THERE ARE AT LEAST TWO SIDES TO EVERY STORY

Is Obesity a Disease?

By Chaya Benyamin
 China Photos / Stringer
*Updated 2018
Obesity in America has been rising steadily since the 1970s. Recent years have seen its heyday, with more than one in three Americans classified as overweight or obese. 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 has 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.

 

Obesity is not a disease.

 

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 their 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 Arnold Schwarzenegger 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.

 

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 depend 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.

Obesity 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 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 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.

Obesity 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. 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.

 

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, 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. It may also provide their doctors opportunity to speak up about such matters; less than half of obese patients have ever been informed by their doctors that they are obese.

 

Bottom Lines: 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, now is the crucial moment to decide. Do you think of obesity as a disease?

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