Obesity Is not Just a Result of Gluttony - Essay Example

Chronic disease defines the Western culture of our day. Whereas previously infectious disease was the biggest killer, diseases such as heart disease and cancer are now the biggest killer. They’re harder and more expensive to treat due to their longevity, which means that the pressure on the healthcare authorities that provide protection is larger than it is for infectious disease. It is thus very important to explore the reasons behind these chronic diseases and their causes to help explain why these diseases are becoming more prevalent in society and how we can prevent these from becoming a larger problem. Obesity is an interesting case because it is classified as a chronic disease (Haslam and James, 2005) and causes several other chronic diseases as a result (Barness and Opitz, 2007). This essay will explore what obesity is and who it affects, as well as exploring what pressures the huge prevalence of this illness is putting upon society and the human body. It will also consider the treatments obesity needs and how society can prevent. Obesity is now the world’s most important and influential preventable disease, affecting around 25% of the British population (Weaver, 2006) and thus this exploration is important to discover more about this important disease and its effects on the UK and the world. Obesity is the fastest growing chronic illness of recent times (Haslam and James, 2005). Obesity is not just a problem in itself, but can lead to several other diseases, such as diabetes and heart problems (McLaren, 2006), and as such poses a great problem not only to the individual sufferers but to the communities and organizations that support them. The NHS, for example, has increased spending by £43.2 billion since 2002 (Dickson, 2007) and part of this can be attributed to the increase in individuals suffering from obesity. Obesity is defined by an individual who has excess body fat in such a proportion that their health begins to suffer (Haslam and James, 2005) and medically an obese individual will be expected to have a BMI of 30 (Gray and Fujioka, 1991). The use of BMI has been criticised as those individuals with high levels of muscle can be described as obese using this scale (Devlin, 2009), however in general terms it can have its uses. BMI is calculated by working out kilograms of weight as a proportion of the height (Gray and Fujioka, 1991) and as such a BMI of 30 or over (obese) is an individual who has 30kg/m2 of body weight. Obesity is known to lead to several illnesses, or increase an individual’s risk of certain illnesses. This includes, but is not exclusive to, diabetes mellitus, heart disease, stroke (and other diseases involving high rates of clotting), high blood pressure and related problems, cancer, osteoarthritis and sleep apnea (Haslam and James, 2005), all at varying severity depending on the individual concerned. Just looking at this list shows that obesity is a serious problem and not just difficult in terms of finding clothes to fit and other superficial issues that obesity causes. However, these superficial problems are not to be completely overlooked as they may have a severe impact on the mental health of the individual involved. It is also worth mentioning that the rates of obesity have increased alongside rates of other eating problems, such as anorexia nervosa (Saguy and Gruys, 2010) and this should not be ignored as these changing typical body images may be an indication of a severe polarised body shape in the future. Obesity used to be considered an American problem, as seen with the work of Sturm (2007). However, obesity is now considered by the WHO to be an epidemic across the Western world. Rates of obesity are also increasing throughout developing nations (Gentilucci et al., 2008) a worrying trend that may suggest that obesity is going to be an even bigger problem in the future and may prove devastating to those countries who do not have the economic infrastructure to support so many individuals with a chronic disease. The UK became the most obese nation in Europe in 1998, overtaking Germany (Weaver, 2006) and became the world’s fifth fattest nation as a result (Dickson, 2007). The rates of obesity in the UK are now so high that a quarter of adults are obese and ‘the proportion of obese children has risen by more than 40 per cent’ between 1995 and 2006 (McLaren, 2006). A major issue with obesity in the UK is the North-South divide, with more adults in the North more likely to be obese than those living in the South (Weaver, 2006) and the attitudes towards health being markedly different also. The article by McLaren (2006) suggests that a quarter of people in the London area are eating the recommended daily allowance of fruit and vegetables, while only a fifth of those living up north doing so. Although the amount of fruit and vegetables an individual eats is not a direct measure of obesity, it is worth noting this fact because it does show that there is a clear difference in attitudes towards healthy eating. This attitude toward healthy eating can be presumed to be a reflection of general eating habits and as such we can see part of the reason why those people in the North tend to experience obesity more than those in the South. It is also important to note that individuals living in the North earn less money than those in the South (Martin, 1988). Obesity trends across the world note that individuals living on a lower income in a developed country are more likely to be obese and countries with a larger gap between the very rich and the very poor have more of a problem with obesity than those that are more economically equal (Mellor, 2011). It is not completely certain why this should be so, but it could be a result of living in a country where fast-food chains are widely found (evidence of living in a developed country) and the food in these chains is seen as cheaper than food from a supermarket (evidence that fast food appeals to those below a certain income threshold). It could also be that advertising for these fast food chains tends to emphasize the low price of these meals (Chou, Rashad and Grossman, 2005) and as a result they become more appealing to those living with lower amounts of money. Race is also an interesting factor when discussing obesity. El-Sayed, Scarborough and Galea (2011) have provided a comprehensive overview of the literature that discusses the relationship between race and obesity within the UK and have found many things. For example, those of Chinese origin are far less likely to suffer from obesity than those of Caucasian origin. There were no conclusive findings for those of South Asian origin, with some of the research discussed finding that they are of higher risk than Caucasians and some finding that they are at lower risk. The same disparity in findings was found for those of African or Caribbean origin. However, these findings will surely provide more clarity in the coming years as rates of obesity with all likelihood increase. Different racial groups in the UK are generally found within their own economic niche, however, and Afro-Caribbean British people generally earn less money than their Caucasian counterparts (Williams, 1999) – we can assume that they probably experience quite high levels of obesity when we use the parameters described in the above paragraph. It is also interesting to note that many people of ethnic minority groups are immigrants and as such will probably experience higher levels of obesity when exposed to British culture for longer, based upon the worldwide trend that Westernisation leads to greater levels of obesity (Gentilucci et al., 2008). While all this information is useful when discussing obesity, it does not help us to understand the statement ‘obesity results from the sin of gluttony’, because raw numbers do not illustrate the people behind the disease. Obesity is often seen by the masses as a disease of greed, something that is completely preventable and any problems that result from obesity should be tackled by the individual themselves. Many people believe that the NHS should not support those suffering from obesity if they refuse to find help and lose weight (Martin, 2008). The sin of gluttony describes the active over-indulgence of food (Prentice, 1995), but St. Thomas Aquinas believed that gluttony also involved the seeking of sauces and the anticipation of meals (Lamothe, 2005). Although these things could lead to obesity, there is no definite link between them. For example, if you were to actively seek and overeat food, then you would become obese unless you did enough exercise (Prentice, 2005). There is, therefore, only a link between gluttony and obesity if the exercise is not sufficient to burn the calories found within the food, and as such we cannot say for definite if obesity results from this sin. We need to explore other reasons behind obesity and the effects that it causes on people’s lives before we can decide this for certain, however, starting with the cultural effects that obesity has. Obesity is currently causing problems amongst Britons for numerous cultural reasons. Obese people are often subjected to extra charges on planes and trains (Credeur, 2009) and as such are paying a financial price for their disease as well as a physiological price. The decision to charge obese people extra for their travel seats is a reaction to them causing problems for other travellers, however overweight people also cause problems due to their size and are not charged similar amounts for travelling. It is perhaps fair to charge them extra for making others uncomfortable, but if it is a psychological or physiological problem then it is not necessary a result of gluttony and as such cannot be said to be the individuals fault. It is then a moral problem: should we now cause economic problems to those who are suffering from a genuine physical disease, even if they are causing others to be uncomfortable in their travel situations? There are other cultural problems involved with being obese, such as the low availability of clothing for these individuals. This could cause psychological problems (and perhaps cause them to be more obese), although there is the argument that providing these individuals with clothing encourages others to become obese (Sobal, 2001) and as such may undo all the health education that the government has provided to help prevent obesity and the related diseases. Obesity does not just affect individuals, but the nation at large, particularly when the country funds the healthcare, such as the example of the UK and the NHS. When people are suffering from chronic illnesses, such as obesity, it places a large burden on the healthcare service, because the very nature of chronic illness is that they last for a long time and require medication throughout the course of the illness. The problem with obesity is that it causes several other diseases such as heart disease and cancer, which require long-term care and thus long-term burden. Other preventable or semi-preventable diseases such as lung cancer have also been targeted by the government for reduction because the money spent on reducing these with public health reduction schemes is less than the money spent on treatment. Smoking and over-eating (and the resulting cancers and other problems) are being targeted heavily by the UK government as seen by the white paper (Department of Health, 2011). This paper puts emphasis on putting patients at the centre of healthcare, and suggests that patients from preventable diseases are entitled to the same standards of healthcare as any other individual. There are also several articles found in the library for public health, such as the one by Ells and Rutter (2011) that suggest that the NHS believes that obesity prevention should begin in childhood and as such they are beginning to focus more efforts upon health education amongst younger people. This all comes at a cost, but if obesity is prevented then it should allow the NHS more money in the long-term to spend on less preventable diseases. Although some people believe that obesity is a preventable disease that could be said to be caused by the sin of gluttony, there are reasons to suggest that psychological illness can be a considerable influence in those who suffer from obesity. Binge eating disorder (BED) is a psychological illness that is linked with obesity for obvious reasons. The DSM-IVR suggests that BED is categorized by over-eating, perhaps in response to stress or other stimulants. Over-eating can cause obesity in those individuals that do not take enough exercise because of the excess in calorie intake (Haslam and James, 2005). Night eating syndrome (NES) is a related disorder that causes people to eat more at night, again as a response to perceived stress (Fairburn and Brownwell, 2005) and as such can cause obesity also. This again could be seen as gluttony, but psychological disorders are not preventable and as such these patients should be treated with more respect than to label them all sinners in the context of gluttony. As previously mentioned, the NHS has increased spending because of obesity by £43.2bn between the years of 2002 and 2007 (Dickson, 2007). The NHS has also had to increase spending on curing obesity, by spending seven times more on gastric bypass surgeries in three years, as seen in the Guardian article (2009). This means that obesity is causing economic problems as well as individual health problems: obesity is a social, economic and biological problem. Having explored the problems that obesity has caused, it is worthwhile exploring how obesity can occur if it is not the direct result of gluttony, first by exploring psychological and the physiological problems that can lead to obesity. It has been found that individuals with psychological and psychiatric disorders are more likely to suffer from obesity (Chiles and van Wuttum, 2010). Although this is not true of all mental illness (anorexia nervosa for example is unlikely to cause obesity) it is worth noting that these people are not necessarily exhibiting gluttony, but are reacting to the world around them by eating more than their body can cope with. It is true, however, that not all people react to the world in this way and as such we could classify obesity resulting from this cause to be a sign of gluttony and as a result refuse healthcare to these individuals. Obesity can also be a result of an addiction to food (Tuomisto et al., 2005), which falls into the category of substance abuse. Individuals suffering from substance abuse are often seen to be victims of themselves and as a result gain less sympathy from the general public and many people perhaps feel uneasy about providing them with free healthcare. However, here again we can see that any addiction is a mental illness (Peele, 1981) and should be treated in the same way as any other mental illness, or indeed any affliction. An addiction to food is not gluttony in the purest biblical sense described above, although the actions of these individuals may be seen as gluttonous to some observers. The reality is that these individuals require an increased exercise and reduced diet program as with anyone suffering from the affliction that is obesity needs to help prevent the more serious chronic problems that accompany it. However, there are some instances when exercise and diet improvements will not cause obesity, in the instance of physiological disease. There are several physiological reasons why a person would be obese, which again suggests that obesity itself cannot be classified exclusively as a result of the sin of gluttony. Genetics play a big part in obesity, both because of certain genetic disease and because of genetic metabolism reasons. There are certain genes that can cause certain individuals to have an excessive appetite (Luca et al., 2002) which will inevitably lead to obesity. These genes may cause an individual appear to be gluttonous, but if it is a genetic predisposition then should it be treated as such? There are around 40 genes that have been linked to a higher likelihood of becoming obese (Poirer et al., 2006), whether this be an increase in appetite or a decrease in metabolism. There is a gene known as the FTO (fat and obesity) gene and individuals possessing this gene have been found to weigh around 4kg more than those who do not (Frayling et al., 2007), again suggesting that obesity is not a result of pure gluttony. Obesity is not only found in these cases, but genetic diseases can have obesity as a symptom. These diseases include, but are not limited to, Prader-Willi, Cohen syndrome, MOMO syndrome and Ayazi syndrome. Prader-Willi syndrome involves symptoms that are evident since birth, and include over-eating, obesity, failure to thrive, sleep disorders, delayed puberty, short stature and is a result of some deleted genes on a paternal chromosome of the individuals that exhibit this disease (Buiting et al., 1995). This affliction is interesting because these individuals appear normal in many ways and are not gluttonous by any fault of their own, but are still obese. Cohen syndrome is slightly more serious, in that it causes mental retardation and facial malformation as well as obesity (Tahvanainen et al., 1994), and as such are even less likely to be considered gluttonous. Individuals with MOMO syndrome exhibit, as seen by the name, macrosomia, obesity, macrocephaly and ocular problems (Moretti-Ferreira et al., 1993), and again, cannot be said to be gluttonous as their size is due to the possession of these malfunctioning genes. Finally, Ayazi syndrome also has obesity as a symptom as well as eye problems and deafness (Rosenburg et al., 1997). Individuals with these diseases (and there are more genetic diseases with obesity as a syndrome) are not gluttonous in the biblical way as they are only responding to the biological expression of their genes. It would be considered wrong by many people to refuse these individuals treatment on the NHS. However, it must be noted that these diseases are very rare and cannot be said to comprise 25% (Dickson, 2011) of the UK and must be discounted as a prominent cause of the affliction. It has also recently been noted that infections can be a cause of obesity, and this is known as infectobesity (Dhurandhur, 2001). However, research on this topic is still not conclusive, although it has been noted that there is a difference in gut flora between obese humans and those in the healthy weight range (O’Hara et al., 2006). This could be crucial in deciding how likely someone is to become obese, but needs more research. As one cannot control their gut flora, these individuals again cannot be said to be gluttonous. Taking all this into account, it has been found that obesity is on the rise and as such not all cases of obesity can be correlated to physiological reasons, but does this mean it is a result of gluttony? The availability of fast food restaurants and other social and cultural reasons (supported by the fact obesity is seen to rise with the Westernization of countries [Gentilucci et al., 2008]) mean that the gluttony these individuals exhibit may not be entirely their fault and as such would not be seen as a sin in the traditional Christian definition of the term. However, it could be argued that these individuals should show willpower when faced with these kind of temptations, and as such it can never be truly argued as to whether obesity is a result of pure gluttony or not, but the fact that there are physiological, psychological and cultural excuses mean that we cannot attribute it this purely to gluttony. Having explored this it is worth briefly exploring the treatments and preventions that are causing the NHS so many financial problems. The main treatments for obesity are to eat less and to exercise more (Barness and Opitz, 2007). However, several individuals do not respond to such treatment or find it difficult, perhaps due to a food addiction, slow metabolism, genetic disease, infectobesity or tendency to have a large appetite, all of which are described in more detail above. In these cases, it becomes necessary to try different treatments for obesity. One of the main options is to have a gastric bypass, a surgery in which the stomach is made smaller in some way (there are several options) so that an individual cannot consume as much food (Glenny et al., 1997). This treatment is dangerous and, as with all surgery, carries significant risk. Another problem is that the patient undergoing this surgery will be obese, which always adds danger to a surgical procedure (Schauer et al., 2000). Other options include diet pills. Diet pills work in a variety of different ways, and can either prevent fat absorption, reduce appetite or speed up metabolism (Gritz, 1991), and often obesity patients will receive treatments that combines one or more of these elements to help their weight loss. Surgery and pills come with a huge cost to the NHS, which will only become a larger burden as more and more people become obese and seek treatment for it, and thus preventative methods such as health education become more important. It also interesting to note that those who consider obesity a result of gluttony do not support the NHS providing these treatments for individuals who are suffering from obesity for a non-physiological cause. To conclude, the evidence provided in this essay show that obesity is not just a result of gluttony, whether that be a sin or not. Obesity can be a result of physiological disease, whether it be spontaneous or genetic, or a result of an underlying psychological problem, and as such cannot be said to be gluttony directly. For example, the result of the genetic disease Prader-Willi is a cause of obesity (Buiting et al., 2005) and although it is rare, people looking at an individual suffering from this disease would assume that they have a problem with overeating or gluttony. It is assumed that these people have a problem with food, but like anything else it is also possible to develop an addiction to food (Tuomisto et al., 1999) and this again can cause obesity. Individuals suffering from this could be seen to be gluttonous but again this is a psychological problem rather than a sin as seen as the eyes of God. Another issue with obesity is the impact that it has on any government providing healthcare for these individuals, and as such this ‘gluttony’ (whatever it is a result of) causes severe problems politically. Obesity is now considered the world’s most common preventable disease (Haslam and James 2005) and as such the UK government has spent a significant amount of money on preventing the condition (Glenny et al., 1997). This reaction of the UK government suggests that it is indeed a result of gluttony (most health education methods focus on the need for more exercise or emphasizing health eating [Glenney et al., 1997]), which is apt for something considered as a preventable disease. It is evident, then, that obesity is a major problem in society today and, whether it is a result of gluttony or not, it needs to be addressed in the proper way and proper governmental precautions need to be put in place to help prevent the disease and the resulting problems that come along with it. 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