Why Classing Obesity As A Disease Might Be A Good Idea

Should obesity be recognised as a disease?

Why Classing Obesity As A Disease Might Be A Good Idea

Obesity rates are unprecedented in human history and should be regarded as a public health emergency.

The obesity epidemic started in the 1970s, initially in the US and subsequently spreading worldwide.

1 Approximately 60-80% of adults, and 20-30% children in most Western countries are now overweight or obese, which is unprecedented in human history.

2-4 Should this change be regarded as a consequence of individual choices (on a mass scale) or a disease affecting the population, and a public health emergency?

Obesity is not just a cosmetic or lifestyle problem. In parallel to the obesity epidemic, we have seen an increase of metabolic diseases, such as diabetes, non alcoholic fatty liver disease, not just in adults, but also in children.5 Currently, the global prevalence of diabetes is 8.

8% and pre-diabetes is much higher.6 Additional physical complications include osteoarthritis, cardiovascular disease and several cancers.7 Furthermore, the prevalence rate of eating disorders has also been increasing, and is now the highest among those with class III obesity.

8 9 A recent population-based Australian study examined the trends from 1995 to 2015 and found significant increases in the prevalence of both obesity (19 to 33%) and binge eating (3 to 11%). The highest increases were in the prevalence of obesity with comorbid binge eating (7.

3-fold), or obesity with comorbid very strict dieting/fasting (11.5-fold) 10

Despite intensive research, the causes of the obesity epidemic remain much debated.3 11 The prevailing view has been that this is a question of energy imbalance between input and expenditure. Whilst this may be true in principle, the calorie in and out hypothesis does not explain the reasons for the overconsumption that affects approximately 80% of the population.

The biological and metabolic effects of modern foods have been studied using the ‘cafeteria diet’ model in animals, in which researchers replace standard chow with human cafeteria foods: cookies, cereals, cheese, processed meats, crackers, all high in sugars, vegetable oils and additives.

Animals fed on these foods exhibit voluntary hyperphagia, which results in dramatic weight gain. Furthermore, cafeteria diet feeding promotes a prediabetic condition with elevated glucose, insulin, and nonesterified fatty acids, accompanied by decreased insulin tolerance.

In addition, chronically inflamed liver and adipose tissues and distorted pancreatic islet architecture develop.

12 13 Furthermore, the cafeteria diet has a profound impact on the gut microbiome, which, may be driving important features of metabolic syndrome14 by influencing host metabolism and can also affect brain function and behaviour through the microbiota-gut-brain axis.15 16

These experimental data mirror the human experience: since the introduction of ultra-processed foods, the majority of the population overeat. Furthermore, the same increase of low grade inflammation is seen in human metabolic disorders, and binge eating disorder.17

A recent, carefully controlled human trial confirmed that participants consumed 500kcal/day in excess when they were placed on an ad libitum, ultra-processed diet, as compared with a minimally processed one, with profound changes in metabolic parameters.

18 The appetite-suppressing hormone peptide tyrosine tyrosine (PYY) increased during the unprocessed diet as compared with both the ultra-processed diet and baseline. In contrast, the hunger hormone ghrelin, fasting glucose and insulin levels were increased during the ultra-processed diet.

This is a groundbreaking randomised controlled trial, demonstrating that ultra-processed foods lead to overeating in humans through altering multiple endocrine pathways.

The decades of guidelines promoting reduced calorie intake and increased exercise have been ineffective in halting the obesity epidemic,19 despite this message being amplified by the diet and weight loss industries.

The ‘eat less and exercise more’ message may have also contributed to the increasing rates of eating disorders, which affect now 4-6% of the population.

A recent large study showed since the 1980s BMI has increased for both genetically predisposed and non-predisposed people, confirming that the environment remains the main contributor to the obesity epidemic.11

Recognising obesity as a disease can transform public health policies, and clean up the food environment, which is harming the health of millions of people, and it can be cost effective for the economy by reducing health care costs.20

Source: https://www.bmj.com/content/366/bmj.l4258/rapid-responses

Scientists now think that being overweight can protect your health

Why Classing Obesity As A Disease Might Be A Good Idea

Around a dozen years ago, researchers noticed that some patients with chronic conditions such as heart disease fared better than others. This should have been encouraging news, perhaps a clue to future treatments. Instead, researchers were baffled. Because the factor that seemed to be protecting these patients was fat: They were all overweight or mildly obese.

“When health-care professionals get their first nutrition books, there’s a chapter on obesity,” says Glenn Gaesser, director of the Healthy Lifestyles Research Center at Arizona State University. “And it generally says that fat people are unhealthy and thin people are healthy.”

Researchers immediately began trying to explain this “obesity paradox”—or, more often, to explain it away.

Carl Lavie, a cardiologist in Jefferson, Louisiana, was one of the first clinicians to describe the paradox. It took him over a year to find a journal that would publish his findings.

“People thought, ‘This can’t be true. There’s got to be something wrong with their data’,” he told Quartz.

“People thought, ‘This can’t be true. There’s got to be something wrong with their data.’”

Since then, dozens of studies have confirmed the existence of the paradox. Being overweight is now believed to help protect patients with an increasingly long list of medical problems, including pneumonia, burns, stroke, cancer, hypertension, and heart disease.

Researchers who have tried to show that the paradox is faulty data or reasoning have largely come up short. And while scientists do not yet agree on what the paradox means for health, most accept the evidence behind it.

“It’s been shown consistently enough in different disease states,” says Gregg Fonarow, a cardiology researcher at the University of California, Los Angeles.

The researcher who did most to kick off the debate, and in the process became the object of much of the pushback it generated, is an epidemiologist at the US Centers for Disease Control and Prevention named Katherine Flegal.

Together with colleagues, she looked at hundreds of mortality studies that included data on body mass index (BMI), which is calculated by dividing a person’s weight in kilograms by the square of their height in meters.

People with BMIs of more than 25 are classed as overweight, and those with a BMI over 30 as obese.

Researchers immediately began trying to explain this “obesity paradox”—or, more often, to explain it away.

Flegal found the lowest mortality rates among people in the overweight to mildly obese categories. It’s true that these groups are slightly more ly to suffer from heart disease and some other life-threatening conditions in the first place.

But many factors influence the lihood of a person getting heart disease. And a strong link between weight and disease only emerges among people with severe obesity.

So taken at face value, the results seemed to be showing that a little extra weight is genuinely beneficial.

Flegal is a meticulous researcher: her most recent analysis incorporated data from almost 100 studies and close to three million people. It was published by the prestigious Journal of the American Medical Association. Yet Flegal’s work has made her a target for those who scoff at the paradox.

Walter Willett, a researcher at the Harvard School of Public Health who has taken a high-profile stance against obesity, told NPR that one recent Flegal study was “really a pile of rubbish” and that “no one should waste their time reading it.” (He was later admonished by the editors at Nature.

In recent comments to Quartz, he reiterated his view that the study was “rubbish.”)

Being overweight is now believed to help protect patients with an increasingly long list of medical problems.

Willett’s complaints are starting to look less credible, however, because no one has been able to make the paradox go away.

One of the most popular explanations is that fat people get more aggressive treatment than thin people, because their weight raises red flags at the doctor’s office.

This seems questionable: studies show that overweight and obese people tend to avoid doctors, get fewer preventive screenings, and receive worse treatment because they’re often misdiagnosed as “fat” rather than with a specific medical condition.

What’s more, at least one team has examined and dismissed the better-treatment explanation.

The researchers, led by a French endocrinologist named Boris Hansel, analyzed data on 54,000 patients who were at risk of stroke and heart attack.

The optimal treatment for these patients is well known: protective drugs statins and beta-blockers. But mild obesity seemed to protect at-risk patients whether or not they were taking the drugs.

Another potential explanation is that the data on people of normal weight are skewed. Researchers know that people tend to lose weight toward the end of life, but don’t always realize that they are sick.

Smoking also makes people thinner and sicker.

So, goes the theory, maybe researchers have inadvertently lumped mortally ill people and smokers in with healthy folk of normal weight, thus making the normal weight group look less healthy than it really is.

No matter how many ways Carnethon sliced and diced the data, the obesity paradox persisted.

There’s some evidence to back up this argument, but the studies on the issue are far from clear. The argument certainly does not seem to make the obesity paradox go away, at least according to Mercedes Carnethon, an epidemiologist at Northwestern University who has analyzed data on diabetes patients.

Carnethon began by excluding patients who died within two years of diagnosis, to account for people who were already sick but didn’t know it; she still found higher mortality rates among thin people. Then she ran the data separately for smokers and non-smokers; still no difference. No matter how many ways she sliced and diced the data, the obesity paradox persisted.

(Flegal also ran her data with and without smokers, and found no difference.)

If the paradox is real, and extra weight can bring benefits, what constitutes a healthy life? Is there any point trying to diet to lose weight, for example?

Researchers are divided on the public health implications of the paradox, but the approach that makes most sense to me is Health at Every Size. This is the idea that healthy behaviors, including nutrition and physical activity, matter more than weight.

Healthy behaviors, including nutrition and physical activity, matter more than weight.

Take exercise. Paul McAuley, a health education researcher at Winston-Salem State University in North Carolina, has been studying fitness for close to 20 years.

He says most studies on weight and health fail to take it into account. “Or they ask one question about it,” he says, and don’t bother to go further.

When McAuley collects data on fitness, he finds that it predicts health and longevity much more strongly than fatness.

Other researchers have found that Health at Every Size, when compared with a weight-loss approach, leads to lower cholesterol, blood pressure, and other metabolic markers. “We’re so stuck on the fact that the only way to mediate health is through weight,” says Linda Bacon, a nutrition professor at University of California, San Francisco and author of a book on the approach.

If Health at Every Size is taken up more widely and continues to deliver results, we may look back and conclude that the most disturbing element of this controversy is that it was a controversy at all.

We don’t know as much as we would about the complex relationship between weight and health. We don’t know for sure what the obesity paradox means and how to interpret it.

Why does it inspire so much pushback?

“We’re so stuck on the fact that the only way to mediate health is through weight.”

“People are furiously looking for some way to make this not the case,” says Deb Burgard, a clinical psychologist in Los Altos, California who treats eating disorders. “And I think that bears some comment.

Theoretically we should be very happy to find out that people aren’t dying the way we thought they were going to, that there’s not going to be this terrible outcome. That people at higher weights are going to be OK.

Even scientists whose own research has identified the paradox often seem ambivalent about the possibility that it might hold true.

Carnethon has published several studies documenting the link between overweight or obese and better survival rates among people with type two diabetes.

Yet nearly every researcher I’ve interviewed on the subject, she resists the idea that fat might not always be unhealthy. “We’d never want to back away from weight-loss recommendations,” she says.

Lavie, who recently wrote a book on the paradox, also seems to buy in to the idea that everyone should aim for a BMI in the normal range. “People who are lean develop heart disease despite having a perfect body composition,” he told Quartz.

But where did this definition of “perfect body composition” come from? People of all sizes develop heart disease, and fat people with heart disease tend to do better overall than thin people with heart disease. Maybe the real paradox here lies in our assumptions about what constitutes normal weight.

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Source: https://qz.com/550527/obesity-paradox-scientists-now-think-that-being-overweight-is-sometimes-good-for-your-health/

Obesity should be recognised as a disease, medical experts say

Why Classing Obesity As A Disease Might Be A Good Idea

A number of medical experts are calling for obesity to be classed as a disease in order to encourage people to seek treatment.

John Wilding, professor of medicine at the institute of ageing and chronic disease at the University of Liverpool, and Vicki Mooney, executive director of the European Coalition for People living with Obesity (EASO), argue that the view obesity is “self-inflicted and that it is the individual’s responsibility to do something about it, is “inaccurate” and reinforces stigma around being overweight.

Instead, the pair believe that the role played by genetics combined with the illnesses created by obesity, such as Type 2 diabetes, high blood pressure and some cancers, means it should be defined as a disease.

Sharing the full story, not just the headlines

According to the NHS, obesity is thought to affect around one in every four adults in the UK, and roughly one in five children aged 10 to 11.

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A girl looks over at the artist, seeming to size her up The performer has taken thousands of photos over six years Morris-Cafiero’s photos have provoked mixed reactions Women crossing a street cast their gazes in Morris-Cafiero’s direction

Body mass index (BMI) is widely used as a simple and reliable way of finding out whether a person is a healthy weight for their height.

For most adults, the NHS states that having a BMI of 18.5 to 24.9 means you’re considered to be a healthy weight. A person with a BMI of 25 to 29.9 is considered to be overweight, and someone with a BMI over 30 is considered to be obese.

Wilding and Mooney add that the Oxford Dictionary supports their argument with its definition of disease as “a disorder of structure or function … especially one that produces specific symptoms … and is not simply a direct result of physical injury”.

They also state that obesity, in which excess body fat has accumulated to such an extent that health may be adversely affected, has been considered a disease by the World Health Organisation since 1936.

“Studies in twins show that 40-70 per cent of the variability in weight is inherited,” Wilding and Mooney write in the British Medical Journal (BMJ) to bolster the theory that obesity is influenced by genetics.

“Body weight, fat distribution, and risk of complications are strongly influenced by biology – it is not an individual’s fault if they develop obesity.”

The pair add that recognising obesity as a chronic disease with severe complications rather than a lifestyle choice could help “reduce the stigma and discrimination experienced by many people with obesity”.

They write: “Instead of discouraging them from seeking treatment it should give them permission to do so.

“The stigmatisation of obesity leaves patients fearful of discussing their weight, and they turn to fad diets or non-prescription medication because they assume that their obesity is solely their responsibility.”

However, not all medical professionals agree with Wilding and Mooney’s stance on the issue.

In contrast, Dr Richard Pile, a GP from St Albans, said the Oxford Dictionary definition of disease “is so vague that we can classify almost anything as a disease”.

Also writing in the BMJ, Pile argues that recommending a change implies that current NHS and public health strategies are “doomed to failure without classifying obesity as a disease“.

”Labelling obesity as a disease risks reducing autonomy, disempowering and robbing people of the intrinsic motivation that is such an important enabler of change,” Pile adds.

“It encourages fatalism, promoting the fallacy that genetics are destiny.”

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The debate in the BMJ follows calls from the Royal College of Physicians (RCP) in January for the Government and the NHS to urgently recognise obesity as a disease.

The RCP said it wanted to see obesity recognised as an ongoing chronic disease to allow the creation of formal healthcare policies to improve care both in doctors’ surgeries and hospitals.

It argued that obesity is not a lifestyle choice caused by individual greed “but a disease caused by health inequalities, genetic influences and social factors”.

Source: https://www.independent.co.uk/life-style/health-and-families/obesity-disease-genetics-diabetes-cancer-health-bmj-a9008091.html

Regarding Obesity as a Disease: Evolving Policies and Their Implications

Why Classing Obesity As A Disease Might Be A Good Idea

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Why Classing Obesity As A Disease Might Be A Good Idea

Why Classing Obesity As A Disease Might Be A Good Idea

Figures that show the scale of the obesity problem in the UK make for very grim reading. A World Health Organisation study in 2014 found that 28% of adults were classed as obese and 62% were overweight or obese, BMI measurements.

Then there are the stats on children in the UK, more than a third of whom leave primary school classed as overweight or obese.

On top of the problems it can cause individuals, obesity costs the NHS billions of pounds a year – and the situation is only expected to get worse.

The growing scale of the problem is an indictment of how the UK currently responds to obesity.

A new report from the All-Party Parliamentary Group On Obesity has found that on both a personal and organisational level the response to obesity is lacking.

According to the report, nine ten obese people have suffered abuse, criticism or stigmatisation because of their obesity, and the NHS is failing people with obesity by not offering enough treatment and prevention services.

There is no magic bullet for solving the obesity crisis in the UK, but steps clearly need to be taken. Coach spoke to John Wass, a professor of endocrinology at Oxford University, about what can be done to combat growing obesity rates, starting with the suggestion for government to ensure that a long, hard look at classing obesity as a disease and the effect this would have.

How would classing obesity as a disease help?

It would be really important that people who have an obesity problem are less stigmatised. We used to have a stigma with HIV – we don’t any more. Journalists, the general public and even the medical profession stigmatise people who have a weight problem, and don’t treat them everybody else. I think if it was a disease people would not think it was their own fault.

I think if you get cancer of the lung, it’s a disease. If you get cancer of the pancreas, it’s a disease. You don’t blame yourself for it.

If you have obesity and it’s a disease, you don’t blame yourself and give yourself a hard time. The fact is that genetics are a hugely important aspect of this.

If you have an appetite that is above normal or you don’t feel full so quickly as some, you’ll eat more. Those two things are genetically determined.

But self-control also plays a role in obesity?

Obviously there are other things, the availability of food or the amount of exercise people are taking.

It’s not just one thing and I think that’s important too, but unless we begin to tackle things one by one, then we won’t get control of the problem.

Our country has the highest levels of obesity in western Europe, some of the highest in the world, and it’s costing the NHS billions of pounds.

Do other places classify obesity as a disease?

In Holland, Portugal, Canada and America it’s classified as a disease. And we know that it has helped in America – it’s helped to destigmatise it and it’s helped to get people treated more readily. There are lots of aspects of making it a disease that will help people that already have a problem.

How else do you tackle the obesity problem?

There are lots of different things you need to do, but you’ve got to get going. You prevent it, that’s very important, but also treat it. You need to do both of those things.

What should be the first steps?

One of the first steps is to set up obesity services in every hospital in the country.

A multidisciplinary team – a physician, a specialist nurse, somebody who can actually help people exercise, a dietitian – all of those things are important.

Then people would have somewhere to go when they have a weight problem where they can get treatment. Treatment has been shown to be very effective.

Is the NHS not adequately supporting people now?

Only 50% of the country have access to obesity services, which is nowhere near enough.

Would stopping the advertising of certain foods help?

That’s a preventative measure which is important. Stopping advertising to children before nine in the evening has been shown to decrease the intake of junk foods.

Advertising junk food before nine makes the obesity problem worse in children.

A fifth of them go into primary school overweight, and a third of them come primary school [overweight], so there’s a huge issue there with people putting on weight during their schooling years.

It’s a preventative step that will carry over to when they are adults?

Yes. If a child is overweight they will carry it on as an adult, and they get more incidence of cancer, obviously diabetes, high blood pressure and heart disease.

Source: https://www.coachmag.co.uk/weight-loss/7518/why-classing-obesity-as-a-disease-might-be-a-good-idea

Is Obesity a Disease: Debate, Why & Who Is Defining It

Why Classing Obesity As A Disease Might Be A Good Idea
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Obesity is a complicated public health issue that medical experts are now acknowledging has multiple factors. These include physical, psychological, and genetic causes.

We’ll define obesity as medical experts currently do. We’ll also review statements and debate from the medical community about whether people should view obesity as a disease.

Major medical organizations consider obesity a disease, while some medical professionals disagree. Here’s why.

Doctors consider obesity to be a condition in which a person develops excess body fat, also known as adipose tissue. Sometimes doctors may use the term “adiposity.” This term describes the state of excess fat tissue in the body.

Carrying this extra fat can cause health complications, including type 2 diabetes mellitus, high blood pressure, and coronary heart disease.

Doctors use measurements body weight, body height, and body build to define obesity. Some of the measurements include:

Body mass index

The body mass index (BMI) calculation is weight in pounds divided by height in inches squared, multiplied by 703, which is used to convert the measurement to the unit of BMI in kg/m2.

For example, a person who is 5 feet, 6 inches tall and 150 pounds would have a BMI of 24.2 kg/m2.

The American Society for Metabolic and Bariatric Surgery defines three classes of obesity range of BMI:Disease of obesity. (n.d.). https://asmbs.org/patients/disease-of-obesity

  • class I obesity: a BMI of 30 to 34.9
  • class II obesity, or serious obesity: a BMI of 35 to 39.9
  • class III obesity, or severe obesity: a BMI of 40 and higher

A BMI calculator the one provided by the Centers for Disease Control and Prevention (CDC) or by Diabetes Canada can be a place to start, though BMI alone doesn’t necessarily say what’s healthy for each person.

Waist circumference

Having a larger amount of abdominal fat relative to the rest of the body causes a greater risk of health complications. So a person may have a BMI that is in the “overweight” range (the category before obese), yet doctors consider them to have central obesity due to their waist circumference.

You can find your waist circumference by measuring your waist just above your hipbones. According to the CDC, a person is at greater risk for obesity-related conditions when their waist circumference is more than 40 inches for a man and 35 inches for a nonpregnant woman.About adult BMI. (2017).
cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

After measurements defining obesity, doctors must consider what the term “disease” means. This has proven difficult as far as obesity is concerned.

For instance, a 2008 commission of experts from The Obesity Society attempted to define “disease.”Allison DB, et al. (2012).

Obesity as a disease: A white paper on evidence and arguments commissioned by the council of The Obesity Society. DOI:
10.1038/oby.2008.231 They concluded the term is too complicated to be fully defined.

Un scientific measurements that have an equation and numbers behind them, “disease” can’t have as much of a cut-and-dry definition.

Even a dictionary definition doesn’t clarify the term beyond the general. For example, here’s the one in Merriam-Webster’s:

“A condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”

What doctors do know is there is a difference in how the public, insurance companies, and various health institutions view a condition that many see as a disease versus one that isn’t.

In 2013, American Medical Association (AMA) House of Delegates members voted at their annual conference to define obesity as a disease.Kyle T, et al. (2017). Regarding obesity as a disease: Evolving policies and their implications. DOI:
10.1016/j.

ecl/2016/04/004 The decision was somewhat controversial because it went against the recommendations of the AMA’s Council on Science and Public Health.Pollack A. (2013). AMA recognizes obesity as a disease. The New York Times. https://www.nytimes.

com/2013/06/19/business/ama-recognizes-obesity-as-a-disease.html

The council had researched the topic and didn’t recommend that the delegates define obesity as a disease. However, the delegates made their recommendations because there aren’t reliable and conclusive ways to measure obesity.

The AMA’s decision sparked what is a continued debate on the complexity of obesity, including how to most effectively treat it.

Years of research have led doctors to conclude that obesity is a health condition that’s more than a “calories-in, calories-out” concept.

For example, doctors have found some genes may increase a person’s hunger levels, which leads them to eat more food.Adult obesity causes & consequences. (2017).
cdc.gov/obesity/adult/causes.html This can contribute to obesity.

Also, other medical diseases or disorders can cause a person to gain weight. Examples include:

  • hypothyroidism
  • Cushing’s disease
  • polycystic ovary syndrome

Taking certain medications for other health conditions can also lead to weight gain. Examples include some antidepressants.

Doctors also know that two people who are the same height can eat the same diet, and one may be obese while the other isn’t. This is due to factors such as a person’s base metabolic rate (how many calories their body burns at rest) and other health factors.

The AMA isn’t the only organization that recognizes obesity as a disease. Others that do include:

  • World Health Organization
  • World Obesity Federation
  • Canadian Medical Association
  • Obesity Canada

Not all medical experts agree with the AMA. These are just a few of the reasons some may reject the idea that obesity is a disease, given the current methods available for measuring obesity and its symptoms:

There’s no clear way to measure obesity. Because the body mass index doesn’t apply to everyone, such as endurance athletes and weightlifters, doctors can’t always use BMI to define obesity.

Obesity doesn’t always reflect poor health. Obesity can be a risk factor for other medical conditions, but it doesn’t guarantee a person will have health problems.

Some doctors don’t calling obesity a disease because obesity doesn’t always cause negative health effects.

A number of factors influence obesity, some of which can’t be controlled. While eating choices and physical activity level can play a role, so can genetics.

Some medical experts express concern that calling obesity a disease can “foster a culture of personal irresponsibility.”Stoner K, et al. (2014).

Did the American Medical Association make the correct decision classifying obesity as a disease? DOI:
10.466/AMJ.2014.

2281 Because doctors often want their patients to take an active role in their health, some worry classifying obesity as a disease may affect how people treat their health or think of their options and their abilities.

Defining obesity as a disease may increase discrimination for those with obesity. Some groups, such as the Fat Acceptance at Every Size movement and the International Size Acceptance Association, have expressed concern that defining obesity as a disease allows others to further separate and classify persons as obese.

Obesity is a complicated and emotional issue for many people. Researchers know there are many factors at play, including genetics, lifestyle, psychology, environment, and more.

Some aspects of obesity are preventable — a person can ideally make changes to their diet and exercise routine to build and maintain their heart health, lung capacity, range and speed of motion, and comfort.

However, doctors know that some people make these changes, yet still are unable to lose significant amounts of weight.

For these reasons, the debate over obesity as a disease will ly continue until other methods for numerically and reliably determining obesity emerge.

Source: https://www.healthline.com/health/is-obesity-a-disease

Why Is Obesity a Disease?

Why Classing Obesity As A Disease Might Be A Good Idea

February 8, 2017
By Melody Covington, MD

The American Medical Association (AMA) designated obesity a disease in 2013 and as a result, the idea that obesity is caused by insufficient willpower, lack of discipline, and bad choices began to transform. The headlines, “AMA Recognizes Obesity as a Disease” were catapulted across both academic and mainstream media.

Obesity was no longer a conversation topic tucked away in a dusty corner but was instead sprinkled across national news for the public to scrutinize.

From “TED Talks” to The New York Times, obesity specialists were asked to “weigh in” on this groundbreaking and somewhat controversial topic and to answer the question, “is obesity a disease?”

Now, four years later, the debate continues. Is obesity a disease? For some, obesity as a disease invalidates the importance of discipline, proper nutrition, and exercise and enables individuals with obesity to escape responsibility. For others, obesity as a disease is a bridge to additional research, coordination of effective treatment, and increased resources for weight loss.

According to Merriam Webster, a disease is “a condition . . . that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.

” In defining obesity specifically, one of the most comprehensive definitions is provided by the Obesity Medicine Association in the Obesity Algorithm.

Obesity is defined as a “chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

Individuals with obesity have an increased accumulation of fat not always attributable to eating too many calories or lacking physical activity.

Individuals with obesity experience impaired metabolic pathways along with disordered signaling for hunger, satiety (the feeling of fullness), and fullness (the state of fullness).

For many, efforts to lose weight are met with unyielding resistance or disappointing weight regain. This is demonstrated by the follow-up body composition results of contestants on “The Biggest Loser.

” As contestants lose even as much as 230 pounds, their body’s response is a slower and less efficient basal metabolic rate. This occurs in an effort to return the body to its previous condition of obesity; it’s a counter-effort by the body that makes weight gain easier and weight loss harder.

The pathology of obesity is vast and varies the cause of weight gain. There is not just one type or cause for obesity. Obesity sub-types include congenital, stress-induced, menopause-related, and MC4R-deficient, to name a few.

Obesity is related to genetic, psychological, physical, metabolic, neurological, and hormonal impairments. It is intimately linked to heart disease, sleep apnea, and certain cancers.

Obesity is one of the few diseases that can negatively influence social and interpersonal relationships.

Why obesity is a disease is becoming more evident as we increase our knowledge of fat mechanics. To successfully confront the obesity pandemic will require attacking the disease and its manifestations, not just its symptoms.

Do you consider obesity a disease? At the end of this Medscape article, you can take a short survey and view the results to find out where you stand compared to other physician specialties.

Is obesity a disease or a disorder?

Obesity is a chronic disease. According to the Centers for Disease Control and Prevention, obesity affects 42.8% of middle-age adults. Obesity is closely related to several other chronic diseases, including heart disease, hypertension, type 2 diabetes, sleep apnea, certain cancers, joint diseases, and more.

Is obesity considered a chronic disease?

Yes. Obesity, with its overwhelming prevalence of 1 in 6 adults in the U.S., is now recognized as a chronic disease by several organizations, including the American Medical Association.

The Centers for Disease Control and Prevention (CDC) defines chronic disease as conditions that last one year or more and require ongoing medical attention or limit activities of daily living, or both. Three leading chronic diseases are heart disease, cancer, type 2 diabetes.

Obesity is associated with all three of these chronic diseases.

CDC also acknowledges widespread consequences of obesity when compared to normal or healthy weight for many serious health conditions, including all causes of death, hypertension, diabetes mellitus, coronary heart disease, stroke and many cancers. Of the $3.3 trillion spent annually on medical care for chronic conditions, obesity alone is associated with $1.4 trillion.

Numerous studies support a strong link between obesity and mental health. This relationship appears to be bi-directional; while mental health disorders increase the risk for obesity, having obesity also increases the risk of mental health disorders, especially in certain populations.

Mental health disorders can increase the risk for obesity for several reasons: 1) Medications used to treat psychiatric illnesses can cause weight gain and insulin resistance, contributing to obesity; 2) Mental illnesses affect behaviors such as decreased sleep, poor eating behaviors, and reduced physical activity, which can contribute to the development of obesity. Conversely, having obesity increases the risk for depression. This is ly due to numerous complex factors, including poor self-image and depressed mood in response to weight bias and stigma, decreased activity due to joint and back pain associated with excess weight, and biological disruptions caused by chemicals secreted by fat cells when a person has obesity. The link between obesity and mental health is complex and multi-faceted. It is important that patients with mental health disorders are monitored for weight, and that people with obesity are screened for mental health disorders.

Source: https://obesitymedicine.org/why-is-obesity-a-disease/