Disabilesity ~ Part I: Intro and My Own Journey

This post was inspired by my own "journey" through what I'm going to call disabilesity.  It got insanely long and cumbersome, so I'll break it up into parts:

  • Intro and My Own Journey of Disabilesity
  • The Forgotten Disabilesity Epidemic
  • How the Obesity Industrial Complex does a disservice to those at risk or suffering from Disabilesity

It has been my observation for a while now that various interests I shall refer to collectively as the Obesity Industrial Complex, are only marginally interested in *fixing* any problems attributable to the obesity epidemic in affluent countries.  Instead, for various reasons and in varying ways, the different factions seem more intent on maintaining some level of the status quo for profit, relevance, notoriety or some combination of the above.

Due to the close link between Type 2 Diabetes and obesity, the term diabesity has made it into the scientific literature and everyday vernacular, and has even been trademarked.  Indeed it seems that the main medical focus for treating obesity has shifted to one of containment of the metabolic dysfunctions associated with it.  In a recent editorial in their Obesity journal, the editors, Eric Ravussin and Donna Ryan wrote a list of conclusions on their defeatist view of obesity treatments.  
5.  For persons with overweight or obesity seeking definitive improvements in their metabolic health, a weight loss of 5%, 10%, or 15% is recommended (3). With this smaller degree of weight loss, patients are unlikely to experience the extreme calorie handicaps that lead to weight regain that were observed in “Biggest Loser” contestants. Instead, they might see only a small deficit in RMR of 50 to 150 kcal/day.
6. Since moderate and realistic weight loss recommendations yield important health benefits, the focus should now shift from striving for dramatic amounts of weight loss toward achieving moderate weight loss with a stronger emphasis on weight loss maintenance. ...
The medical establishment concedes it is utterly inept in treating the "disease" they have now created.  So now we will be treated to all manner of rhetoric on "managing obesity".  Reading the above, the *health* goal is no longer achieving a normal weight, or even a slightly elevated weight.  Rather, it is to lose just enough to bring the blood-work in line with nominal health.  The goal now being to stave off metabolic diseases, but ignoring almost entirely the other negative consequences of obesity.

As I went to edit this post my attention was drawn to yet another article on the topic.
Unlike other life successes — earning a postgraduate degree, for example, starting a family or buying and renovating a dream house — weight loss is not a permanent state, says Dr. Valerie Taylor, chief of psychiatry at Women’s College Hospital in Toronto.
“Weight loss is something that, if you don’t stay on top of it, you can absolutely backslide. That can become psychologically challenging.”
Rather than set big, far-reaching goals, such as losing 20 pounds in four weeks, Taylor advises patients to focus on small, obtainable goals, such as walking 10 minutes a day, ballroom dancing on Friday nights or losing enough weight so a seatbelt extender isn’t necessary for airplane travel.
“People build on successes. They don’t like to build on failures.”
Losing enough so as not to need a seatbelt extender??    I get the idea of setting smaller goals.  I don't think I ever needed the extender, but I was getting close at one point in my life.  When faced with losing a large amount of weight, we all have to start somewhere and it is extremely daunting.   I'm so thankful that, like Elia in the article, I "did it alone" beginning a decade ago ... and I'm so thankful we didn't have the mangled scientific evidence fueling the defeatist rhetoric from the "experts" back then.  I'd likely still be severely obese.

Moving the goal line into that "still morbidly obese" category when talking about obesity as an incurable chronic disease just makes no sense.  It's being portrayed as darned near impossible to lose and keep off weight which is translating into an acceptance of the medically unacceptable. 

You can't have it both ways scaremongering over the health and societal costs of a disease.  It's as if a football team can't even get to midfield, so they celebrate success when their quarterback gets sacked on their own 20 yard line.  After all, at least he wasn't in his own end zone!!??!!    Forget even trying to get the ball across mid field!    

I have not seen any evidence that the "definitive improvements" (metabolic)  observed in short-term weight loss trials will even persist through, say, six months of maintenance.  In most cases, we're still talking about improvements of risk on paper, and not manifest disease.   This person's lipids and blood glucose may improve with 10% weight loss, but little else is likely to change.  Sure, any significant weight loss may alter how energetic one feels and will improve mobility somewhat, but at the end of the day, getting 20% of the way "there" will not reap folks the full physical and psychological rewards of a more complete success reversing obesity.   Furthermore, this dragging of the goal posts to the other side of the field completely ignores the other negative consequences of obesity:  physical ability.     Human beings were not designed to carry around 100 extra pounds of weight with every step, bend and reach.  If you lose 20 of those pounds, that's still 80 extra pounds that you're loading onto your bones and joints, and supporting with your heart, liver, kidneys, etc.    Health is more than bloodwork.  

The Continuum of Physical Ability and Disability

If we get anything from the endless video footage of obese people in the near daily news stories, it's an appreciation of how obesity, at some point, alters nearly everything.  Nevermind the basic aesthetics.   That is not what I'm talking about.   I am talking about gait and movement and what's involved in doing everyday activities.   This is something for which there is no hard cut-off.  That middle-aged spread?  Dad bod?   It's something that didn't happen overnight.  The person adjusts ever so slightly along the way ... they don't notice these changes, these ways they adjust to and accommodate increasing weight and size.   At what point they began to waddle more than walk, have the thighs rub together, or knees seem to "collapse" inward, pelvis tilts forward with a hanging belly, inability to cross ones legs, etc.  That point when they go from opting for elevator over stairs to being unable to take the stairs.  This is different for different people, how that person distributes and carries their weight, any predisposition or pre-existing minor impairment that becomes amplified, etc.    Watch a young generally fit (not necessarily an athlete) person go up or down a flight of stairs, now watch an overweight or obese person do the same (or perhaps pay attention to how you move).

When movement becomes even slightly impaired, or even slightly discomforting, this impairs all that NEAT stuff subconsciously.  The obese stand less, walk less, move less.  This can be a very vicious cycle.  Furthermore not only are the joints and such bearing extra weight, they are often loaded in unbalanced ways that can turn 5 lbs into many more, never mind at higher impacts.  Watch even trained elite runners when they fatigue, the announcers will be quick to remark on the flagging form.  What do you think happens when an overweight or obese person gets out of breath and fatigues from short bouts of everyday activity?

So what I'm getting at here is that while many overweight and obese would not qualify as technically disabled, it's not a black and white situation, there are any manner of gray areas along the continuum.

One does not need to be "technically disabled" for impaired ability to negatively impact overall quality of life ... virtually every aspect.  

Unlike metabolic impairment, physical impairment along a continuum is near-impossible to measure or quantify.  How do you put a number to something as seemingly minor as being uncomfortable sitting in a chair?  It's far easier to measure metabolic parameters and attach at least risk factors to those measurements if not outright indicators of disease.   How does chronic discomfort to the tune of #1 on the pain scale translate?

If you have ANY pre-existing physical issue, excess weight can only make it worse.  It may not.  It may not do so in acutely perceptible fashion.  One thing for sure, however, is that excess weight will never benefit this aspect of your health.

I will repeat this!

My Personal Story ~ My Struggle with Disabilesity

I'll begin at the end ...  Twelve weeks ago today, I had a total hip replacement done on my left hip.  I am eternally grateful that my surgeon does the anterior-approach (newer, less invasive), AND more importantly that because of my reduced weight I was a candidate.    The hip issue was a relatively new thing, and didn't really bother me until a twinge or few towards the end of the Summer in 2016.  It didn't become an obvious issue of its own until December, and really accelerated to the point of unable-to-sleep-constant-pain in January.    My opposing hip is completely healthy and there's a strong genetic tendency on Mom's side for joint issues.  It's fair to say that obesity didn't cause my bad hip.  I would also be kidding myself, however, if I didn't acknowledge that years of obesity certainly played a role in its deterioration by my early 50s instead of decades later.   I can't change that now ... I could have likely forestalled it.

I cringe at the thought of had that hip given out just one year earlier.   I don't even want to think of my prognosis had I still been at my 2007 weight.   In my recovery I've come to recognize that I was surely compensating for the hip for quite some time, if perhaps the arthritis/injury to my opposing ankle took precedence in the pain department.    In any case, I returned to work within a week, and was walking without any mobility aids within 2 weeks.  I don't want to sugar coat it, I had a set back after that (nerve related, the anterior surgery stretches a nerve and I still have surface numbness I was warned of in advance, and that may never resolve -- don't "roll out" this shiz!) and out of an abundance of caution I used wheelchair service through the airports when traveling a month later.    But all in all my recovery has been great.   In fact, the focus is already on trying to fix what can be done for my ankle and rehabilitating that joint and there are days where I find myself forgetting I even have a bad hip.  I just finished a short summer semester teaching virtually 6 hours straight (15 min between classes) for 4 days a week, while doing pretty much all of the chores as my husband needed surgery of his own and was in bad shape prior.  I cannot be more proud of my smaller body, and aesthetics has zero to do with that!!

Speaking of the ankle.  That too, was likely not caused by obesity, but I'd be kidding myself even more if I were to ignore the role of added weight there.  I injured it somewhat several years ago, that came and went, but when I regained some weight I found myself nearly disabled by it in the Fall of 2015.  What began as a come-and-go nuisance of occasional pain and flares of swelling deteriorated to a state of near constant pain and swelling in the Fall of 2015.   Then, in the company of my 80-ish parents and aunts and an uncle in his 90s, I realized I was LESS able than them!   I dreaded the upcoming winter heating season ... how was I going to heat the house with firewood when I could barely walk?  Shovel?  Etc.??   We have no kids.  I am supposed to be here to help as my own parents age.   What if they needed help?

More than anything, 

I did not want to be disabled by my weight. 

For the foreseeable future (my husband is currently recuperating from his own ankle surgery -- due to an unfortunate run-in with a pineapple cart in the grocery -- a surgery that had been put on hold for my hip surgery ... we make quite a pair huh?) the best and only thing I can do for my ankle is keep my weight down.  Being some 65 lbs lighter today than then has been huge.  Until the hip began bothering me, I had good times when I could walk normally, but I still had flares.  But post hip surgery?  No WAY I could have rehabbed my hip on that bad ankle at a higher weight.  JUST. NO. WAY.

So as you can see, this is personal.  Five years ago I felt invincible.  I was super-healthy-obese.  Splitting stacks of wood ... feeling younger than in my thirties.    Feeling more capable in one's forties than they did in their thirties is a powerful "convincing agent" of future invincibility.  But I think even had I not regained some, I still would have realized the consequences of too-high-a-weight-for-my-skeleton at some point.

This is why I'm speaking out more of late.  Not to berate or belittle, but to raise awareness.

Peace out till next installment.