Obesity as Disease and the Health Care Culture’s Take on Personal Responsibility and Suffering

Doug OlsenBy Doug Olsen, PhD, RN, associate professor, Michigan State University College of Nursing, and AJN contributing editor. Olsen regularly addresses topics related to nursing ethics. His most recent article for AJN was “Helping Patients Who Don’t Help Themselves” (July issue; free until August 15).

Why does the American Medical Association’s recognition of obesity as a disease (AMA, 2013) stir strong feelings? People are just as heavy as before, their health is suffering as much, and the therapies for obesity remain the same. The main difference is that the label may give clinicians a better rationale to seek reimbursement for obesity-related services, which might help increase treatment rates. No one yet knows if the new label will really have an effect on treatment rates; in any case, this is not what people are concerned about.

The issue is what labeling a health problem with a behavioral component as a “disease” implies about personal responsibility—or what people think it means. How does personal responsibility relate to individual suffering?

The relationship between decision making, suffering, and personal responsibility is at the heart of bioethics as it is practiced in the United States. But bioethics didn’t invent our cultural tendency to connect personal responsibility and sympathetic regard for suffering, and our current approach to the issue was developed through […]

2017-04-03T12:12:36-04:00July 11th, 2013|Ethics, patient engagement, Public health|0 Comments
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Web Pickings: 2013 Predictions, Good Fat, Mammograms, Moderation, Nurse Wisdom, More

By Jacob Molyneux, senior editor

Cartoon showing baby representing New Year 1905 chasing old man 1904 into history/ Wikipedia Cartoon showing baby representing New Year 1905 chasing old man 1904 into history/ Wikipedia

Ah, another new year starts (not 1905, despite the illustration) and received wisdom is overturned. Sort of. Consider the widely reported news that a JAMA study has found that being overweight doesn’t seem to increase your risk of dying, or, as the Kaiser Health News headline puts it, “A Little Extra Fat Could Be Protective.”

Many news summaries do point out that severely obese people had a higher risk of dying than did people of normal weight. What the study does and does not mean is being debated, with some pointing out that the study didn’t look at whether being overweight increased consumption of health care resources, number of prescribed medications, etc. We’re sure to hear more on this.

To continue with the theme of questioning long-term assumptions, NPR’s story “Breast Cancer: What We Learned in 2012” gives a nice summary of updated guidelines for who should and shouldn’t get mammograms, including pro and con arguments, the latest research, and so on.

Some pretty cynical journalism can be found in an opinion piece in the Palm Beach (Fl.) Post, which suggests that Hillary Clinton’s blood clot is a hoax.

A New York Times piece, in giving a tidy summary of important exercise-related research from the […]

2016-11-21T13:08:38-05:00January 2nd, 2013|nursing perspective|0 Comments
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Gym Class, or Physical Education?

Photo by Krossbow, via Flickr

By Michael Fergenson, AJN senior editorial coordinator

Gym class. Some of us may have memories of a brusque man tossing a ball into the middle of the gym, telling us to play and occasionally blowing a whistle. Popular culture certainly portrays the “gym teacher” in this way—or worse, sometimes they’re cast as the villain. I put gym teacher in quotes in the last sentence because my dad would get angry with me if he heard that term, or “gym class” for that matter. My father considers himself a physical educator. When people call him a gym teacher, which is most of the time, he replies with the quip: “The gymnasium is the room that I teach in, but I am a physical education teacher.”

There’s something more important going on here than mere semantics. Is this pop cultural view of the gym teacher causing harm to students? I believe so.

My father has been a physical educator for a little more than 20 years. For a long time I had the same negative view of gym teachers as most people. That was until I began to study education myself. I definitely wasn’t going to be a gym teacher—oh no, it was literature for me. I would be a high school English teacher, but […]

2016-11-21T13:10:03-05:00May 23rd, 2012|Nursing, personal health practices|3 Comments
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Sarcopenia and Me – Or Why Exercise Really Matters as We Age

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Recently I started an exercise program with a personal trainer. I’ve been a runner for 25 years, even ran five marathons. I’ve never had a problem being disciplined about running four or five days a week, no matter what the weather. But I’ve never been able to stick to any other exercise program for more than a week or so. Working with weights, yoga, step classes, just doing push-ups in my living room when I get back from a run—never stuck with any of them.

Getting older isn’t kind to those who don’t exercise. Years ago my lack of upper-body fitness was hardly noticeable. Shoveling snow, raking leaves, playing racquetball, carrying my kids around, all of it kept me in good enough shape. That’s not the case now that I’m in my fifties. Lifting my grandson above my head—not happening. Hanging a new shower curtain – three clips – rest – three clips – rest…

When I found I couldn’t blow-dry my very short hair without lowering my arm repeatedly because of muscle fatigue, it was time to do something about it.  That’s when I decided to invest in a personal trainer. It was expensive—but I figured I would just do it long enough to make exercise, other than running, […]

2016-11-21T13:11:13-05:00December 7th, 2011|nursing perspective, personal health practices|3 Comments
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Health Care Reform Must Target Hospitals, Physicians Who Push Expensive Treatments Over Prevention

But the cost of the hospitalization alone for an uncomplicated bariatric surgery is now about $28,000. That goes up to over $38,000 if complications arise—and almost $70,000 if the patient has to be readmitted. Now, what if a patient decides he'd like to go to a nutritionist every week for several years to gradually lose the weight and change his eating habits permanently? Let's say that the cost of seeing a nutritionist is $100 per visit—that's just over $15,000, but who's paying to put up signs advertising a hospital's nutritional service for weight loss ?

2016-11-21T13:22:38-05:00September 10th, 2009|health care policy|3 Comments
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