Let’s call it what it is

In June 2013, the American Medical Association announced that it was officially updating its classification of obesity; the most prominent organization of physicians in the U.S. designated obesity as a disease. This was a controversial move for many reasons. For some reason I was thinking about this lately, and I’m not sure how I feel about it.

There were a few primary reasons for this new classification. For one, calling obesity a disease would encourage insurance companies to cover treatment for obesity, including perhaps nutritional counseling and other weight loss programs (good), but also weight loss drugs (bad). This makes a lot of sense from a public health as well as an economic standpoint, because it’s less expensive and much healthier for someone to lose weight than to let their weight make them sicker until they need drugs and/or surgery for heart disease, high blood pressure, and type 2 diabetes, which insurance already covers. Ironically, labeling obesity as a disease might encourage a prevention focused course of action as opposed to an unsustainable treatment one, even if the label is encouraging doctors to “treat” obesity. However, while I definitely think insurance should cover counseling for weight loss and dietary intervention for overweight and metabolically unhealthy individuals, the most sustainable way to reverse the obesity epidemic lies in the reform of the food system. So I’m not sure if this label matters in this respect.

Another pro to this disease label is that it may lessen the stigma towards the obese, who are typically considered to be at fault for being lazy and overeating the wrong foods. Weight stigma is a huge issue, definitely, and doctors should be aware that people can be overweight for many complex reasons. If you have read my other posts, you probably know that I believe a substantial portion of obese individuals are victims of the food system, which values corporate wealth over public health at every level. But the idea that your behaviors (namely, your diet) influence your health can actually be very empowering in the right context; I worry that telling an obese patient they have a disease might make them feel like their weight is out of their control, so they might as well throw up their hands. But again, I’m not sure if this designation will actually have enough of an impact to change the stigma. On a related note, a potential con of labeling obesity as a disease is that doctors may be more likely to promote weight loss through drugs and surgery as opposed to diet and physical activity, the former of which is much more dangerous and drastic. 

Another important consideration is that obesity is “diagnosed” according to a person’s BMI, which doesn’t take into account body composition. Also, some people are healthier than others at a given BMI, depending on their genes, diet, activity levels, and especially where the fat is distributed. Subcutaneous fat (the fat on your arms, hips, and thighs) is, as far as I’m aware, not strongly associated with chronic disease, while visceral fat (fat in your abdomen) is known to be very dangerous. Just being technically obese doesn’t necessarily mean one has any of the associated pathologies, although the risk is definitely higher. 

So maybe it is misleading to call obesity a disease, when it is more accurately (in my opinion) a risk factor or cause of disease. And of course excess weight is not always present in patients with heart disease, type 2 diabetes, and the like. There are people who are “normal” weight with bad eating and exercise habits who get the same illnesses as the obese people. 

I guess I think that calling obesity a disease just reinforces the disease management mindset of the current healthcare system (instead of a disease prevention mindset). The reclassification might not make anything worse, but I can’t see how it could help either.

What do you think? Is obesity a disease? 





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