Is Obesity a Disease?
Is having a big gut a form of disease? The answer could affect health care policies.
Michael Marin Self-Poisons in Courtroom
July 3, 2012 --
Shortly after hearing a guilty verdict while on trial for setting fire to his Phoenix mansion in an effort to get out of his mortgage, former Wall Street trader Michael Marin shocked the courtroom by collapsing and dying in a suspected suicide. Video of Marin suggests he swallowed what media reports are speculating to be a poison pill. Within minutes of swallowing the pill, Marin goes into convulsions and later he's pronounced dead. Whatever Marin succumbed to needed little time to take full effect if the video of the courtroom drama does in fact detail the 53-year-old swallowing the poison that killed him. In this slideshow, take a look at some of the most dangerous poisons known to man.
Amatoxins The mushroom in this photo may not seem as terrifying as its nickname would imply. But a single ounce of this "death cap," which unfortunately can resemble its more edible cousins, is enough to kill a human being. Amatoxins, the poison found in this fungus, is what's behind this mushroom's deadly kick. They can severely damage liver and kidneys, and lead to coma, organ failure and more.
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Anthrax Anthrax was a bacteria that was all but off the radar thanks to decades of vaccination and sterilization programs aimed at containing infection rates. Then in 2001, anthrax became headline news when a series of attacks through the United States Postal Service killed five and sickened 17, according to the Federal Bureau of Investigation. Anthrax spores can spread through the air and can infect a person or animal by coming into contact with a wound on the skin, by being inhaled by the host, or by being ingested in the form of tainted meat. Symptoms of anthrax infection depend on the method of exposure, but typically resemble the common flu. Inhaling anthrax is the most dangerous means of exposure and can be fatal up to 90 percent of the time.
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Botulinum Given that there are many poisons that can be lethal in small doses, pinning down the most dangerous can be considered a somewhat objective exercise. But toxicology experts all seem to agree that botulinum toxin, the same stuff that's used in Botox injections to clear up wrinkles, takes the cake. Botulinum, which causes botulism as the name implies, can cause respiratory failure, neurological damage and more at its worst. The bacteria can enter the body through open wounds or by being ingested in food.
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Cyanide If there's one toxin that has almost become a synonym for poison, it's cyanide. Cyanide can come in the form of a crystal or colorless gas that's been described as having a "bitter almond" smell, according to the Centers for Disease Control and prevention. Cyanide also happens to be everywhere: It's naturally occurring in some foods and plants. It's in cigarettes. Cyanide is used to manufacture plastics, develop photographs, remove gold from ore, and of course kill unwanted insects, among other applications. Cyanide exposure can come from inhalation, ingestion or even touch. Poisoning from cyanide can lead to convulsions, respiratory failure and death in extreme cases.
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Mercury As described by the National Institutes of Health, there are three forms of mercury that can be potentially deadly: elemental mercury, inorganic mercury and organic mercury. Elemental mercury, which is what you find in glass thermometers, older dental fillings and florescent light bulbs, is harmless to the touch, but can be fatal if inhaled. Even if the person exposed survives, poisoning can still lead to long-term or even permanent lung and brain damage. Inorganic mercury, which is used to make batteries, can be deadly when ingested, and lead to kidney damage and worse. Organic mercury, found in fish, can be inhaled or ingested, and usually only affects those exposed over the long term, except in rare cases. Symptoms can range from memory loss to blindness to seizures and more.
Ricin Derived from castor beans, ricin is a naturally occurring poison, and humans can be exposed to it in the air, food or water, according to the CDC. Although the symptoms can vary depending on the method of exposure, ricin works by preventing cells from creating proteins they need to survive. Eventually, these cells die off, which can lead to organ failure.
Sarin Unlike all of the other entries on this list so far, Sarin is a synthetic toxin manufactured as a nerve agent. As explained by the CDC, sarin was originally developed as a pesticide, but this odorless, clear gas quickly became a tool for chemical warfare. Sarin can be inhaled or exposure can come through contact with the eyes or skin. The most recent use of sarin gas was in a series of terrorist attacks in 1994 and 1995 in Matsumoto and Tokyo, Japan, respectively, causing 20 deaths and injuring some 1,600 others. Symptoms from sarin gas exposure include blurred vision, convulsions, respiratory failure and more.
Strychnine Derived from the Strychnos nux-vomica tree native to India and southeast Asia, pure strychnine comes in the form of a white, bitter powder that can be deadly when inhaled, injected or ingested. Although commonly used as a pesticide, it has also surfaced in illegal drugs such as heroin and cocaine, according to the CDC. Strychnine poisoning can lead to muscle spasms, respiratory failure and even brain death within 30 minutes of exposure.
Tetrodotoxin Pufferfish may not seem like particularly dastardly animals based on their appearance alone, but they harbor one of the most deadly poisons known to man. Found in the skin, liver, intestines and other organs of the pufferfish, tetrodotoxin can cause paralysis, convulsions, mental impairment and more to anyone who eats this fish, at least when it's been served improperly. Although only a handful of cases are ever reported in the United States, there are as many as 200 cases annually of tetrodotoxin poisoning in Japan, with a 50 percent mortality rate, according to the Food and Drug Administration (FDA).
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- Obesity puts people at risk for Type 2 diabetes, hypertension, heart disease and even some cancers.
- Scientists don't agree on whether obesity is a disease, itself, although research is suggesting it may qualify.
- The verdict could affect what health care providers cover.
With more than one-third of U.S. adults struggling to keep off the pounds, obesity has left its mark on Americans' waistlines and wallets.
Yet when the Institute of Medicine released its recommendations for essential health benefits to include in the Patient Protection and Affordable Care Act recently, the term obesity was nowhere in sight. The report helps Congress dictate what health insurance companies should cover when the act goes into effect.
Obesity didn't make the cut.
Ambiguity surrounding the condition's causes and a lack of evidence-based medical treatments are likely to blame. But given what researchers know -- and the costs associated with the condition -- should obesity be considered a disease? Should it gain some health care coverage from insurers?
A growing number of researchers think so.
Typical definitions of disease include a change in a person's body that negatively affects its structure and function. Obesity not only causes structural changes in a person's fat tissue, but it also dictates how the body handles lipids, insulin and blood sugar. As a result, fat exists where it's not normally found in muscle, liver, cardiac tissue and the pancreas, interfering with organs' ability to work properly.
Jyme Schafer, director of medical and surgical services at the Office of Clinical Standards and Quality for the Centers for Medicare and Medicaid Services, told Discovery News that when it comes to providing health coverage for the Medicare population, the centers aren't in the position to view obesity as a stand-alone disease. Instead, the focus is on reducing obesity's role in other health problems.
"We recognize that [relieving obesity] improves health outcomes," Schafer said. "And that's the bottom line."
Currently, Medicare may cover weight loss surgery for some patients with obesity diagnosed alongside conditions such as Type 2 diabetes, and the centers plan to introduce a program focusing on ways to target obesity with behavior. The surgery remains one of the few interventions that insurance companies may cover, even for other people not on Medicare, though policies can vary by state.
Is having a big gut a form of disease? The answer could affect health care policies.iStockPhoto
Rather than being worthy of coverage in its own right, obesity often gets consideration only when it coincides with other conditions.
Despite the debate surrounding obesity's label, genetic studies look deeper than the "calories in, calories out" mantra.
"The evidence is very clear there is a genetic component to the risk of becoming obese," said Claude Bouchard, a professor and researcher in genetics and nutrition at the Pennington Biomedical Research Center in Baton Rouge, La. "And this genetic component is stronger for severe obesity than it is for milder forms of obesity or being overweight."
Years of family and twin studies have singled out 32 genes influential to obesity. But the condition usually isn't a "one-gene affair," he said. Because people receive two variants of genes -- one from mom and another from dad, that leaves 64 possibilities for a genetic predisposition to obesity.
But there are a few exceptions, mostly extreme cases of the health problem, where no matter what people do or eat, they become obese. This can be attributed to a single genetic mutation, Bouchard said. A similar phenomenon has been observed in other animals, including primates and rodents, despite individuals eating similar diets and having the same activity levels as other members in their groups.
Still, where do sedentary lifestyles and "obesogenic," Super-Size-Me environments come into play?
Environment plays a role, but it's unclear exactly how it interacts with a person's genetics. In fact, Bouchard said epigenetics, or measuring what changes gene expression, is the mysterious frontier of obesity research.
Until scientists can piece together nature's effects on nurture, it will be tough to be sure what exactly causes obesity -- and even more difficult to create medical interventions to include into health care policy.
Refusing to treat obesity like other metabolic diseases seems prejudiced, Bouchard said.
"When we put obesity in another category, I always feel it is purely a consequence of looking at it from a discriminatory point of view," he said.
Some people may think that calling obesity a disease rids people of personal responsibility to watch their weight. Other research suggests that people who cannot properly produce a compound called leptin are more likely to become obese, too, said Judith Stern, a distinguished professor of nutrition at the University of California-Davis. Other theories put forth that viruses or infections might factor into a person's risk.
Above all, she said, obesity patients -- especially those who have tried everything -- need consistent treatment and support.
"We're stacking the decks against obese people," she said. "I think it will take many years to turn this around."