On the issue of obesity, from a psychological perspective, it is often a symptom of poor emotional regulation. A lot of the time Binge Eating Disorder goes unchecked because people, especially family and friends, tiptoe around the topic as a personal choice. The individual's behavioural patterns, like avoidance, may drive their environment to adopt body shape acceptance practices.
For the lay onlookers, it's easy to blame the obese for their condition; they don't eat right or don't exercise enough. But we know socio-economic status plays a role, just like parental education, air pollution, and so many factors that funnel into macro and micro environmental, behavioural, and genetic phenotypes.
Obesity should be treated as a public health issue just like smoking, drugs, alcoholism. If we keep avoiding talking about it, we may miss signs of emotional struggle that often lead to worse outcomes (e.g. suicide).
There’s a tough needle to thread here—particularly because the person we don’t want to blame is the only one with the power to change course. From a societal perspective, there are certainly actions we can take, like improving food quality and education, but historically, we’ve done a terrible job of both in the U.S. Entrenched interests make it nearly impossible to create effective dietary recommendations at a government level, which ultimately gives an advantage to those motivated enough to take matters into their own hands by doing research, consulting dietitians, exercising, etc.
I've never investigated this, but I would be curious if the socio-economic status risk factors hold true only in developed countries or are consistent globally. The reason I mention this is that many underdeveloped countries, despite facing high levels of poverty, limited education, and significant pollution, seem to have much lower rates of obesity compared to developed nations. This makes me question whether these factors are truly causative or if they are more correlative within specific contexts.
I agree, it is absolutely a public health emergency. I’ve said this before, but weight loss drugs, particularly GLP-1 receptor agonists, have now become the best-selling class of drugs in the U.S. this year, surpassing even cancer drugs. And it’s not because we’ve beaten cancer, or that its rates have plateaued—it’s simply that we’re becoming fatter faster than we’re developing cancer. It’s a grim outlook for those affected, their families, and the solvency of our healthcare system.
An interesting point about extreme obesity is that several contestants on My 600lb Life, many of whom were well over 600 pounds, managed to lose 30-80% of their body weight (200-500lbs), yet still passed away shortly after their significant weight loss. This demonstrates how devastating obesity can be on the body, even after a substantial reduction in weight. Taking preventative measures early is always the best approach, eat healthy, and exercise! A majority of them died at the exact age of 49 or 51, the body probably can't handle much extreme conditioning around that age.
This comment is in reply to the Carlin clip. The nomenclature of the dsm, particularly the expansion from the third iteration to the fourth, was one that R. Spitzer and his very small task force had undertaken behind closed doors relying not on scientific, pathological evidence, but on whether these men 'agreed' to include a diagnosis in the manual.
Many of the diagnoese we still have today were based on shaky evidence, that wouldn't stand critique using CASP checklist or APA JARS. A handful of men, facing political pressure to keep up with WHO's ICD, made decisions that would victimise victims of sexual abuse (see SDPD) and stigmatise individuals with neurodevelopmental disorders or trauma-induced reactions. At the time, considering how the individuals in question felt was never considered, as it was a race with Europe's ICD and politicalisation of medicine.
The ICD was designed as a bottom up approach to diagnosis, finding the pathological causes via tests, etc and building a diagnosis from there to prescribe medication. The DSM doesn't come close to the rigour of the ICD, and therefore we see an explosion of nomenclature that has very few organic illnesses, alas, not even separated by pathology (e.g. dementia and amnesia). Big pharma needed the development of top down approaches to mental diagnosis. That is if an individual's behaviour meets certain criteria they get diagnosed and prescribed medication without pathological testing. The dsm expansion, revolutionised big pharma, at the expense of the population.
So Carlin has a point. If it weren't for the rapid change in nomenclature, medical and community services wouldnt be so slow in recognising the symptoms. The APAs monopoly on mental illness ensures that there are more and more people that need a pill, regardless whether what they have necessitates a pill, and ensures that those suffering the most, remain stigmatised, jumping from service provider to another without any real recovery.
Raina, this is really interesting to read. I had never really thought about how mental disorders are diagnosed and categorized when listening to this standup bit. I always assumed there was a stronger scientific rationale behind it, even if imperfect. It’s eye-opening to realize how a top-down approach, influenced by pressures from big pharma and the need to keep pace with the ICD, has shaped mental health diagnoses and treatment practices. It makes me wonder if this is partly how we ended up with an entire generation relying on amphetamines just to study at school.
What made me think of Carlin’s bit is the way we keep trying to redefine the elephant in the room. If we were brutally honest with the most straightforward language, we’d have to say something like, “we’re becoming fatter, likely due to overeating and poor diet.” There has to be a comedian out there who’s made the parallel about this evolution in softening language.
The Carlin bit I’d love to hear would trace the journey from fat → overweight → obese → plus-sized → full-figured or curvy → roundness. Metabolic syndrome probably should go in there somewhere as well.
I think this matters for the same reason we've been mentioning. The nicer, sanitized language, is obscuring a serious medical issue that drastically raises mortality.
On the issue of obesity, from a psychological perspective, it is often a symptom of poor emotional regulation. A lot of the time Binge Eating Disorder goes unchecked because people, especially family and friends, tiptoe around the topic as a personal choice. The individual's behavioural patterns, like avoidance, may drive their environment to adopt body shape acceptance practices.
For the lay onlookers, it's easy to blame the obese for their condition; they don't eat right or don't exercise enough. But we know socio-economic status plays a role, just like parental education, air pollution, and so many factors that funnel into macro and micro environmental, behavioural, and genetic phenotypes.
Obesity should be treated as a public health issue just like smoking, drugs, alcoholism. If we keep avoiding talking about it, we may miss signs of emotional struggle that often lead to worse outcomes (e.g. suicide).
There’s a tough needle to thread here—particularly because the person we don’t want to blame is the only one with the power to change course. From a societal perspective, there are certainly actions we can take, like improving food quality and education, but historically, we’ve done a terrible job of both in the U.S. Entrenched interests make it nearly impossible to create effective dietary recommendations at a government level, which ultimately gives an advantage to those motivated enough to take matters into their own hands by doing research, consulting dietitians, exercising, etc.
I've never investigated this, but I would be curious if the socio-economic status risk factors hold true only in developed countries or are consistent globally. The reason I mention this is that many underdeveloped countries, despite facing high levels of poverty, limited education, and significant pollution, seem to have much lower rates of obesity compared to developed nations. This makes me question whether these factors are truly causative or if they are more correlative within specific contexts.
I agree, it is absolutely a public health emergency. I’ve said this before, but weight loss drugs, particularly GLP-1 receptor agonists, have now become the best-selling class of drugs in the U.S. this year, surpassing even cancer drugs. And it’s not because we’ve beaten cancer, or that its rates have plateaued—it’s simply that we’re becoming fatter faster than we’re developing cancer. It’s a grim outlook for those affected, their families, and the solvency of our healthcare system.
An interesting point about extreme obesity is that several contestants on My 600lb Life, many of whom were well over 600 pounds, managed to lose 30-80% of their body weight (200-500lbs), yet still passed away shortly after their significant weight loss. This demonstrates how devastating obesity can be on the body, even after a substantial reduction in weight. Taking preventative measures early is always the best approach, eat healthy, and exercise! A majority of them died at the exact age of 49 or 51, the body probably can't handle much extreme conditioning around that age.
This comment is in reply to the Carlin clip. The nomenclature of the dsm, particularly the expansion from the third iteration to the fourth, was one that R. Spitzer and his very small task force had undertaken behind closed doors relying not on scientific, pathological evidence, but on whether these men 'agreed' to include a diagnosis in the manual.
Many of the diagnoese we still have today were based on shaky evidence, that wouldn't stand critique using CASP checklist or APA JARS. A handful of men, facing political pressure to keep up with WHO's ICD, made decisions that would victimise victims of sexual abuse (see SDPD) and stigmatise individuals with neurodevelopmental disorders or trauma-induced reactions. At the time, considering how the individuals in question felt was never considered, as it was a race with Europe's ICD and politicalisation of medicine.
The ICD was designed as a bottom up approach to diagnosis, finding the pathological causes via tests, etc and building a diagnosis from there to prescribe medication. The DSM doesn't come close to the rigour of the ICD, and therefore we see an explosion of nomenclature that has very few organic illnesses, alas, not even separated by pathology (e.g. dementia and amnesia). Big pharma needed the development of top down approaches to mental diagnosis. That is if an individual's behaviour meets certain criteria they get diagnosed and prescribed medication without pathological testing. The dsm expansion, revolutionised big pharma, at the expense of the population.
So Carlin has a point. If it weren't for the rapid change in nomenclature, medical and community services wouldnt be so slow in recognising the symptoms. The APAs monopoly on mental illness ensures that there are more and more people that need a pill, regardless whether what they have necessitates a pill, and ensures that those suffering the most, remain stigmatised, jumping from service provider to another without any real recovery.
Raina, this is really interesting to read. I had never really thought about how mental disorders are diagnosed and categorized when listening to this standup bit. I always assumed there was a stronger scientific rationale behind it, even if imperfect. It’s eye-opening to realize how a top-down approach, influenced by pressures from big pharma and the need to keep pace with the ICD, has shaped mental health diagnoses and treatment practices. It makes me wonder if this is partly how we ended up with an entire generation relying on amphetamines just to study at school.
What made me think of Carlin’s bit is the way we keep trying to redefine the elephant in the room. If we were brutally honest with the most straightforward language, we’d have to say something like, “we’re becoming fatter, likely due to overeating and poor diet.” There has to be a comedian out there who’s made the parallel about this evolution in softening language.
The Carlin bit I’d love to hear would trace the journey from fat → overweight → obese → plus-sized → full-figured or curvy → roundness. Metabolic syndrome probably should go in there somewhere as well.
I think this matters for the same reason we've been mentioning. The nicer, sanitized language, is obscuring a serious medical issue that drastically raises mortality.