Originally Posted by cloudatlas
It's strange to see something that is a compulsion being described as a disease.
A compulsion can be a disease. We are conditioned by society to separate mental health from physical health but when we are sad our eyes produce tears and when we are nervous we sweat or feel nausea. The brain is part of the body, so if it contributes to obesity that doesn't make it less of a disease.
There is no denying that obesity has serious effects on health. The causes of obesity vary from one person to the next and the reason is rarely (if ever) a lack of willpower. That is a myth that we have all bought into without examining the evidence.
It is also a myth that we always need to treat problems in the brain through therapy or some other non-medical method. Some people need anti-depressants and it changes their lives. Some people get dementia and the anti-dementia drugs help them to live much better lives. Bariatric surgery may be done on the stomach but the evidence is that it causes a reset in the hunger centres of the brain, so it is doing much more than changing the physical act of eating.
There is a tipping point when someone goes from overweight to obese. Physical activity becomes more difficult, muscle mass decreases, and then you have the background natural changes that affect our metabolism as we age - for example, it is much more difficulty to build and maintain muscle in our 50s than in our 30s. Muscle mass is key as muscle burns more calories so if you are more muscular you can eat more.
A friend of mine who has always been slim made some really good points about this when I asked her opinion on the surgery. She said it is so hard for average weight people to lose even 1 or 2kg. Why? Surely people should just be able to eat a bit less? The answer is that our brains and our various endocrine (hormone) systems decide for us whether we are hungry and whether we are the right weight. If people are a little bit overweight, losing the few kilos can be hard - if people are obese then it can be almost impossible by "willpower" alone.
If we try to cut calories, our bodies can ramp up the hunger signal until we are overwhelmed and give in. For some people, that system is perfectly balanced and they have a modest appetite that they can easily control. For others, the system is off kilter and even when they eat an adequate amount their brain and body insist that they are still hungry.
If I break my hip, I will not just be able to overcome the pain by willpower alone. I will need painkillers and an operation to fix it. When I was obese, it was taking a huge amount of my mental energy to eat less and I was frazzled by all of the other things life required of me. The surgery removed a huge amount of that mental strain and can now focus better on family, work, etc. It also allowed me to exercise more, so I now have more muscle mass to burn off calories and help me to control my weight.