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Sample Critique Paper of a Controversial Issue in Healthcare: Obesity’s Disease Status

Abstract

This paper aims to compare arguments for and against obesity’s designation as a disease, as a controversial issue in nursing and healthcare, and assess the relevance of this issue in the nursing profession and healthcare practice. The paper utilizes relevant viewpoints and facts from credible resources in this analysis. The analysis demonstrates that obesity fulfills most of the criteria for disease status, including its nature as a condition of the body, its result from genetic, environmental, and nutritional/dietary factors, its characterization by identifiable and marked symptoms/signs, and its influence of deviant bodily structure and functioning. The only criteria that obesity does not satisfy in this regard are those of diagnosis and definition. The paper concludes that the status of obesity as a disease is largely valid and highly beneficial since it allows public health stakeholders to alleviate its burden on healthcare resources and human health and wellbeing proactively through structured resource allocation.

 

Critique of a Controversial Issue in Healthcare: Obesity’s Disease Status

One controversial issue in healthcare and the nursing profession is obesity. In particular, the controversy about obesity in a nursing context is its status as a disease. In June 2013, the American Medical Association’s House of Delegates acquiesced to the activism of medical societies and stakeholders and voted to recognize obesity as a disease state that required the concerted action of society and its public health resources to treat and prevent it. This recognition is highly significant because of the American Medical Association’s huge influence on health policy and its renowned philosophy of adhering to science in its decision processes. Nonetheless, some experts have criticized this status of obesity based on perspectives, such as its definition and diagnosis. The following analysis compares arguments for and against the controversial status of obesity as a disease, before assessing the relevance of the issue in healthcare practice and the nursing profession. The main point in the analysis is that the role of obesity as a major risk factor for chronic diseases/conditions with a heavy and long-term burden on healthcare resources and human health and wellbeing makes its disease status highly beneficial. This status presents public health stakeholders with a strong opportunity to alleviate this burden through proactive and structured resource allocation to relevant healthcare policy plans and strategies.

Arguments for and against Obesity’s Disease Status

In order to understand the controversy of designating obesity as a disease, it is essential to understand the definition of a disease. There is no single widely accepted definition of a disease, but it generally involves a deviation from usual or average functioning in a living thing’s body or an organ in the body. The Merriam-Webster dictionary (2020) defines a disease as a condition that impairs normal functioning in a living animal or plant, or in a part of its body, and usually manifests in distinguishing symptoms and signs. Disease is essentially the opposite of health, which the World Health Organization (WHO) defines as a state of complete social, physical, and mental wellbeing, rather than merely the absence of infirmity or disease (De Lorenzo, 2019). Rosen (2014) notes the definition of disease in terms of its nature as a condition of the body or its part, its result from infections, parasites, or genetic, environmental, nutritional/dietary, or other causes, its characterization by identifiable and marked symptoms/signs, and its deviation from normal function or structure (impairment, disturbance, interruption, or disorder of organ/body functioning). The implication of these definitions is that disease is an important undermining factor (though not the only one) in wellbeing, such that its occurrence contributes to a lower level of wellbeing that is diagnosable through identifiable symptoms. It is a pathological process that influences some deviation from a biological norm.

For the designation of obesity as a disease to be logical, the condition has to fulfill the criteria identified in the definitions above. Nonetheless, it is also essential to note the significance of a lack of a single widely accepted definition of disease in reasoning for the designation of obesity as a disease. Obesity, by definition, describes the accumulation of adipose tissue (fat) in the body of an individual to the extent that poses significant challenges for human health and wellbeing. Obesity is a significant risk factor for various chronic diseases whose long-term management is a heavy burden on both individual patients’ health and wellbeing and public healthcare resources. Feingold et al. (2018) note findings in the research that obesity has a significant role in increasing the risks of development of disorders, such as type 2 diabetes, osteoarthritis, and cardiovascular disease. At the same time, obesity has significant adverse effects on the emotional and psychological wellbeing of individuals. It affects individuals’ self-esteem, self-confidence, and participation in social activities due to issues such as stigmatization, depression, and social exclusion (WHO, 2020). The primary cause of obesity is an imbalance in the calories that individuals consume from food and drinks and those that they expend in daily activities and work. Genetic factors have an important influence on metabolism, and hence on the development of obesity, but obesity is also the outcome of a complex interplay among factors in society, including food culture, sociocultural influences on individuals’ decisions, commercial influences, and psychological factors (Mozaffarian et al., 2018). This assessment shows that obesity fulfills most of the criteria for a disease, including its nature as a condition of the body, its result from genetic, environmental, and/or nutritional/dietary factors, its characterization by identifiable and marked symptoms/signs, and its influence of deviant bodily structure and functioning.

Proponents have argued that rather than being only a condition that underpins major chronic diseases, obesity is a serious debilitating disease in its own right. Obesity is a disease because of its basis on the pathologic build-up of adipose tissue (fat) that causes disturbances to the functioning of the human body and its organs (De Lorenzo, 2019). Obesity influences adverse immune and endocrine responses that cause and/or worsen metabolic impairments. Obesity’s status as a primary disease is evident in the fact that it promotes adisopathy ("sick fat" or adipose tissue dysfunction) and the dysregulation of metabolic mechanisms in the human body, thereby contributing to hypertension, atherosclerosis, type II diabetes, dyslipidemia, and hyperandrogenemia and hyperestrogenemia in men and women, respectively (De Lorenzo, 2019). These effects of obesity fulfill the criteria for disease.

Critics argue that the definition of obesity as a disease is invalid because of difficulties in its definition and diagnosis, which are important elements of a disease state. Muller and Geisler (2017) observe that the use of body mass index (BMI) scores to define and “diagnose” obesity is an invalid method because of the limitations of assessing fat mass and measuring disturbances relating to overweight and obesity. The “healthy” range of BMI scores (between 18.5 and 25kg/m2), which researchers associate with the lowest rates of mortality, is subject to variations by ethnicity, age, and the occurrence of chronic diseases (Muller & Geisler, 2017). Critics argue that the definition of obesity based on statistical criteria that have no biological meaning undermines the status of obesity as a disease. They argue that BMI is only a score, rather than an objective measurement of fat mass or related disturbances. It is also biologically unsound and does not reflect a phenotype that is open to study. Muller and Geisler (2017) note further that some research has shown significant variances in the association between BMI and either visceral adipose tissue or subcutaneous adipose tissue from one person to another. These problems in the definition and diagnosis of obesity undermine the validity of its designation as a disease.

Relevance in Nursing and Healthcare Practice

The designation of obesity as a disease is relevant to nursing and healthcare practice because of the influence of this status on the allocation of healthcare resources to address obesity and its complications. As discussed above, obesity is an important risk factor for common chronic conditions and diseases that require a long-term commitment of healthcare resources in their treatment and management, such as diabetes, hypertension, and cardiovascular disease. The designation of obesity as a disease influences urgency and structure in the allocation of healthcare resources for more proactive health policy interventions against it (and hence against these chronic diseases). This influence is essential because it enforces a proactive capacity in healthcare and nursing practice to confront and address obesity and its role as a risk factor for various chronic diseases in local communities. It allows nursing and healthcare practice to play their roles in the prevention of disease and contributions to public health and wellbeing more effectively.

Own Position

My position is that the designation of obesity as a disease is valid and appropriate despite problems in its definition and diagnosis because of the relatively more benefits than demerits that such designation presents in public health. Obesity fulfills most of the essential criteria for a disease, with only diagnosis and definition being the problem criteria. The disease status allows public health stakeholders, including nursing, healthcare, the government, and society, to adopt a proactive approach towards the management of obesity and chronic diseases/conditions for which it is a major risk factor. This approach yields benefits in terms of healthcare resource savings and a more effective promotion of the health and wellbeing of local communities.

Conclusion

The analysis above illustrates that obesity’s disease status is largely valid and highly beneficial. Despite the problems of definition and diagnosis, obesity’s disease status provides public health stakeholders with a strong opportunity to confront and resolve its role as a risk factor for major chronic diseases/conditions with a heavy and long-term burden on healthcare resources and human health and wellbeing. Do you not agree that the choice to designate obesity as a disease is reasonable action to empower public health stakeholders to structure proactive and efficient initiatives to alleviate its burden on society and healthcare resources?

 

References

De Lorenzo, A., Graterri, S., Gualtieri, P., Cammarano, A., Bertucci, P., & Di Renzo, L. (2019). Why primary obesity is a disease? Journal of Translational Medicine 17: 169. 1-13.

Feingold, K., Anawalt, B., Boyce, A., et al. (2018). Clinical problems caused by obesity. South Dartmouth, MA: MD Text.com Inc. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK278973/

Merriam-Webster (2020). Disease. Merriam-Webster dictionary. Retrieved from: https://www.merriam-webster.com/dictionary/disease

Mozaffarian, D., Angell, s., Lang, T., & Rivera, J. (2018). Role of government policy in nutrition - barriers to and opportunities for healthier eating. The BMJ 361: k2426. Retrieved from: https://www.bmj.com/content/bmj/361/bmj.k2426.full.pdf

Muller, M., & Geisler, C. (2017). Defining obesity as a disease. European Journal of Clinical Nutrition 71: 1256–1258

Rosen, H. (2014). Is obesity a disease or a behavior abnormality? Did the AMA get it right? Missouri Medicine 111(2): 104-108.

World Health Organization (WHO) (2020). Obesity and Overweight. WHO Fact Sheet. Retrieved from: http://www.who.int/mediacentre/factsheets/fs311/en/

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