5, 2015

I believe the latter. In the case of the 600+ pounders, there are some serious psych issues that allow family members to continue to enable the obese person to continue their death spiral.

Someone who hasn't been out of bed in years and can't roll over certainly isn't raiding the fridge alone in the wee hours of the night while everyone else is sleeping.

Most of the people on that show are in serious denial about how much they eat. The fact that there are so many people who actually tip the scales over 600 pounds is frightening.

kalycat, BSN, RN · Mar 5, 2015

I feel like it's a complicated combo of many factors. Epigenetics, the new research coming out regarding enzymes and the microbiome, psych issues, meds (prednisone, I'm looking at you!!) and lifestyle all come in to play. We see complex issues in nursing, and as we have heard over and over again, correlation doesn't equal causation, nor are there very many disorders with a single causal factor. Just my .02, for what it's worth.

I have personal experience losing someone (my mother) to the complications of extreme obesity combined with food allergies and extreme genetically based hyperlipidemia made worse by obesity, stress, smoking, and lifestyle. She was a nurse, and I know in her mind she tried to be healthy, but she also had a lot going on mentally and physiologically and ended up passing away from necrotizing pancreatitis at age 40 after over a month in the hospital where she worked. I am the slimmest female in my family by nearly 100 pounds, and while I'm a healthy weight, I'm at the upper end of that healthy scale and gain weight like no other when sedentary. I was in marathon shape when I had to have a complex abdominal surgery at age 30, which required a 6 month recovery before working out again. The day I made it back to the gym, I was almost 50 lbs heavier. And I wasn't living in the McDs drive through, either. I work hard to stay healthy through activity and diet, but eat what I enjoy also. now that I'm in my 40s, I try to pay more attention to my overall *health* than overall appearance :) Sometimes, I think too much emphasis on the latter can cause rebound eating and other issues for people. (Not that it isn't great to look fabulous and healthy!)

Anyway...I think that sometimes it's super complex and needs to be tackled as such -- in a multidisciplinary fashion with multiple supports. Sometimes, just knowing the pathophys and what works for many isn't enough...you need to know HOW to slay your own personal demons as well.

Pangea Reunited, ASN, RN · Mar 5, 2015

I've been overweight, and it was because I ate too much and ate the wrong things. I didn't feel good about being overweight, so I started eating less and eating the right things.

From what I've observed, people who eat themselves to ridiculous weights don't have a strong internal sense of control. They feel helpless and controlled by the world around them. They are eternal victims...

There are also people who are marginally overweight and just don't care. They enjoy the food more than they enjoy being thin.

Libby1987 · Mar 5, 2015

I don't think it's anymore a lifestyle issue for the super morbid obese than just the obese, or even the overweight. Whether 100bls overweight or 300 lbs, the same issues got them there, it just went farther for the super morbidly obese.

All 3 are factors I believe but #4 is the metabolism aspect ie "runaway" IR.

"Why We Get Fat" Gary Taubes.

I'm lean and part is due to my usual strict food habits (off the wagon lately) and regular exercise (also off the wagon) or rather that's what gets me in bikini shape. But at 50 and menopausal, it's my genetics that makes it easy to stay lean. I can get away with a lot, I'm one of those and I come from a line of lean people. Who also happen to pay attention to diet and fitness much of the time but still, we have our metabolism on our side.

Why does someone else become overweight on my life style? They're all of a sudden lazy while I'm respectable because the same lifestyle keeps me at a 19 BMI?

Once in IR, and our diets promote IR, much faster and more severe in the endomorph. Throw in one or more of the other 3 factors (and how many of us don't have any of them?) and it becomes a train you can't turn around.

And I don't believe the OP has anything but an interest in the topic, nor do I know OP's or the other posters' weight, but overweight/mild-mod obese people looking at the super obese and wondering how they got there is like me looking at anyone overweight and wondering how they ever let that happen. Much of it is favorable or relatively favorable metabolism. Certainly the super morbid obesity is on a whole other scale (I'm trying to come up with a different word here!)

I wish "Why We Ger Fat" was required reading for everyone. Not so much for the low carb push (tho I'm a believer) but to understand the underlying resistant metabolic causes of endemic and epidemic obesity. Not just intellectually understand, I'm sure most here already do, but *understand* from a perspective of empathy and gratitude.

0.adamantite · Mar 5, 2015

From what I've observed, people who eat themselves to ridiculous weights don't have a strong internal sense of control. They feel helpless and controlled by the world around them. They are eternal victims...

I agree with other posters that obesity is a very complicated factor and all 3 points the OP listed probably combined with other factors are what can cause an individual to be obese.

However the quoted piece above I see again and again and again. Not just in patients suffering from extreme obesity but other patients. Even myself at times (I personally spent a long time in denial of my spending habits/personal finances). I think learning to take control of our lives and not being a victim is a HUGE issue a lot of people need to overcome.

Gooselady, BSN, RN · Mar 5, 2015

People CAN'T get that obese without some kind of metabolic disorder. Medical science is just beginning to isolate gene areas and map brain areas having to do with appetite/satisfaction, and are finding structural problems and genetic differences in people with morbid obesity -- including their children. Apparently there are more than one genetic 'cause', just like everything else.

A typical person can stuff themselves with high calorie food and NEVER get to 600 pounds. A typical person CAN'T stuff themselves like that if they tried. Some people emotionally eat and become obese, but why doesn't everyone who overeats emotionally weigh 600 pounds?

It's got to be all of the above, plus a metabolic 'difference' of some kind. Perhaps in another 25 or 50 years morbid obesity will be seen as less than a moral issue, or 'lifestyle choice' (ie lazy, gluttonous, careless about health) in the same way psychiatric disorders are no longer considered 'personal weaknesses' or 'demon possession'.

jadelpn, LPN, EMT-B · Mar 5, 2015

I believe it is a combination of all three of the factors listed by the OP. Addiction can come in many forms. With addiction comes the manipulative behaviors-- doesn't matter if it is meth or meat. And part of an addiction cycle is the poor self esteem/guilt--until such time as the mind of an addict wants another fix. Wash, rinse, repeat.

Chesterton1 · Mar 5, 2015

I choose "all of the above"

DWillaman72 · Mar 5, 2015

I am in agreement that it is all of the above as well, but it is different for different people. Maybe each person gets a percentage to each of the three categories? Some may have 1 or 2 factors but most all have 3 of the traits. I personally am 450 pounds and I was a world class powerlifter, ran a 6:30 mile at 298 lbs etc. etc. I dont eat like a rabbit, but you will never see me at a buffet or being sick over eating too much. My lifestyle is definitely not the healthiest or most active, but part of it is because im so damn big it's hard to be as active as I want. Disease is probably the least of a factor for me, I do not have an addictive side to me, if anything I will do a bad thing to excess once or twice (such as drinking one day really hard 1-2x year). I would definitely say mental health is involved for me. I fight the depression train every day, some days I win some I lose, and usually starting in January-February I lose more than I win. I think genetics play the most important role for me. It is the easiest place to put the blame, but obesity runs in my family and noone runs in my family (pun intended).

I cant say noone likes working with obese patients, but lets just say not a whole lot of nurses I know get excited about having a 350 pluser to take care of. They need more care, more caregivers, and are usually not the happiest of campers. However, we have to deal with it, and make the best out of the patients we do care for. As for me, Im over everything and am taking the surgical route. Gooselady hit the nail on the head!

RNperdiem, RN · Mar 5, 2015

It is a sign of the times. Once in the not too distant past, unless a person was very rich, making that amount of food available to grow a body to massive proportions was simply not possible. Most of us lived in the land of barely enough, not the land of plenty.