Obesity – a disease or not?
The American Medical Association (AMA) thought so when they classified the weight-related condition as a disease in 2013, but not everybody felt the same way.
The debate on classifying obesity as a disease is a historical one that stems from clashing perspectives on measurement methods and definition. But stick with me: let's figure this out together!
Image source: paperfury.com
The Obesity Yardstick
As Bruce J. Noble puts it, measuring obesity is difficult. Medical professionals rely on several measurement standards to deem whether a person is obese - the most prominent of which being body mass index (BMI) and waist circumference.
BMI calculates the mass of a person per square meter, giving a rough estimate of how physically fit he or she appears. Using this online calculator, you can check your BMI and see whether you fit in one or none of the American Society of Metabolic and Bariatric Surgery obesity classes.
A person’s waist circumference takes into account the measurement of their waist, just above the hipbones, and bodyweight. The biggest advantage waist circumference offers is that it measures how much of your waist’s bulk is due to a buildup of dangerous visceral fat. Use this free online calculator to find your waist-to-height ratio.
Individually, these measurements may not reflect a person’s true physique. For instance, the BMI of Arnold Schwarzenegger in his prime would be 30.2 which falls on the lower end of class I obesity according to the ASMBS.
Image source: ebaumsworld.com
However, his 30-inch waistline and 235-pound build would fall into the “healthy” category according to the US Department of Health and Human Services.
Together, the figures can give a truer depiction of a person’s figure. However, physicians should look at the patient rather than grouping them based on two calculations.
From the example of the Terminator and countless other professional athletes and bodybuilders, the numbers simply don’t add up.
Here’s the thing:
Nobody can produce a universally accepted definition of “disease.”
The Obesity Society attempted to do so in their 2008 position paper but ultimately concluded it was far too complicated to draw clear lines. Merriam-Webster’s definition of disease isn’t all that helpful either.
The AMA’s decision to label obesity as a disease was met with backlash from all over the place, including the AMA’s own Council on Science and Public Health. The council recommended that without a widely accepted definition, obesity should not be classified as a disease. Others attacked the decision by calling it “irresponsible.”
But as we already know, the AMA disregarded its own council and jumped the gun. Despite the lack of a clear definition and measurement standards, obesity is a disease in the AMA’s eyes.
For Obesity as a Disease
The central arguments from proponents of the 2013 AMA ruling focus on individual patients. It’s widely acknowledged that obesity is more complicated than taking in more calories than you can burn, and genetics may be the largest factor. Our genes can dictate our hunger levels which force us to eat more, thereby contributing to extra weight and obesity.
But perhaps the most noteworthy “blame the genes” argument is looking at a person’s basal metabolic rate (BMR) - that is, how many calories their body burns to fuel the most necessary bodily functions like breathing and maintaining body temperature.
In theory, slow BMR indicates that a patient is predisposed to weight gain and obesity in the future, but researchers from the Mayo Clinic shot this idea down.
Against Obesity as a Disease
The AMA’s 2013 decision was not met with unanimous cheers from the crowd, and opponents were quick to deliver a response on how obesity is not a disease. A majority of the arguments against the categorization are centered on how obesity is a risk factor.
Lee Stoner and Jon Cornwall in New Zealand released a paper one year later stating that obesity opens the door to dangerous health issues like cardiovascular disease and type 2 diabetes. David L. Katz of Yale wrote a piece stating that labeling one-third of the US population as physically and/or psychologically dysfunctional would have countless unforeseen ramifications.
Treatment options for obese patients would also take a huge hit. Diseases are typically dealt with by medication, surgery, and a number of different procedures which can create complications in the future. If obese patients are seen as “diseased,” bariatric surgery may be used as the first line of defense to get rid of surplus fat rather than as a last resort.
Another frequently used argument proposed to discredit the disease dilemma is that a person can be overweight while still being fit. Although this may have been true for Daniel Lambert, this is not always the case. Carrying extra weight for longer will shorten a person’s lifespan by up to 6 years compared to those of normal weight.
Impacts of the Obesity Disease
Living with extra weight around the hips can drive a person to a downward spiral of depression. The typical cause of unfathomable depths of despair is stigmatization where being ridiculed for having a less-than-ideal figure is commonplace.
Support groups like the International Size Acceptance Association feared that ruling obesity a disease was an invitation to further discriminate against the obese demographic.
An increase of “fat-shaming” since 2013 has yet to be found, but what is clear is that defining obesity as a disease did nothing to reduce the stigma. Some patients may have to continue living with the prejudice, neglect, and discrimination.
The silver lining is:
Labeling it a disease has forced insurance companies to recode their current policies and pay for obesity treatments and related health complications.
Hopefully, these new policy changes combined with a revamped healthcare system will reduce the obesity epidemic as it did to cardiovascular mortality.
So... What Do YOU Think?
The initial question still stands:
Is obesity a disease or not?
For the time being, as long as the AMA’s 2013 ruling is in place, there’s not much we can do.
And although the debate on whether obesity should be ruled a disease or not is ongoing, we can’t say that the AMA didn’t do anything right.
If anything, obesity as a disease has done a lot of good for the world – from prompting researchers to dig deeper in search the underlying causes (behavioral or genetic) of the condition to changing tight insurance policies.