Obesity worldwide and in America has been rising steadily since the 1970s. Recent years have seen its heyday, with more than 40% of American adults classified as overweight or obese. Amid what is considered a childhood obesity epidemic, Harvard researchers foresee that 57% of children will be obese by the time they turn 35. This figure is likely to increase due to the pandemic and the negative effects that extended social lockdowns and stress had on levels of nutrition, eating habits and exercise in adults and children worldwide. In response to the growing number of individuals affected by obesity, medical organizations like the WHO have toyed with the idea of codifying obesity as a disease, and the American Medical Association and Mayo Clinic have already done so. But does calling obesity a disease really make it one?
Below, we’ll discuss three reasons we should think of obesity as a disease and three reasons we should not.
Is obesity a disease? No.
Obesity diagnosis is imprecise.
Most health professionals diagnose obesity by calculating Body Mass Index (BMI), which is an estimation of a person’s body fat based on weight and height. But BMI does not measure body fat directly, and as such, people who are not obese according to their body fat percentage are deemed obese with the BMI diagnostic. By this definition, fitness fanatics like Dwayne Johnson (The Rock) and the lion’s share of NFL athletes are technically “obese.” Worse, BMI is not an effective prognosticator of metabolic wellness; one study found that approximately one in four people with normal BMIs nevertheless had some kind of metabolic dysfunction. Plus, when it comes to children, BMI doesn’t work well to identify health issues, especially mental health issues, that may contribute to a child’s obesity.
Thinking of obesity as a disease can backfire.
Yale disease prevention researcher, D.L. Katz, points out that in terming something a disease, one would expect remedies to lie within the realm of pharmacological treatment, clinical visits, or surgery. Therefore, classing obesity as a disease may inadvertently steer treatment toward drugs and gastrointestinal surgeries, for a condition that can often be overcome (albeit less easily) through diet and exercise. Worse, it may diminish an obese person’s sense of control over their weight, and effectively discourage behavioral changes that contribute to weight loss.
Heavy people aren’t necessarily ill.
People of all shapes and sizes fall ill for reasons that have nothing to do with weight, and many people are in prime physical health despite being obese. The development of diseases like cardiovascular disease, stroke, and cancer depends on a great many factors beyond weight. A full third of people deemed obese indicate no increased risk for diabetes or heart disease. Interestingly, while obesity is a risk factor in some diseases, it provides a safeguard against others. For example, obese women are less likely to develop osteoporosis, and another study showed that people deemed overweight by BMI measurements actually outlived their counterparts in the normal BMI range.
Obesity is a disease.
Obesity isn’t a choice.
While scientists today don’t have a consensus on what causes obesity, many think it is often caused by a number of underlying genetic or metabolic factors that cause people to gain weight or make them unable to lose weight. Genes control everything from a person’s ability to metabolize food to how full one feels after a meal. In some individuals, genetic factors can influence obesity by as much as 80%. Those who have a greater genetic disposition toward obesity are not usually able to lose weight or maintain weight loss through diet and exercise alone. Studies have shown that for long-term success, chronically obese patients indeed require intervention beyond incorporating a healthy diet and exercise into one’s lifestyle. Bariatric and other forms of gastric surgeries show the most salient results for long-term weight management.
Treating obesity as a disease makes economic sense.
Let’s take a closer look at why obesity should be identified as a disease: It is positively correlated with diseases that are highly expensive to treat, like kidney disease. Dialysis, a common treatment for kidney failure, costs an average of $72,000 per year, per patient. With nearly 500,000 individuals on dialysis in the US, it constitutes a significant cost burden for individuals, insurance companies, and the government. Sources estimate that obesity costs the US health system $173 billion a year. By defining obesity as a disease, cost-effective treatments for obesity – like consultations with a nutritionist, physical therapy, or even bariatric surgery – can help to circumvent cases (and therefore costs) of the diseases with which obesity is associated. As the old adage goes, an ounce of prevention is worth a pound of cure. As such, in the works are federal, evidenced-based dietary guidelines for infants, pregnant women and young children in an effort to prevent obesity.
Obesity as a disease encourages treatment.
While being overweight or obese can have a number of negative effects on overall health and quality of life, especially increasing the risk of Covid-related death, obesity is hardly a focus of medicine. Medical schools tend to focus on pathology, devoting little time to matters of nutrition and activity’s impact on health. This leaves physicians ill-equipped to advise their patients on such matters. As such, terming obesity a disease stands to restructure physicians’ values and learning on the topic. Designating obesity as a disease rather than a consequence of poor lifestyle may relieve the stigma surrounding it and encourage those affected to seek medical assistance, instead of avoiding appointments for fear of humiliation. It may provide doctors the opportunity to address such matters diplomatically and accurately, instead of equating obesity with lifestyle behavior, thereby leaving patients feeling fat-shamed, which has been found to promote weight gain, or wanting to avoid the issue altogether.
The Bottom Line: Can obesity be kept at bay through healthy lifestyle choices, or does it require more comprehensive medical interventions for a sustainable cure? With adult and childhood obesity cases rising across the globe and increasing the risk of Covid-related hospitalizations, now is the crucial moment to decide. Is obesity a disease or not?