Garth Rattray | Rethink and rename ‘obesity’ | Commentary

The medical sciences are in constant flux. Understandably, this may cause some degree of scepticism, confusion, and a loss of confidence among some medical practitioners but more so among patients. 

However, the fact is that we are always discovering, learning, adjusting, and fine-tuning how we serve those who entrust their healthcare to us. In other words, when changes occur, they are beneficial and going in the right direction. It represents the (inevitable) evolution of the medical sciences. 

 This is why, for patient safety, almost all registering organisations require that all practising doctors, nurses, and individuals in professions allied to medicine, complete a requisite minimum number of hours of continuing education annually.  

A recent, prime example of changes in nomenclature, and concomitant refocusing on a specific disease process, is the renaming of polycystic ovarian syndrome (PCOS). It took a 14-year global effort on the part of clinicians, researchers, along with over 50 organisers, and patient-care advocates to rename PCOS. It is now aptly called polyendocrine metabolic ovarian syndrome (PMOS). Credit for the initiative goes to Professor Helena Teede, an endocrinologist and director at Monash University in Australia. 

We always knew that “polycystic ovarian syndrome” is an endocrine problem with multiple manifestations. In fact, the described ‘cysts’ on the ovaries are not cysts. They are multiple unruptured ovarian follicles. Additionally, many patients don’t even have those. Although difficulty in conceiving is often its main presentation, ‘PCOS’ is secondarily a reproductive problem. It is primarily an endocrine problem. It is a systemic disorder that affects insulin to a significant degree (up to about 70 per cent), and cortisol to a lesser degree (up to 30 percent). Those with cortisol dysregulation are said to have ‘adrenal PCOS’. 

The outward (visible) manifestations may include difficulty with weight control, excess hair on the face and torso, male-pattern thinning and/or baldness, stubborn acne, and thick, velvety, dark areas of the skin (called acanthosis nigricans), especially around the neck, and/or under arms and under the folds of the breasts. There is also the tendency for mid-section fat deposits. However, the internal problem associated with insulin resistance causes a strong tendency for type 2 diabetes and its attendant health risks. Although they are invisible and asymptomatic, they are far more troubling.    

Renaming PCOS to PMOS allows clinicians to see things for what they really are and not become distracted by the associated, popularised gynaecological challenges. They can refocus on the real problems caused by this poly (multiple) endocrine disorder and better investigate and treat patients appropriately. This will reduce the stigma and reduce the morbidity and mortality caused by the cardiovascular risks linked to PMOS. 

Similarly, medical science needs to rethink and rename “obesity”. The origin of the word is “obesus”, which literally means “having eaten until fat”. The word puts 100 per cent of the ‘blame’ for being overweight squarely on the shoulders of the individual. Because of this, ‘obese’ people are often stigmatised as being slothful, gluttonous, dysfunctional individuals with weak minds, who are incapable of exercising a little self-discipline for the sake of their health.

On day 2 of our Medical Association of Jamaica annual conference, Dr Adriele Downer-Austin spoke on “Social Determinants of Obesity in the Caribbean”. She pointed out that 65 per cent of Jamaicans are living with excess adiposity and 30 per cent of those are living with ‘obesity’.

Science has proven that ‘obesity’ is not just about too many calories in and too little out. It is an extremely complex problem with millions of victims. Therefore, it is ridiculous to inaccurately simplify it. If losing weight were so easy, everyone would be thin, but only about 5 per cent of people can maintain weight loss permanently.

The reasons for weight problems are numerous, but genes are to blame for being overweight in 40 to 70 per cent of individuals. Several hormone problems play key roles. These include, but are not confined to, dysfunctions in Leptin (the satiety hormone from the fat cells), Ghrelin (from the stomach), Glucagon-Like Peptide-1 (from the gut), Peptide YY (from the gut), Insulin (from the pancreas), Adiponectin (from fat tissue), stress and thyroid hormones (which affect the basal metabolic rate), and the sex hormones. 

It is believed that our many trillions of gut bacteria (microbes) might conspire against us. Not only can they be superefficient at extracting energy from food, sometimes they influence fat storage and fullness. They also interact with the gut-brain axis and release appetite-regulating hormones.

Other factors affecting weight management are  the conditions that were in the mother’s womb, the nutritional environment during early life, socialisation, poor sleep patterns, anxiety (stress), depression, financial constraints, infrequent eating, rapid eating, inflammation, physical activity, and poor food choices, which are sometimes predicated by one’s economic status.

Therefore, as a rule, the word, the label, the designation, the diagnosis of “obesity” is so inaccurate that it is a misnomer. And using the BMI to classify it is also flawed. BMI is measured by only using height and weight, but it also depends on muscle mass, bone density, and on-board fluid. At his youthful peak, the famous bodybuilder, actor, politician, entrepreneur, and celebrity Arnold Schwarzenegger was 6’2″, weighed about 235 lbs but had a seven per cent body fat when competing. However, at his height and weight, he had a BMI of approximately 31, which classified him as obese!

Now that ‘PCOS’ has been renamed ‘PMOS’, clinicians will pay closer attention to properly treating the malady. And if ‘Obese’ is renamed to reflect its multifactorial causative factors, the proper treatment of excess body fat will begin. 

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.