The Problems With Saying Obesity Is a Disease

Posted on July 2, 2013


Is it or isn’t it?  The American Medical Association and the general public are both sharply divided, but the hotly contested AMA decision to call obesity a “disease” will have far-reaching and as yet unforeseen consequences.

As of yesterday, Medpage Today was running an informal survey asking “Is obesity a disease?”  Of 1729 votes when I last looked, 48.7% of respondents answered “no,” while 51.3% said “yes.”  The AMA itself was nearly as divided at last month’s House of Delegates meeting.   The new designation of obesity as a disease was approved by 60% of the House, in direct opposition to the AMA’s Council on Science and Public Health, which had just published a report concluding that obesity is not a disease.

What struck me about the debate, though, was the character of it.  The motive behind the whole debate was not about whether obesity really is a disease as we understand it; it was more about the public benefit which would result from labeling it that way.   Even the Council only dissented on the basis of semantics, the lack of an accurate measure of obesity, and the lack of a clear definition of the word “disease.”  Almost the entire yes-or-no argument in their report was laid out in terms of what will happen in the public policy arena as a result of the new label.

Some of the points in the Council’s report  arguing the pros and cons:

Greater investment from the government and private sector for treatments, but that could be at the expense of programs that promote healthy lifestyles

Pressure on the FDA to approve new anti-obesity drugs; pressure on doctors, and increased patient expectations, for prescriptions of these obesity treatments, but “medicalizing” obesity will increase dependence on drugs and surgery, place too much emphasis on mere body size as opposed to other measures of health, and increase unnecessary treatments for metabolically healthy obese people

Pressure on employers and insurers to pay for obesity treatments, but employers might raise the cost of their health plans or limit the hiring of obese people due to increased costs

Stigma could be reduced if obesity were no longer associated with lack of self control or other character flaws, but the perception of obesity as a disease may result in a view that personal behavior has little impact on health outcomes, and reduce the practice of healthy behaviors and choices.

We can see what a can of worms this is from a policy angle, and it doesn’t even touch on a wide array of unintended effects:  will parents of obese children be accused of neglect?  Will employers have to (expensively) remodel their facilities and replace their furnishings to accommodate this “disability?”  What about public transportation, airlines, trains?  Will disability-related lawsuits increase on the basis of the “obesity” disease?  And what about the whole debate over supersized sodas or school vending machines?  Are we to alter everyone’s environment and choices to accommodate the “diseased” among us, or is it more about removing bad choices?  For that matter, what does it say about us as a nation that more than 35% of our adult population is obese diseased?  Diseased?  Really?

This policy-based approach to the AMA’s decision-making really kind of offends me.  Nowhere in this report, nor in the arguments in the AMA’s House of Delegates, did anyone argue whether obesity is or is not, scientifically, by some agreed-upon medical definition, actually a disease.  The whole argument revolved around what the label could achieve in terms of money, of investment, of perceptions, of legal protections… or what havoc it might cause in the same areas.  It was a political decision, not a scientific one.  And I think it was incorrect.

So here’s another politically incorrect decision from Lila, an equally unscientific source: obesity is not a disease.  Some people have diseases that cause it; some people have diseases and their medications cause it; some people are genetically predisposed to be heavy yet metabolically healthy (roughly a third of obese people!); and waaaay too many people just eat too dang much.  And finally, of all of these people, a high percentage will develop vascular and metabolic diseases as a result of their obesity.  But the obesity itself is a symptom, a condition, a cause, or just a genetic expression.  Labeling all of these various people as “diseased” is not going to solve America’s “obesity crisis.”

I have to agree with Lionel Shriver, writing for Time magazine:

“Switching labels is cheap and changes nothing…  Yet designating a state of being as an illness has a subtle distancing effect. It gently suggests that this turn of events is due either to outside forces or to weaknesses inherent in the body that are beyond your control….  But there is no perfect cure, and the one enduringly effective therapy out there is the exercise of personal responsibility. (No, I will not buy potato chips.)  Medicalizing the condition actually undermines personal responsibility by turning something you get rid of into something you chronically have. And even then, the overweight cannot embrace the alcoholic’s total abstinence. We all have to eat, and so, barring removing part of your stomach, we all have to make choices about what and how much.”

So what do you think?  Is it, or isn’t it?  If Medpage Today’s poll is any indication, we are pretty evenly divided on this one.