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AACE Proposes Certification in Obesity

October 30, 2012

I read this article in MedPage Today and I was livid! One of the things the AACE wants to do by creating a Certification in Obesity is to have obesity universally considered a disease and treated as such.

The American Association of Clinical Endocrinologists (AACE) plans to develop a certification process for physicians who treat obesity, which, they say, is a complex disease that goes beyond simple weight loss.

No, obesity is not a “complex disease that goes beyond simple weight loss.” A symptom of underlying conditions, a side effect from a prescribed drug, but not a disease in and of itself alone. As for being “a complex disease that goes beyond simple weight loss,” that’s not quite right either. I would say “obesity” (if we have to call it that) is more a condition that is made up of a myriad of complex factors that we are just beginning to define and haven’t even begun to understand in its entirety yet.

“With today’s understanding of obesity as a complex hormonal, neuronal, and metabolic disease with derangement of energy balance leading to multiple comorbidities, it is clear that highly trained and qualified endocrinologists can provide clinical leadership and mentoring in this area,” the association said in a position statement published in the September/October issue of its journal, Endocrine Practice.

I’m sorry, I’m laughing too hard right now to even be able to parse this coherently. Give me a few minutes to catch my breath and quit laughing and I’ll see if I can take this apart without collapsing into laughter again.

Right, “With today’s understanding of obesity as a complex hormonal, neuronal, and metabolic disease with derangement of energy balance leading to multiple comorbidities.” Llet me stop them right there. What part of “correlation is not causation do they not understand? They’re leaving out genetics, socio-economic factors, and a whole host of other factors that aren’t necessarily physiological, but have a lot to do with those so-called co-morbidities that they seem to think are caused by “obesity” (even though thin people have them too).

And that understanding that they think they have? It isn’t really all that complete or correct, and is being updated, changed, and found flat-out wrong all the time. So forgive me if I don’t have much faith in their “certification” process.

A certification program is the next logical step for the endocrinologists given the metabolic processes obesity involves, and physicians could better tag-team the epidemic, the statement explained. The position statement doesn’t reveal details about certification.

“Physicians could better tag-team the epidemic.” The epidemic that doesn’t exist, the epidemic that was created out of thin (excuse me, fat) air. And the position statement isn’t giving any details about certification, probably because there aren’t any new, improved classes for doctors on how to treat obese patients. Just the same old recommendations for the Nightmare on ELMM Street and WLS, with a side of “Eat This, Not That,” none of which have worked for long-term weight loss for the majority of patients for the last 50 or 60 years, that I, personally, know of. I’m totally not impressed.

Other medical societies have offered similar programs for their members. For example, the newly formed American Board of Obesity Medicine — formerly the American Board of Bariatric Medicine — is offering a certification program for the first time. Nearly 250 physicians are registered to take the first exam when it’s offered next month.

The American College of Physicians doesn’t have a certification for treating obesity. Instead, the college’s public positions encourage policies that promote increased attention on wellness and prevention of chronic diseases, including obesity.

The American Medical Association offers continuing medical education in areas such as helping patients to make healthy food choices and to lose weight.

Aaaaannnndddd the emphasis is still on seeing “obesity” as a chronic disease and pushing weight loss. You would think that 50 to 60 years of research showing that the majority of fat people who diet may temporarily lose weight, only to gain some, all, or more of the weight back would tell them that weight loss is not the solution. It doesn’t make people healthier, and in some cases it can have deleterious effects on the dieter’s health. *headdesk*

Together the groups would advance its Obesity Comprehensive Care Plan. The plan would allow the groups to develop and participate in obesity medicine education, research, and social advocacy programs.

Advocacy efforts should include recognition of the impact of the obesity epidemic, more effective anti-obesity legislation and policies, and more data-driven evaluation of new anti-obesity drugs by the FDA, the position statement said.

This is the part that scares the living daylights right out of me: Advocacy efforts should include recognition of the impact of the obesity epidemic, more effective anti-obesity legislation and policies. More effective anti-obesity legislation and policies. Just WTF does that mean? I’m sorry, the government has no business legislating against “obesity” or setting policies that do the same. It’s bad enough that governors, mayors, and state representatives think they have the right to tell people that they can’t buy certain drinks in sizes over 16 ounces, or that fat people aren’t allowed to eat in restaurants if their BMI is too high (thank Maude that one failed), or that fat people in general don’t have the same rights to equal pay/jobs/health care as their thinner peers. More legislation/policies against being fat that we don’t need, thank you very much.

AACE also says in the statement that framing obesity as a disease is “a paradigm shift that stands in stark contrast to the notion that obesity simply results from the personal tendency to overeat and engage in a sedentary lifestyle.” The idea that obesity is a disease and should be treated as much should not be overlooked, AACE said.

“Obesity has not been universally considered a ‘disease’ in multiple segments of society including government health policy, healthcare payers, popular media, and even in some medical circles,” Sebold told MedPage Today.

AACE said it hopes that treating obesity as a disease “will help mobilize society towards the importance of prevention and treatment, and enlist the aid of government, healthcare providers and payers.”

The problem with treating “obesity” as a disease is that fat people are then considered “diseased” and need to be “cured” of their “disease.” I’m sorry, I’m not “diseased,” I don’t need to be “cured,” and I sure don’t need to be told that by a doctor who isn’t going to prescribe anything other than more of the same old, same old. Sorry, been there done that, got the hat, t-shirt, poster, AND the key chain.

As for mobilizing popular media, don’t make me laugh (really, I’m crying here). Mobilizing the media? As if the fucking media isn’t mobilized enough already. You think we don’t see it enough, every day, that being fat is “bad”? As if the media doesn’t tell us already that being fat is going to “kill” us? As if the media doesn’t tell us that being fat is going to give us all these diseases and cost the country trillions of dollars and drag it into ruin? As if the media doesn’t, in one way or another, every fucking day of our fat lives, tell us that we’re disgusting blobs and we have no right to exist? And you want to mobilize them even more? Fuck you, AACE, fuck you.

I have a question for AACE: Do you really think mobilizing health care providers and payers is that great an idea? Do you really think more of the same, or even new tests and treatments, are going to “solve” the so-called “problem” of “obesity”? Throwing more tests and treatments at something you don’t fully understand, something you hate and fear, isn’t going to make it disappear. Fat people have been around for thousands of years, and there are reasons for that.

Get rid of all the fat people and you just might doom humanity to extinction.

10 Comments leave one →
  1. pyctsi permalink
    October 30, 2012 11:33 am

    The only plus side I can see is if this is properly implemented they might actually test for conditions that have weight gain as a side effect and look for causes so some conditions might be treated earlier, the downside of that being they might stop prescribing the appropriate medication for a condition because it might make you fatter. Given that the down side of the most hopeful scenario is lots of people getting inadequate treatment for on going conditions (gee, why does that seem familiar) it just seems like a whole lot of running to get to the same place, it looks good to the unaware but it’s really just expensive smoke and mirrors. Oh and if the press does mobilise it’s first target will be obesity costs even more with custom certificates – cue eat less move more comments from the idiot gallery.

  2. October 30, 2012 11:37 am

    What a load of bullcrap. I smell a scheme to just milk doctors for more money to get this certification, and a way for them to feel like they’re Doing Something about fat people.

    • vesta44 permalink
      October 30, 2012 12:10 pm

      Jen – That was what some of the doctors thought who commented on the original article – that it was just a way to milk them for more money for a certification that they will need to renew in perpetuity, and isn’t really going to teach them anything that they don’t already know.

  3. drpattiethomas permalink
    October 30, 2012 4:09 pm

    Translation: “But all the other doctors get to make money off fat people. We want our cut!”

  4. October 30, 2012 10:04 pm

    If obesity were a disease, then it would follow a predictable pathophysiology. If anything, obesity is a symptom, but what it’s a symptom of is the difficult part of being a physician. Someone who is fat and metabolically healthy is not diseased. Someone who suffers from diabetes, heart disease, liver disease, or any other correlate of obesity is not suffering from the disease of obesity. If anything, they are suffering from insulin resistance first and foremost. If you want to label something a disease, if you want to certify someone, then teach them how to identify insulin resistance without relying on some arbitrary diagnostic criteria. Or, better yet, certify them in HAES.


    • The Real Cie permalink
      October 31, 2012 6:05 pm

      Exactly. I have idiopathic hereditary hypertension that onset when I was 45 years old. This is actually a fairly common condition that does not discriminate by weight. I also have hypothyroidism, which tends to cause a tendency to have a heavier body type. The heavy body type itself is not the disease. The hypothyroidism is the disease.

  5. lifeonfats permalink
    October 31, 2012 8:58 am

    I wonder if any of this is being funded or supported by Allergen, or any of those companies who are making money off WLS and other weight-loss products and practices.

  6. The Real Cie permalink
    October 31, 2012 6:02 pm

    I’m just gonna go all Beavis and Butthead here for a minute and ask how the hell come it’s so hard for these fartknockers with degrees and letters behind their name to understand that CORRELATION IS NOT CAUSATION!!!
    There may be a common factor that contributes both to my being overweight and to the fact that I have hypertension. (Although given my family history, I doubt it. My late father was not overweight and his uncontrolled hypertension led to a stroke. My younger brother is not overweight, and his hypertension onset at age 19.) But just as an example, let’s say that my hypothyroidism leads both to a tendency to weight gain as well as to hypertension. Thus, the obesity, for lack of a better word, would not be “causing” the hypertension.

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