Friday, July 5, 2013

A Walk in Their Shoes

It was inevitable that, at least in certain corners, the decision by the American Medical Association (AMA) to label obesity disease would be politicized in certain quarters. To be specific, writer Michael Tanner opined in the very conservative National Review yesterday about how the decision is really nothing much more, in his mind, than an attempt by doctors and others to persuade the government to pay for the poor lifestyle choices of patients, presumably by forcing the government to subsidize weight loss surgery and other treatments.

All we can say is that it's pretty evident that Mr. Tanner has never had to seriously struggle with his own weight and that he's woefully unaware that the decision is far from unprecedented. While we can spend all day defining what a disease is, the fact of the matter is that the AMA declared alcoholism an illness in 1956, possibly well before Mr. Tanner was even born. Anyone who has ever dealt with weight issues knows that it's very much like an addiction but with one diabolical additional problem: You can give up alcohol completely; you can never smoke a cigarette again and be much healthier for it; you can't stop eating completely. No wonder that so many people find permanent, healthy weight loss in Los Angeles or anywhere else to be next to impossible.

While we understand that not everyone agrees with classifying any addiction as a disease, the entire weight of medical thinking about these issues holds that it is. It's also clear to most people that addiction to overeating is far tougher to end that just about any other addiction because our need to eat it so utterly basic. That's why such outstanding procedures as gastric sleeve surgery are becoming more routine every day.

The problem here, of course, is that people who have no personal experience of addictive problems, and who have bothered to learn much about them, are unaware of what it feels like from the inside. They have no idea that the brain, which is a bodily organ like any other, is constantly sending very strong signals that the desired substance -- whether it's a, a double sized martini, or a cream filled donut -- must be obtained immediately, just to feel normal. For a non-addicted person, the decision to have a cocktail or a donut is an act of volition. They may even remember occasions -- often in their youth -- when they, more or less on purpose, decided to overindulge in food or drink for fun, maybe suffered some short term consequences, and moved on. They may think that addicts are doing the same thing, but on a daily basis. If only it were that simple.

We suppose it's inevitable that political types who have no experience of medical issues will misunderstand decisions made by doctors. We'd like to suggest that they exercise their capacity for empathy, but that's not always a strong suit.

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