Obesity not an 'epidemic'

I beg to differ concerning labeling our very large percentage of obese citizens as an “epidemic.” (“The obesity epidemic,” February 25, 2013.) Because epidemic means “upon the people” and is used in medical terminology to refer to conditions that are imposed on, or introduced into, individuals, it is misleading to include obesity under that rubric. 

Obesity is in fact a state that an individual enters into of his or her own accord. That some obese people have varying needs, gimpulses, or behaviors that incline them to overeat cannot be gainsaid. In no case, however, is the result of obesity secondary to overeating imposed on the individual by an outside, undesired source. To say that the obese are victims of advertising, or of fast foods, or of high-calorie prepackaged foods, is at odds with the fact that other individuals, exposed to the same environment, are not similarly affected.

Our “obesity epidemic” is in fact an “epidemic” of individual poor choices. To call it anything else is to rob the obese individual of autonomy and thus his or her sense of worth, freedom, and responsibility. Moreover, the misunderstanding of obesity as an epidemic leaves the field open to governmental and institutional legislation and policies designed to cure it. These efforts and actions will result in unintended consequences that will have further untoward effects on both obese and non-obese individuals.

Does obesity, especially morbid obesity, have evitable, and even inevitable, medical consequences? Without question, the answer is yes. Should physicians discourage obesity, and offer encouragement and practical methods for losing weight to obese individuals? Again, yes. But the obese, we physicians, and the rest of society are ill-served by the ethical implications and the social and economic consequences that flow from the premise that obesity is an epidemic.

Mitchell G. Moffat, MD

Nome, Alaska

Patients are accountable for their health

When are we physicians going to demand that our patients take responsibility for their healthcare? I don't accept the current thinking that I should be rewarded (or punished) based on whether my patients are controlling their chronic diseases. I address (and document) with the patient at each visit what the goals are and how to achieve them. The patients are informed of the consequences of non-adherence. Obstacles to adherence are discussed. I refuse to be put in a position where I would have a financial motivation to terminate non-adherent patients.

We physicians are all too accepting of the label of caregiver when the term babysitter is more accurate. Just like the attorneys who have made personal responsibility an archaic concept, so too now is the government telling patients that they are not responsible for being unhealthy. It is the sellers of oversized soft drinks who are the culprits in our obesity crisis. It is the doctors who are at fault and will be duly punished if our patients are not healthy enough.

If we want to have real cost control, then we must make the patient have a skin in the game. Tie the cost of health insurance to their adherence. Charge patients more for health insurance coverage if they are obese, smoke, or are not at goal for chronic disease states. Require any insurance that offers prescription drug coverage to cover a fixed percentage of the cost of all medications. Let the patient and doctor decide whether the brand-name medication is worth the extra cost. 

Expanding Medicaid and mandating health insurance coverage will do nothing but exponentially expand the cost of healthcare. We need to make people more, not fewer, accountable for their health.

Keith Dinklage, MD

New Castle, Indiana

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