Dear DOCTOR Owen:

I have a friend who is very overweight—by perhaps 75 pounds or more. She swears that she feels fine and that her obesity is not a problem. I find this hard to believe because I feel miserable when I gain 15 pounds. Do you think she is lying?

Fat and Happy

Dear “Happy”:

Your question is valid. Is obesity a disease or a risk factor for disease? Does everybody who fits into a category of risk, relative to weight, have problems? The answer is “no”! To be honest, there is no definition of “obese” that most scientists can agree upon. People have been categorized into groups, based on their risk tendencies. But, people must be viewed individually for specific problems or risks, relative to their health.

The first question I ask a new patient is: “Why are you here?” The answer is usually the same: “To lose weight. “ Next, I ask, “How does your weight bother you?” Answers may be as simple as “rejection” at home, socially, at work; or they may be as complex as “14 medical problems being treated with 15 medications/day.” (My record: someone who takes 26 medications/day.)

As a physician, it is my job to help patients identify their illnesses, pinpoint physical risk and liability, and spot early disease. In the case of a patient with a complex medication regimen, it is my job to determine:

• How to attack each of the problems and in what order.
• The most serious problems.
• The problems of most concern to the patient.
• Pain—e.g., joint- and spine-related—that patients are unaware of because they have tolerated it for a long time.

Rarely, on close examination, do I see someone who is “perfect”—not at risk and needs to lose only a few pounds.

An article in Obesity Research, Vol. 8, No. 2, 160–170, reports on researchers at the University of Oxford (England) and the British Heart Foundation Health Promotion Research Group, who evaluated a random sampling of people’s views of their own health, disabilities, and well-being. The researchers concentrated primarily on physical well-being, as emotional health is subjective and can involve many variables. They used the Body Mass Index (BMI) as their measurement of choice. This is the first measurement of body size associated with various forms of risk (see BMI discussion in “Measurements of Obesity” in this chapter). According to the researchers, 31% of those surveyed were overweight (BMI of 25–30) and 11% were obese (BMI above 30).

The study results were not surprising to me. People in the higher categories (BMI above 30) reported many more visits to their physicians—more than twice as many. The researchers found that physical deterioration was more substantial in the obese (BMI above 30) group. Most interesting to me was the finding that even those surveyed—who listed themselves as “healthy” and having no active medical problems—scored much lower on the physical impairment survey questions. All of these obese subjects were compromised in some manner compared to the lean subjects—even though all the obese individuals did not perceive it. My “take” on this is that the obese people really did become accustomed to their disabilities—to whatever degree.

A vast majority of patients do not know what is wrong with them—which is why they go to doctors. Something as simple as “tiredness” could be due to serious, diverse medical conditions such as sleep apnea, anemia, depression, hypothyroidism, or even liver disease.

I suspect that your friend is similar to the patients I describe in this column. She may have accepted minor problems as “normal” and not needing medical attention. They will likely get worse, but she’ll address them when it is too late for beneficial medical help. That is why I do what I do. I have spent the first part of my career helping the sick “tread water” until they died. Now I can help people live—really live.