Let’s stop worrying about what we call obesity

Should we call obesity a disease—or a condition?

This is a question that has become really controversial. This week, the Council on Science and Public Health of the American Medical Association (AMA) put out a report saying that obesity shouldn’t be classified as a disease. The next day, the AMA’s House of Delegates disagreed, saying it should be.

You know what I think? I don’t care.

It’s not that I don’t care about obesity. I passionately care about it, because it is stealing the futures of far too many of my patients. Currently, one-third of U.S. kids are overweight or obese.  This is not a “baby fat” problem; current research overwhelmingly suggests that baby fat turns into adult fat. And being overweight increases your risk of all sorts of diseases, from heart disease and diabetes to cancer. Not only that, it increases your risk of social and emotional problems. This isn’t what I want for my patients.

Nobody wants it for anyone, of course. That’s exactly why this controversy has become so heated. Those who want obesity to be classified as a disease say that if we were to do that, it would draw much-needed attention and resources to the problem. They say that it would force us to take obesity seriously and come up with effective solutions for it.

But the people who don’t want it to be classified as a disease worry that if you call it a disease, the money would go to drugs and surgical treatments, and not into ways to make healthy eating and exercise more widely available. They worry that prevention efforts would take a back seat to the latest coolest medical treatment. They worry that obese people would say, oh, I have a disease—and not try as hard to lose weight. They worry that calling it a disease would mean that employers would have to make special accommodations for obese employees, further decreasing incentives for lifestyle change.

It’s so interesting that people equally passionate about fighting obesity can end up on opposite sides of an argument. Maybe that means it’s the wrong argument.

There’s also the problem that obesity doesn’t fit comfortably into the definition of a disease. Yes, it can affect the body in bad ways—no argument there. But it’s hard to define clearly when someone is obese; measures like body mass index (BMI) aren’t as reliable as we’d like them to be. There isn’t a clear way to say what the “signs and symptoms” of obesity are, and we should be able to do that for a disease. Not only that, while extreme obesity is clearly very bad for you, there are some obese people out there who don’t have any health problems—and some non-obese people with the health problems we associate with obesity.

More to the point for me, calling it a disease puts the attention on the patient, because that’s how we think about diseases. We might think about their environment and risk factors, but we don’t think big picture—and obesity is a big picture issue (no pun intended). We will never solve obesity if we don’t make healthy food and safe, affordable exercise opportunities available to everyone. We will never solve obesity if we don’t deal with the grain subsidies that make unhealthy foods so widely available and cheap.  We will never solve obesity if we don’t deal with the corporate and cultural factors that contribute to selling and buying super-sized sodas and fries.

I don’t care what you call obesity. Maybe it’s better not to call it a disease or a condition. Maybe we should just call it what it is: a thief. Because it is: it’s stealing the future of our children. It is increasing their risk of health problems, shortening lifespans and even taking away employment possibilities.

Maybe if we looked at it that way, we might get mad—and getting mad may be exactly what we need. Because more than anything, solving obesity is going to take a whole lot of effort and energy on the part of every single person, no matter what their weight. It’s going to take creativity, initiative, collaboration, tenacity and a whole lot of elbow grease.

Let’s stop worrying about what we call it—and start working together to fight it. Let’s not let our children’s future be stolen.

Claire McCarthy is a primary care physician and the medical director of Boston Children’s Hospital’s Martha Eliot Health Center.  She blogs at Thriving, the Boston Children’s Hospital blog, Vector, the Boston Children’s Hospital science and clinical innovation blog, and MD Mama at Boston.com.

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  • Eric

    I completely agree with you. Personally I think modern medicine can often focus a little too much on trying to define everything. I do worry that if we define obesity as a disease, it may discourage people from making lifestyle changes to maintain or achieve a healthy weight because the blame would be shifted to the disease. Perhaps not. Regardless, I think you make a great point not just for obesity but also other conditions which seem to straddle the line between philosophical definitions of health and disease.

  • ncbill

    Call it whatever you want as long as you give me access to pharmaceuticals in addition to encouraging me to modify my lifestyle.

  • meyati

    personally, I think that any condition that can be controlled by saying-no- is not a disease. When I was a kid, I went to Walteria Elementary school, where the first grade teacher brought in films about the dangers of DDT-racial prejudice, should a family have to change their name from Martinez to Martin to get a professional job after college-how much water we needed to drink each day-the benefits of milk, cheese, fresh vegetables, what a balanced diet was-which is still true today, we saw horrible pics of rotten teeth, dead birds from DDT-how flies became DDT resistant. We even saw a health dept film about typhoid Mary and why we should wash our hands. Then this was repeated by our fourth grade teacher.

    Health and education about nutrition belongs in childhood- health starts in childhood. We have the wrong priorities in school. The milk council should provide X-Rays of an old person’s spine and the X-Rays of a person that has Dowager’s’ Hump. I always posted those on the outside of my classroom door. A principal came to tell me they were inappropriate-this was high school-when a group of kids came in and asked me about the X-Rays. The X-Rays stayed up, and nobody vandalized them. I think that the other teachers didn’t like it because they always had a can of soda pop-and the students asked them if they wanted their bones to go-I always had yogurt cartons, cheese sticks. and juice.

  • querywoman

    School children would not eat the slop Michelle Obama wanted them to eat, and the regulations were softened in January 2013.
    During the last century, most American children started living until maturity. Infant and childhood deaths decreased dramatically. In times with more infectious disease like tuberculous, some fat helps a child or an adult survive a while.
    Children also are not supposed to be doing as much manual labor and are in more sedentary school instead.
    Okay, so we have more children living longer than they used to be and being allowed to be in school instead of working. Some of them are fatter. So?
    Telling a child to lose weight is devastating to self-esteem. Many children are already on self-imposed diets.

    American life expectancy also goes up constantly.

  • natsera

    It perturbs me when people, physicians included, jump to the simple, but wrong conclusion that diet and exercise are the sole factors that influence obesity. If that were so, why aren’t ALL the children who are pretty much eating the same foods obese? When I was in high school in the 60′s, we ALL had to participate in PE every day, for four years, but some of us were obese and some were not (it’s a myth that everyone was thin then!). There’s more to it than diet and exercise, folks. 95% of people who lose weight regain it, even when maintaining their diets. A person who diets down to 130 lb. CANNOT eat like a person who was always 130 lb. without regaining the weight. Ergo, there’s something else going on, and the classification of obesity is nowhere near as important as continued research to find out what is causing it, and how to eliminate those causes. Simply pointing the finger at diet and exercise is like assuming that it’s the vapors that cause tuberculosis. Nice theory, but it’s wrong.

    • querywoman

      The same when I was in high school in the 70s.