Is Obesity a Disease?

 

In June 2013, the American Medical Association (AMA) House of Delegates voted to recognize obesity as a disease requiring treatment and prevention efforts. A number of other medical societies had sponsored a resolution to support this idea, including the American Association of Clinical Endocrinologists, the Endocrine Society, the American College of Cardiology, the American College of Surgeons, and the American Heart Association. The National Institutes of Health had declared obesity a disease in 1998.

The AMA's decision remains controversial, since the AMA’s own Council on Science and Public Health in 2012 said that there was not sufficient data to support calling obesity a disease. So then is obesity a clinical condition or a behavioral problem?

Right now, 42% of the population of the USA are obese (a BMI of 30 or higher). Another 30% are overweight. And despite spending $3.7B on weight loss products and programs in 2020 more than 70% of us are overweight and the number keeps growing year after year. Being overweight is a risk factor for over 200 chronic diseases including cancers, hypertension, diabetes, arthritis and heart disease.

In designating obesity as a disease, the AMA recognized that it is not simply a matter of choice and willpower but of a complex set of factors that include genetics, socioeconomic status, education, medications that a person may be taking, sleep quality and more. This does not negate the timeless advice to "eat less and move more". But it suggests that it is a condition serious enough to merit the attention of doctors and other healthcare practitioners. 

The stigma associated with obesity is also an important factor. No one who is obese does not realize it. But, unlike a person hobbled by arthritis or insulin dependence, they are often shamed and told to "just stop eating so much". There is no shame in needing therapy to treat a cancer but many obese people are too ashamed of their condition to seek help.

Another mitigating factor is the lack of insurance coverage for weight loss support programs. Considering the the serious and widespread negative public health impact of obesity this may seem strange. But as long as it is seen as purely a matter of personal choice and willpower, insurance companies are reluctant to provide coverage.

No one is saying that a healthy lifestyle that includes whole, nutrient-dense foods, exercise, stress management and restful sleep is not the foundation of weight loss. But many people are not able to succeed at it. Failing to recognize it as a serious health condition, if not a disease, worthy of support and attention from insurers, doctors, the healthcare community and society at large seems likely to allow the alarming prevalence of obesity to continue to grow.