Is obesity really a disease?

A few years ago, while I was teaching in the hospital, a medical student presented the case of a man with coronary artery disease, diabetes, hypertension, and hyperlipidemia. When we entered the man’s room I was surprised that the student had omitted a certain fact from his presentation: the man weighed well over 400 pounds.

No one argues that diabetes and blocked coronary arteries are diseases. And nobody argues that obesity, at least in part, causes these diseases — or that losing weight helps improve or even reverse them. But the question of whether obesity itself is a disease has been controversial.

The American Medical Association, the nation’s leading organization of physicians, has announced its stand on the question: obesity is a disease.

Some might wonder why this announcement is news, why the issue is controversial at all. I think it has to do with our ambivalence about conditions that have a behavioral component. In the last few years the question of whether certain behaviors are diseases or disorders — drug use and alcoholism, as well as hoarding, gambling, and Internet overuse (which the American Psychiatric Association now lists as disorders or potential disorders) — has come up repeatedly.

We tend to like to think we can control our behaviors, and everyone knows someone who — by sheer effort and willpower — has given up certain self-destructive behaviors. No doubt, many will see the AMA’s designation of obesity as a disease as an encouragement of “victim mentality” — an absolving of personal responsibility.

But the causes of obesity are complex, and include genetics, stress, the food supply, medications, and other factors. One could argue that if self-discipline alone cured obesity, people like Oprah Winfrey, Gov. Chris Christie, and millions of the rest of us who exhibit this quality in so many other aspects of our lives wouldn’t have a problem with weight. I can’t tell you how often someone who holds down two jobs, volunteers, and takes care of their parents and kids tells me they can’t lose weight because they’re “lazy.”

Another objection to classifying obesity as a disease will be that it’s so common. Do one-third of adults and one-fifth of children in America have a disease? By 2020, when, as is projected, 75% percent or more of us are obese, will most of us be “sick?” Does the word “disease” have any meaning if it affects a majority of people? If it’s the new normal?

The AMA has no specific authority to designate obesity as a disease, but it’s decided to use its considerable influence to effect a cultural shift. The hope is, that if obesity is thought of as a disease, insurance companies will be more supportive of obese people, researchers will pursue the problem more aggressively, public health efforts to curb obesity will be strengthened, and individual clinicians–like that medical student I mentioned above–will be better trained to address obesity with their patients.

study last year showed that only about half of primary care doctors felt competent to deal with their patients’ obesity. Among doctors who were obese themselves, the percentage was much lower.

Suzanne Koven is an internal medicine physician and a Boston Globe columnist.  She blogs at In Practice at Boston.com, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50

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  • Guest

    Obesity is a bodily state with negative repercussions on physical, mental, and social health. That fits MY definition of disease. High prevalence doesn’t magically make something into a good thing. 

    Of course, then, there’s a disease with 100% prevalence. It’s called aging. As much as we try to moralize it denial or promises of immortal afterlife, no one can act like an aged body is not disabled relative to it’s former state.

    It is frankly ridiculous to act like a form of poor health is OK, as long as everyone else is unhealthy too. “Oh, you’ve got cancer? No worries, that happens to lots of people! It’s not really a disease, it’s a fact of life!” 

    Normalizing things that make people unhealthy is not what is needed. We might not be able to resolve these issues now…but if we simply accept them as facts of life, we resign ourselves to unnecessary limits on life and livelihood.

    The goal of the medical profession is to improve health, not to rationalize diseases because they are more common or difficult to treat than we would prefer.

  • Guest

    Obesity is a bodily state with negative repercussions on physical, mental, and social health. That fits MY definition of disease. High prevalence doesn’t magically make something into a good thing. 

    Of course, then, there’s a disease with 100% prevalence. It’s called aging. As much as we try to moralize it with denial or promises of immortal afterlife, no one can act like an aged body is not disabled relative to it’s former state.

    It is frankly ridiculous to act like a form of poor health is OK, as long as everyone else is unhealthy too. “Oh, you’ve got cancer? No worries, that happens to lots of people! It’s not really a disease, it’s a fact of life!” 

    Normalizing things that make people unhealthy is not what is needed. We might not be able to resolve these issues now…but if we simply accept them as facts of life, we resign ourselves to unnecessary limits on life and livelihood.

    The goal of the medical profession is to improve health, not to rationalize diseases because they are more common or difficult to treat than we would prefer.

  • BionAlexHoward

    Good post. I really hate the prevalence argument. Obesity is a bodily state with negative repercussions on physical, mental, and social health. That fits MY definition of a disease. High prevalence doesn’t magically make something bad into something good.

    There’s another relevant disease, this one with 100% prevalence. It’s called aging. As much as we try to moralize aging with denial or dubious promises of immortal afterlife, no one can say that an aged body is not disabled in various ways relative to its former state. The fact that it happens to all of us does not make it any better.

    It is frankly ridiculous to act like ANY form of poor health is OK, as long as everyone else is unhealthy too. Imagine an oncologist saying, “Oh, you’ve got cancer? No worries, that happens to lots of people, so it’s not really a disease, it’s a normal fact of life.” 

    The goal of the medical profession is to improve health, not to rationalize diseases simply because they are more common or difficult to treat than we would prefer. So yes, I consider obesity a disease because it reduces health, and I don’t care that that means most of America has a disease right now. The truth hurts, but it is our job to tell it.

  • ErnieG

    Actually, the goal of medicine is to diagnose and treat medical disease. It is not necessarily to cure disease, which we can and often, do. Improving health is another matter.

  • Observer

    “A study last year showed that only about half of primary care doctors felt competent to deal with their patients’ obesity.”

    Based on the stats of likelihood of maintaining a sustained weight loss, about half of the respondents to that survey are wrong. But it’s not the half who felt they weren’t competent.

    Unless “deal with” means something different than “get rid of”, I suppose.

  • drll

    It is for drug companies and that’s what counts.

  • Sergio Balcazar, MD

    Yes!!!
    Obesity is a disease. But don’t blame it to your genes. Do not even blame it to stress. Obesity is not either a Degenerative Disease. It is, plainly said, a Lifestyle Disease. It is the result of Addiction to Food and Taste, addiction to sugary drinks, also the result slothfulness. Logic tells us that obesity, like any other addiction is the result of a poorly trained frontal lobe.

    • Dorothygreen

      Obesity by definition is Excess Adipose Tissue. From 40 to 80% of humans have it in depending on the eating culture of their country or at different times in their life. Adipose Tissue is regarded as an organ. I guess at some point it can cause anorgan dysfunction but I can’t see why “the word is even used”. It comes from a Latin word obesus which means in simple translation to intensely overeat – a verb. That would be the “condition”. It would also be an addiction – an eating disorder. And what are the substances or activity that one becomes “addicted” to. Consumption and as you mention – sugary drinks but there are folks with EAT who do not drink sodas but other potentially addictive substances – unnatural fats, high sodium foods that are also nutrient poor.

      Using this word as a disease to try to get insurance companies to pay is not the way to go. They will be paying doctors and hospitals anyway (no more pre-exiting conditions) for the chronic preventable diseases and ultimately the income tax payers, employers will get the bill. We are now. It is part of the waste in health care along with the fraud and abuse.

      Physicians should get behind an effort to reduce the consumption of the substances that are so highly palatable because they are cheap and laden with sugar (including refined grains), unnatural fats (much created by corn), and added sodium. The genetic predisposition is just being human because we have taste buds for sweet, fatty and salty. Think about what happened when the medical community supported Dr. Koop and the tobacco model. We now have one of the lowest tobacco smoking rates in the world.

      It is going to take a lot of effort (the Bigs push back is probably bigger than the physician lobby and “we the people combined). But there is a growing grass roots community tto reform our eating culture and yes, that will mean while subsidizing the production and purchase of vegetables and fruits. It will also mean making them less expensive than processed foods – call it the RISK model – a RISK tax. My preliminary calculations show that over $100 billion along with other components of the RISK model will not only provide the money for the education, education and more education, but jobs – local farms, urban gardens, vertical farming and the many trained wellness workers needed.

  • soveery

    It’s a difficult question. If you study photos of Americans taken 50 years ago, the adult or child who is merely overweight is rare. But back then neither did we have the truckloads of processed food and snacks that we have today, nor all the advertising. I really believe that today’s advertising can’t be underestimated in its power to sway our behavior.

    • Andrew K

      Also remember, that 50 years ago, people didn’t have the internet or computers. No smart phones or gaming consoles. No jobs in the internet or technology markets like we have today, which require zero physical movement. 50 years ago, the manufacturing jobs were the cornerstone to our economy, jobs which involved physical movement everyday. It isn’t just that our food has become more processed, but also the sedentary lifestyles we have inhabited from the technology boom.

  • Noni

    A disease? No. An epidemic? Yes. The epidemic is based on poor lifestyle and diet choices from a young age.

  • lissmth

    Not a disease unless there is an underlying problem – like hypothyroidism.