I’ve had cancer, and can tell you quite a bit about my own disease and my own lived experience of being a cancer patient. I can give you some useful tips about getting through the whole ordeal, and point out resources your doctor might not be aware of. But you’d be a fool to come to me for expert advice on how to treat your own disease.
I certainly can’t imagine lecturing readers of an international magazine on the correct way to cure cancer.
Yet this is what novelist Lionel Shriver did today when she published an opinion piece in Time, claiming that the best response to obesity was “personal responsibility”. She’s up in arms about the American Medical Association’s decision to categorise obesity as a disease.
The AMA decision has caused all sorts of debate, which I won’t go into here. But what Shriver is upset about is that calling obesity a disease lets people off the hook for their own choices.
But what does Shriver actually mean when she says that obesity is about personal responsibility? She’s specific that it’s all about will power:
Currently, there are no medical cures that improve upon will power.
As if that isn’t bad enough, dieting itself is a predictor of obesity. The more of it you do, the fatter you ultimately make yourself.
Does anybody manage to keep the weight off? Yes. Some people do. But they’re rare enough that they’re being intensively studied and so far the only conclusions that anybody have come to is that if you really want to keep large amounts of weight off (e.g. more than 5% to 10% of your starting weight), you have to behave like someone who is eating disordered. You have to treat your fat like a chronic condition and expend considerable time and effort managing it. And even that dedicated population finds it hard to reverse weight gain once it happens.
The medical literature on weight loss and weight maintenance is pretty grim reading, to be honest.
But what’s even more striking is how little is understood about fat and fat accumulation. It used to be believed that fat cells were a form of insulation, protecting you from temperature fluctuations, which could also be burned as fuel when required. It turns out that’s way too simple. Fat cells aren’t inert and play a role in the endocrine system. Just how big a role is only gradually being teased out.
I can understand where Lionel Shriver is coming from. Her brother was morbidly obese, and he died from the consequences. She’s been so affected by what happened that she’s even written a novel based on it, Big Brother. Her lived experience of being a sibling of someone with morbid obesity means she probably has interesting things to say about living with the condition.