Obesity and autism: a comparison on the meaning of disease

This week we are featuring a post by guest blogger Karen Lau, one of our Medical Humanities summer school students. Karen just completed her first year of Pharmacy Studies at the University of Hong Kong and is drawing a very interesting comparison between two complex and multifaceted diseases such as obesity and autism, elaborating from one of her favorite movies. ‘What’s Eating Gilbert Grape’ takes an unusual angle in depicting a young man’s living with an autistic brother and an obese mother.

The three weeks of summer school have flown by and personally I really enjoyed

Last day of summer school at the CHH

participating in it as a tutor, attending some of my CHH fellows’ lectures and joining the students to the visits to astonishing and kind of out of the usual London path museums such as the Gordon Museum, the Hunterian Museum and the Florence Nightingale Museum.

One thousand thanks go to our great manager Ben Chisnall for organising all the summer school basically by himself. Ben is off soon to become as a medical doctor himself, and I am pretty confident I can talk on behalf of everybody at the CHH and say we will deeply miss you. All the best of luck to you Ben for your future medical career, where I am sure you will be able to make the most of this year as manager at the Centre for the Humanities & Health and bring in the humanities to enrich your future profession.

I am leaving now the floor to Karen:

“I feel really fortunate to be here at King’s College for the summer course on medical humanities. During my time here looking at and listening to all the different things about medical humanities, I feel like entering a new world of medicine that is much more wide and fascinating that what I had known before. This was when I was reminded of one of my favourite movies, ‘What’s Eating Gilbert Grape’, which depicts an autistic child and an obese mother, of how disease can be seen from different perspectives.

‘What’s Eating Gilbert Grape’ is about a young man’s life with his autistic brother and his obese mother. It is the struggle of living with and taking care of both of them that lays the theme of the film. This inspired me to think about how diseases are seen in our lives. With diseases, we generally classify them into either physical or psychological disorders. At first glance, autism seems to be a psychological disorder, while obesity a physical disorder. However, I now think that instead of being clear cut as either category, the nature of a disease lies somewhere between a spectrum of the two extreme ends. For autism, the cause is rather physical since it is fundamentally a neurological disorder. The effect of this disorder, though, is rather psychological. Autistic people have impaired social interactions, as well as a general lack of empathy. Obesity, on the other hand, is often sparked by psychological factors. In this movie, for instance, the mother had once been a healthy and pretty girl. She only started to eat uncontrollably after her husband committed suicide, resulting in obesity. In contrast to autism, here in obesity, a psychological problem led to a physical problem. Of course, the case of each patient is unique, thus the extent of physical and psychological factors will always be different for each individual. That is, disease is not a black-or-white picture. If disease is science, then science is then not merely about yes-and-no-s; and if science is all about yes-and-no-s, then disease may not be comprised purely of science after all.

When we think about disease, we often think of a person having a disease, looking for a physician to help this patient. The traditional view is that disease is concerned with one individual’s problem alone, his disease. However, this movie challenges this view. Let us first consider autism. Autistic children require a lot of time and resources from the parents and the family. This often puts distress on the family, especially those with siblings. Since autism is incurable, the treatment aim is to lessen associated deficits and family distress. This is apparently a new concept to the traditional view of ‘treating the patient’s disease’, because the treatment coverage expands from the disease individual to those around him.

While on the topic of treatment, let us consider another perspective by taking a look at obesity. During the course of treatment, the picture of it usually includes the physician, the patient, drugs and other treatment methods. The people subjects concerned are basically the one with the disease and the one to treat the disease. Yet, for obesity, a support group which neither has the disease nor is responsible for treating the disease is a crucial element in the success of eradicating obesity. Due to discrimination and rejection from the society, negative emotions bother obese people a great deal. They tend to stay at home in order not to be seen and mocked at, where they continue eating without much physical exercise, thus entering a vicious cycle of weight gain. Even if the obese person is determined to keep his weight off, withdrawal symptoms may be difficult to deal with. This is where the support group, friends or family, can make a real difference. The treatment thus no longer consists of only the patient and the doctor, but together with support from others to make the treatment easier for all parties.

With more insight into medical humanities, we begin to think of health and disease in ways that we had never considered before. I believe this is significant and essential to further development in medicine, because after all, medicine is all about people. It is about how we, as human beings, live our lives”.

You can see Karen’s quite outstanding prezi presentation here, and contact her at karen1lauathotmail.com if you are keen to know more or have any questions for her.

Last -but not least!- many thanks to all the summer school students. It has been great to meet you and I really enjoyed listening to all of your presentations on Tuesday. Plus I learnt a lot from you! If any of you is interested in being a guest blogger as well, just drop me a line.
To all: I wish you a great summer!

Obesity: the causes behind the causes

There is much talk about the causes of obesity and about responsibility for health. But what gets discussed little – far too little, in fact – are the causes behind the causes: agricultural policy and economic interest.

Read the New York Times‘ fascinating article that explores the US government’s role in the marketing of high-calorie junk food. The brief story is this: reductions in countrywide milk consumption as well as an increased demand for low- and non-fat milk (people watching their diets maybe?) have resulted in excesses of milk-fat. These excesses need to be sold – in other words, eaten. The easiest and fastest way to eat milk-fat is in the form of cheese, therefore the US department of agriculture has created a marketing group called ‘Dairy Management’. Dairy Management works with junk food sellers and producers to encourage them to add more cheese to their products.

Yes, that’s where those appealingly melting cheesy pizza crusts come from!!!

In other words, the US government simultaneously promotes healthy diet through fat-reduction, whilst subsidising the invention, marketing and sale of high calorie, cheesy food varieties. As a result the very same person that is diligently attempting to cut calories and fat-intake by changing to low fat milk may be unknowingly reingesting all that extra milk-fat, or even more, by buying a subsidized pizza slice containing 40% more fat and calories that it did before.

I hardly need to point out that the people shopping at Wholefoods (the US’s upmarket organic supermarket) are unlikely to find their favourite foods insidiously enhanced with cheese. The people that will end up disproportionally ingesting the excess milkfat will be a familiar sounding lot: the ones that have little education or awareness, little time for cooking and shopping – if a supermarket is even accessible to them – and little health insurance. These very same people will often be feeding a family.

We can talk about ‘health promotion’, ‘life-style change’ and ‘responsibility for health’ till the cows come home. But as long as countries continue to produce more food then they need, and as long as they continue to insist on forcing that food down the throats of their own population, with the full force of government subsidy and industrial marketing behind it, individuals and health promotors are doomed to fight a loosing battle. I do not deny that, ultimately, individuals have freedom of choice. But at the moment the powers that are very much conspire to stack the deck in favour of certain choices only. And, as ever, the further down the socio-economic ladder you go, the worse the deck becomes.

For more, do read the article, it is absolutely fascinating. Note also the conflict of research interests described.

For a similar story about corn, Michael Pollan’s Omnivore’s Dilemma gives a very accessible, if popularized, analysis, explaining at once why processed food (in the USA) is so cheap, and why the consumption of soft drinks has spiralled up; soft drinks are the easiest vehicle for getting a population to consume more corn. The corn industry keeps increasing it output at decreasing profit margins, and continues to be heavily subsidized by the US department for agriculture.