Is Obesity a Disease?

[Fragile Bird]

I had mixed feelings when I heard the American Medical Association declared this past week that obesity was a disease. While I definitely know people who have medical problems that have contributed to their weight gain, for many people the cause is essentially a lifestyle issue, isn't it? And declaring obesity a disease won't help most of them, because there's no medication or treatment plan that will help, is there? Is this just not opening up the probability more doctors will become weight-loss coaches? Which may be a good thing, of course, but it seems like a whole new branch of the weight-loss industry just opened up.

This blogger expressed some of the thoughts that crossed my mind, though she was a lot more blunt (crude? cut and dried?) than my own POV, which is much more sympathetic to the issue than she appears to be:

This week the American Medical Association recognized obesity as a disease. One good thing about the change is that it should simplify procuring insurance coverage of treatments, programs, and drugs to help people whose weight is negatively affecting their health. But other than that, the decision doesn't have much to recommend it. While many obese people have serious metabolic and hormonal issues, some don't. Conversely, some healthy weight people suffer from the same metabolic and hormonal issues that we associate with obesity. In other words, though obesity may be a decent proxy for elevated health risks, it's not a disease in itself. Will pretending otherwise really cause people to afford the problem more gravitas, as is being claimed, or will it simply debase the currency of the "disease" label in general? And does any of it really matter if doctors are terribly equipped to treat obesity either way?

Given what a complex and emotional issue obesity is -- few other health conditions are so closely tied to self-image, social standing, and shame -- it would have been more constructive if the AMA had chosen to emphasize to the public that this isn't a clear cut problem. Are obese people powerless to help themselves? Obviously not. The healthy-diet and exercise mantra may sound trite, but it's been proven beneficial in reducing the risks for the conditions associated with obesity. Are obese people the sole authors of their own problems -- lazy over-eaters who just don't try? Obviously not. At least, it should be obvious from a look at the booming weight-loss industry. If achieving and maintaining significant weight loss were as simple as eating less and moving more, Jenny Craig would have filed for bankruptcy long ago. Innumerable individual variables such as genetics, endocrine function, metabolic efficiency, and personal history matter too. Until we recognize and acknowledge this grey area that obesity inhabits -- somewhere in between the black of disease and the white of individual choice -- we shouldn't hold out much hope for improving the situation.

Was this the right way for the AMA to go? Has any other country done this?

[kairparavel]

I'm watching Bill Maher and Michael Pollan and panel talk about this very issue right now. I don't think it's fair to suggest it's rooted in either underlying medical conditions or lifestyle. There's a lot going on besides those two options.

On the one hand, calling it a disease will lead people to believe there is some magic pill or elixir that will cure you (or kill you, as so many 'diet pills' have in the past). It will also somehow allow some people to take themselves off the hook for their lifestyle choices. But, having said that, some people will perhaps stop beating themselves up and realize there's more going on with them than just shoving food in their mouth and not moving around much.

This is super correct: Given what a complex and emotional issue obesity is -- few other health conditions are so closely tied to self-image, social standing, and shame -- it would have been more constructive if the AMA had chosen to emphasize to the public that this isn't a clear cut problem.

I'm overweight and have been for the bulk of my adult life. I can make poor food choices. Is it because I'm just dumb and lazy? Some people might think so. But it's so much more complex than that. I have such an unhealthy relationship with food and have since I was young child. It's often my greatest pleasure while also being my greatest shame. Something that can give me such a high and can then drop me to the floor and leave me there miserable. I often jokingly talk about 'eating my feelings'. Does that sound like an easy to fix problem by just telling me to put my fork down? And I'm just one person. Everyone has to eat, and everyone has their own relationship with food. There's an emotional aspect, socio-economic aspect, familial/traditional pressure aspect, addiction and just SO much information out there on food that contradicts itself.

Is it a disease? I suppose as much as smoking or gambling or alcohol consumption is a disease for some people

Is it a choice? I suppose as much as smoking or gambling or alcohol consumption is a choice for some people

I'm guessing the pharmaceutical industry is thrilled. And maybe the health insurance machine. And does any other country have the purported obesity crisis the US is experiencing?

The council summarized the arguments for and against calling obesity a disease.

One reason in favor, it said, was that it would reduce the stigma of obesity that stems from the widespread perception that it is simply the result of eating too much or exercising too little. Some doctors say that people do not have full control over their weight.

Supporters of the disease classification also say it fits some medical criteria of a disease, such as impairing body function.

Those arguing against it say that there are no specific symptoms associated with it and that it is more a risk factor for other conditions than a disease in its own right.

They also say that “medicalizing” obesity by declaring it a disease would define one-third of Americans as being ill and could lead to more reliance on costly drugs and surgery rather than lifestyle changes. Some people might be overtreated because their B.M.I. was above a line designating them as having a disease, even though they were healthy.

The delegates rejected the conclusion of the council and voted instead in favor of a resolution pushed by the American Association of Clinical Endocrinologists, the American College of Cardiology and some other organizations.

This resolution argued that obesity was a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like Type 2 diabetes and cardiovascular disease.

http://www.nytimes.c...-a-disease.html

[Fragile Bird]

Kair, it's really interesting, isn't it? The very same sentence you quoted was the one that leapt out at me. It is so damn complex. and the best of intentions can fail miserably. I really have mixed feelings about the decision. There seems to be too much "it's not my fault, someone else is to blame" going on in our lives. But maybe that's the first step to getting a lot of people to say "will someone help me then?" And surely that's a good thing?

[straits]

I had mixed feelings when I heard the American Medical Association declared this past week that obesity was a disease. While I definitely know people who have medical problems that have contributed to their weight gain, for many people the cause is essentially a lifestyle issue, isn't it? And declaring obesity a disease won't help most of them, because there's no medication or treatment plan that will help, is there? Is this just not opening up the probability more doctors will become weight-loss coaches? Which may be a good thing, of course, but it seems like a whole new branch of the weight-loss industry just opened up.

I was under the impression that obesity is a symptom to a number of different medical problems and lifestyle choices. Is that what constitutes a disease? And in that case, is low body weight considered a disease too?

[Fragile Bird]

Interesting point. Very often low body weight is the result of an illness, like anorexia or bulimia, or some other medical condition, but I don't think having a low body weight has been labelled a disease.

One of the articles linked in the OP blog talks about the fact there is no real definition of what disease is. And while lifestyle may contribute to you catching a communicable disease, like an std, or drinking and cirrhosis, which is liver disease, calling obesity the disease and not the result of a disease strikes me as being odd. But that may be because I don't know how that works, we need someone like Aemon Stark to comment.

[Blisscraft]

KP, FB - This is such an important discussion. Obesity is more than simply a pattern of behavior. Personally, as in my family, it seems more of an heritable condition established not only by our ancestors as to size, but also as to metabolism. Certainly, obesity is worthy of study and treatment whether classified as a "disease" or not.

[Lily Valley]

KP,

Great post. This will open the doors to research on this issue. Research can't exist in a vacuum, it needs funding. Future income from insurance companies and a healthier population will generate money for research. I can only see positives from this.

I think a comparison to addiction is a good example. Given a choice people would choose to be healthy.

Having addiction labeled as a disease made intensive treatment programs more accessible to people. Research into addiction showed that most addicts have a lower "normal" dopamine tone than non-addicts before they even start using. New medications are being used to correct problems with dopamine tone. Treatment programs are using medication and therapy to treat addiction along with long term follow up care. Even 15 years ago the only people who would help addicts were other addicts in recovery. Nobody else would touch it.

If the AMA actually monitored programs for obesity people might not resort to dangerous surgery or drugs. There also might be guidelines available to parents and schools to help prevent obesity in children. Another win.

In addition, the language used in discussing obesity is infuriating. It is as thoughtless and heartless as the language people still use to talk about addiction. This is slowly changing for addiction and I think the AMA's decision may start the ball rolling to change the tone of the conversation on obesity as well.

OP, nice topic.

[Hodor knows]

To me, saying obesity is a disease is the same as saying humans do not have free will. Sorry if that offends anyone, but it is that simple to me. I have been on both sides.

[awesome possum]

I think its a disease for a very small percentage of the people who are obese.

The rest... well, if bad diet and no exercise is a disease, then absolutely.

[Sci-2]

I would think it's a disease as much as alcoholism is a disease.

There must be various factors involved, but it seems a combination of mental and physical states that leads to an unhealthy outcome. Labeling it a disease seems to be an acknowledgement of that fact.

An alcoholic must own the disease and make a change, and ultimately so must someone who is obese. Neither disease presumes someone else is to blame. However I suspect in many cases there are people who, perhaps with good intentions or unintentionally, shifted the person into the lifestyle that contributes to obesity.

But ultimately it doesn't matter who or what came before, because the necessary change must be made by the person who is unhealthy. I don't say that in condescending sense - not trying to get on a high horse and make myself feel better for not being obese - but I think obesity is a disease where the cure ultimately lies in one's own self.

[straits]

I would think it's a disease as much as alcoholism is a disease.

Development of alcoholism requires intake of an unnecessary poison. Eating is a regular, daily function in the way that drinking (alcohol) isn't, so it's harder to separate the problem. There's a spectrum of good and bad food, whereas alcohol consumption is in comparison a binary choice.

[Guest]

This column touches on the comparison to addiction.

I definitely want to read more about this, but I had the same reaction as this columnist. Calling things diseases can be a bit confusing and often suggests something permanent or something that one cannot control, so it can sometimes be a self-defeating thing even if it was done with good intentions.

And a lot of heavier people already feel a lot of shame on the matter. Is telling them that they actually are diseased going to make them get motivated to take action, or is it going to make them feel hopeless? Probably some of both, but I would suspect that it's more of the latter than we realize.

But the research angle is interesting. I completely agree that this is complex, and I think the whole "calories in/calories out" idea is bunk.

[straits]

There's a couple of studies with results that have lead to disturbing conclusions wrt weight loss. This one claims that the number of people who lose weight without gaining most or all of it back soon after is statistically zero.

[TalalOfDorne]

Im no expert in the subject, but I don't think calling it a disease is a bit misleading.

To most people, a disease is something infectious, and I think thats what it does mean. Saying obesity is something you can catch from someone or something does sound a bit strange to me. I do believe the AMA has to at least explain what they mean by naming something that is mostly influenced by life choices, or is a result of other illnesses (Whether they are physical or mental), but like I said Im no expert on the subject.

[Guest]

I do not think that being infectious is necessary for defining disease. That said, it does not seem that society has a very clear-cut definition of the word "disease."

This is some of the pushback against the new DSM. People are worried about calling everything under the sun a disease.

[Sci-2]

I do not think that being infectious is necessary for defining disease. That said, it does not seem that society has a very clear-cut definition of the word "disease."

This is some of the pushback against the new DSM. People are worried about calling everything under the sun a disease.

I don't understand why is this a problem.

Once you acknowledge genetics and conditioning, wouldn't combinations of the two that lead to negative health outcomes be considered a disease?

[kairparavel]

Because obesity isn't necessarily itself a disease. It's not cancer. Or Alzheimer's. It's a precursor to several conditions which probably makes it more a sign than a disease. Obesity is the outcome. The disease is what's causing the outcome - addiction, depression. But sometimes it's socio-economic causing the outcome. And being poor isn't a disease. And neither is being lazy, which is another cause. So it's dangerous and confusing and an easy way out of trying to answer far more difficult and quite frankly, beneficial questions.

[lionhead]

The lionhead diet: Eat slightly less, exercise slightly more.

You should lose weight.

Not hard, if you eat it, you store its as fat unless you burn it off.

I say as a slightly overweight man.....Dam beer.

[Sci-2]

So it's dangerous and confusing and an easy way out of trying to answer far more difficult and quite frankly, beneficial questions.

How is it an easy way out? And how does considering it a disease prevent us from asking the difficult and beneficial questions?

Drug addiction is a disease, depression and anxiety are considered to be diseases. All three of those take a certain amount of willpower to deal with.

To me, acknowledge that a disease can be a combination of mental and physical states is a step forward. Do people think calling obesity a disease will lead to a significant number of obese individuals giving up on changing their lives?

[Ixodes]

A disease is anything that causes disruption in normal organ function. A disease can be defined by pathologies that create a series of clinical signs, creating a reproducible definition. Once the clinical signs are defined and understood, this leads to a logical approach to diagnosing/treating/managing the disease.

Obesity is most certainly a disease. It causes a host of clinical signs, including damage to blood vessels, disruption of hormonal balances, and altered mobility. More and more research shows that an obese individual will have altered hormonal and genetic changes that perpetuate the condition (some pretty interesting stuff is coming out of cat, dog, and rodent models). Without understanding these clinical signs, the prospect of successful treatment is pretty dim. And I think we can all agree that successful treatment of obesity would be a huge benefit to both individuals and society.

For those treating diseases and illness, placing a value judgement on a diagnosis is a minimally useful, often counterproductive, avenue. It doesn't really matter if a patient chose to create a disease state or not, what matters is how can we change the situation in order to promote health. In other words, I understand the obese dog sitting in my exam room was created and did not occur spontaneously. And it doesn't matter to me. All that matters is that I have evidence based tools and strategies that will help me move forward and improve the health of my patient.

This is where classifying obesity as a disease is helpful. Caregivers, researchers, and academia can more usefully study the pathology and evaluate different treatment strategies.