Health studies: A biomedical and social approach to obesity.

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A biomedical and social approach to obesity in the modern society using mandatory health studies bibliography.

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Health studies: A biomedical and social approach to obesity.

  1. 1. 250.131 - HEALTH STUDIES A BIOMEDICAL AND SOCIAL APPROACH TO OBESITY: A SIZEABLE PERSONAL TROUBLE, A LARGER PUBLIC HEALTH ISSUE Course Coordinator: Dr Suzanne Phibbs Massey University School of Health and Social Services Palmerston North Campus Student name: Virginia Westerberg ID: 10143519 Date: 28 March 2009
  2. 2. Student: WESTERBERG, V. I D: 10143519 Page 2 of 8 A SIZEABLE PERSONAL TROUBLE, A LARGER PUBLIC ISSUE: A BIOMEDICAL AND SOCIAL APPROACH TO OBESITY “The I in illness is isolation, and the crucial letters in wellness are we.” Anonymous (as quoted in Guarneri, 2006, p. 1) Health has been defined as: A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (...). Health is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities. (World Health Organization [WHO], 1998, p.1). This broad definition of health implies that some pre-requisites must be present in order to achieve individual and community health like living in an equalitarian society where individuals have access to good quality food, water, education, housing, jobs, health services, etc. These assumptions are not considered in the biomedical definition of health, which is simply the absence of disease. Therefore, someone suffering from obesity would be labelled as “healthy” until that person develops an objective and usually irreversible disease related or not to a significantly increased Body Mass Index (BMI), not taking into account the environmental and socio-political contexts that person lives in and how they can impact health outcomes. This essay will discuss how the biomedical and the social health models could work together to achieve a more holistic concept of health and it will suggest that the two models are not self-exclusive, showing that they can and should co-exist within society. The micro-individual and macro-social levels of analysis (Mills, 1959), which represent the biomedical and social models of health respectively, may be linked together to achieve individual wellness through activism as suggested
  3. 3. Student: WESTERBERG, V. I D: 10143519 Page 3 of 8 by Baum (1998) who compels doctors to take both social and political action to create a healthier society. In order to understand how failure to take into account the social perspective of health, i.e.: the lack of sociopolitical action, has led to increasing rates of obesity, an issue which is reaching nearly epidemic proportions in developed countries (Hill, Peters and Jortberg, 1998), it is necessary to briefly explain this condition from a biomedical model standpoint so as to understand how healthcare professionals see obesity as just a personal trouble affecting a growing number of people but not as a public issue requiring sociopolitical action and institutional intervention. Biomedically, obesity is considered a disease related to an abnormal feeding behaviour (Jordaan, Roberts & Emsley, 1996) that can be explained on the basis of the presence of either structural (anatomic) or non-structural (psychiatric) pathology. Anatomical pathology may lie at a central (hypothalamic or hormonal) or a peripheral (gastric dilatation) level. Modern, processed foods are more calorically dense and contain lesser nutrients than natural foods and when eaten for long periods of time or in large amounts they have serious effects in the organism. (Lisle & Goldhamer, 2006). Obesity, once established, leads to the "obese mind set" which results in self-perpetuating behaviours - sedentary lifestyle, overeating, social isolation, fatigue and feelings of being "out of control." (McElroy et al., 2009). Processed foods are served in so-called “fast, or junk, food restaurants”. These establishments are widely spread (this means that local administrations readily grant them the license to open), sell at low prices compared with regular restaurants (attracting people of the lower socio- economic strata of society), always have promotions (get 2 pay 1, a larger menu for just 1 more
  4. 4. Student: WESTERBERG, V. I D: 10143519 Page 4 of 8 dollar) and add flavour and aroma enhancers to their meals (making them addictive). (Taylor, 2010). From a business-for-profit or consumption perspective, obesity is a good source of income for fast food restaurants, pharmaceutical companies, institutions and governments. Additionally, obese people seek frequent and expensive medical and surgical treatments for secondarily developed pathologies ranging from hypertension, diabetes, hypercholesterolaemia and heart disease to gastric reduction procedures and plastic surgery to deal with redundant skin and subcutaneous tissue (Lisle & Goldhamer, 2006). Being and staying overweight appears to be good for business and the Establishment so, why would those who have the power to do something about it, like governments and institutions, want to put an end to it? Power (Mills, 1959) means the capability to influence large scale, macro-level, political decisions in the global market which would lead to changes in the micro-level situation resulting in significant benefits for the individual constituents of society. Mills thought it was possible to create a good society on the basis of knowledge, and that people of knowledge must take responsibility for its absence. A few examples of lack of action that promote obesity are: the location of fast food restaurants near schools, the location of ticket collection booths at the pop-corn counter, healthy food not being readily available or being expensive, not having enough gyms, bicycle lanes or safe jogging areas, not banning publicity of fast food restaurants sponsoring sporting events, lack of health promotion campaigns on TV, educational centres and communities, and there not being awareness that sociopolitical level actions from governments are a right people are entitled to and that it is the result of those large-scale actions that could bring about a healthier society with healthier individuals.
  5. 5. Student: WESTERBERG, V. I D: 10143519 Page 5 of 8 Conscious that the predominant model of health in developed countries is the biomedical model, Baum (1998) encourages healthcare professionals to additionally implement and promote the social model of health claiming that a shift away from the predominance of the former towards the latter is the sensible way to achieve sustainable and long lasting health improvement. Baum (1998) appeals to healthcare professionals who wish to create communities which optimize health for people. Underlying this change is political activity in a context of globalization that emphasizes social, economic and environmental change over lifestyle changes (Baum, 1998). A potential threat to Baum´s proposed actions to create a link between models of health, is modern societies´ tendency to “medicalization”. In the past, natural occurrences like giving birth and dying were managed without the intervention of professional assistance. Today, these situations have been “made medical”. Likewise, a condition like obesity is currently considered a disease that only doctors can diagnose and treat, seeing individuals, now labelled as “patients”, as entities that stand alone, disregarding the social context in which they live and that may have driven them to that situation of risk. Given the developed world tendency in terms of health and contrary to Baum´s efforts to find a common ground between health models, Illich (1976) clearly positions himself in favour of the social model of health saying that "the medical establishment is a major threat to health" (p. 11) in view of the detrimental effects healthcare professionals and their procedures can have on the health of individuals, a situation known as iatrogenic pathology. An example of this is the development of obesity in patients with asthma, allergic reactions, arthritis, hepatitis, organ transplants and adrenal insufficiency due to the administration of corticosteroids (Braunbald, 2008).
  6. 6. Student: WESTERBERG, V. I D: 10143519 Page 6 of 8 Governments design institutional healthcare training in such a way that it produces professionals who focus exclusively on science, objectivity and rationality neglecting the social dimensions of health and illness (Lyons & Chamberlain, 2006) and these professionals are possibly intentionally not made aware of the social aspect of health during their studies, a worrying issue which could be solved with the introduction of a compulsory paper on social health awareness in medical, nursing and midwifery schools. Another possible way to achieve social awareness in this group of professionals would be to include social health as part of their compulsory continuing medical education through, for example, in-hospital conferences. Malaise can come with the creation of modern societies (Mills, 1959) and the increasing growth of obesity illustrates that Mills´ concern about negligent institutions creating individuals in need of assistance is a fact, knowing that those who are the most dependent are people of lower socio- economic levels, people with no power, knowledge or means to claim their right to health, health not just understood as absence of disease after medical treatment, but as absence of risk factors after social and political action. When conditions like obesity are regarded as a personal trouble and not as a public issue, that day, an equalitarian society will have been created, one with a more holistic model of health that managed to integrate the best of the biomedical model in the social model of health.
  7. 7. Student: WESTERBERG, V. I D: 10143519 Page 7 of 8 Reference list: Baum, F. (1998). The new public health: an Australian perspective. Melbourne: Oxford University Press. Braunwald, E., Fauci, A.S., Hauser, S.L., Jameson, J.L., Kasper, D.L., Longo, D.L., et al. (2008). Harrison's Principles of Internal Medicine (17th ed.). Columbus, OH: McGraw- Hill. Guarnieri, M. (2006). The Heart Speaks: A Cardiologist Reveals the Secret Language of Healing. Westport, CT: Touchstone. Hill J., Peters J.C., & Jortberg, B.T. (1998). The step diet book: Count steps, not calories to lose weight and keep it off forever. New York, NY: Workman Publishing Company. Illich, I. (1976). Medical nemesis: The expropriation of health (1st ed). New York, NY: Pantheon Books. Jordaan G.P., Roberts, M.C., & Emsley R.A. (1996). Serotoninergic agents in the treatment of hypothalamic obesity syndrome. International Journal of Eating Disorders. 20 (1), 111- 113. Lisle, J. D., & Goldhamer, A. (2006). The pleasure trap: Mastering the hidden force that undermines health and happiness. Summertown, TN: Book Publishing Company. Lyons A.C., & Chamberlain, K. (2006). Health Psychology: A critical introduction. Cambridge: Cambridge University Press.
  8. 8. Student: WESTERBERG, V. I D: 10143519 Page 8 of 8 McElroy S.L., Guerdjikov A.I., Winstanley E.L., O'Melia A.M., Mori N., Keck P.E., Hudson J.I. (2009). Sodium oxybate in the treatment of binge eating disorder. Retrieved March 18, 2010 from http://clinicaltrials.gov/ct2/show/NCT00514995 Mills, C. W. (1959). The Sociological Imagination. London: Oxford University Press. Taylor V.H., Curtis C.M., Davis, C. The obesity epidemic: the role of addiction. CMAJ • March 23, 2010; 182 (5). doi:10.1503/cmaj.110-2026. World Health Organization (WHO) (1998). Retrieved March 12, 2010 from http://www.who.int/hpr/NPH/docs/hp_glossary_en.pdf

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