Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
26 Jun

Is Obesity a Disease?

Is Obesity a Disease?You’ve probably heard that the American Medical Association recently classified obesity as an official disease. I’m still mulling the whole deal over, and I’m not quite sure what to think about the decision. First, what exactly is a disease?

A disease is defined thusly:

  1. A disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.
  2. A particular quality, habit, or disposition regarded as adversely affecting a person or group of people.

By those literal definitions, obesity could be considered a disease. It’s caused or characterized by disordered diets, disordered hormonal responses to food, and disordered energy intake/absorption/expenditure ratios. Furthermore, obesity can lead to other, worse diseases, like heart disease, diabetes, and cancer. It’s also a “quality” (a preponderance of body fat) that adversely affects a person (increases the risk of other metabolic diseases, increases impact on joints, impairs physical ability, etc.).

But I’m not sure if obesity is actually a disease in the sense that most people imagine it, nor am I sure it should be called that. When people hear words, they don’t consult the dictionary to determine their meaning and mount a response. Unless it’s for language class, they care not for denotations, but rather connotations – commonly held cultural or emotional responses to words or phrases. This tendency of ours is not by choice. It’s simply how language works in the real, immediate world made up of actual thinking, feeling humans. So, what are a few connotations aroused by the word “disease” and how might they affect an obese person’s response to such a “diagnosis”?

Diseases are:

Immutable – A disease “stays with you.” Everyone knows that. It’s here to stay, and nothing’s going to change that unless you’re taking some serious pharmaceuticals or surgical interventions. You, a layperson, couldn’t hope to get over a disease all by yourself. Why try?

Deadly – You get over sicknesses, which are just minor annoyances. But diseases kill. This will either light the fire of god underneath you or fill you with despair.

Out of your hands – Disease strikes. It acts upon you, and you have no say in the matter.

Diseases require:

Medical intervention – You can’t beat this by yourself. A medical professional – an “expert” – needs to intervene and save you.

Pharmaceuticals – You’re probably gonna need a pill or three to get over or manage this, costs be damned.

In other words, for many people, having a “disease” may remove their sense of urgency and give them the idea that they need someone else to fix their problem. They can’t fight it, so why even try? Though other people may be motivated to “cure” their disease, they’ll likely do so through “official” routes, i.e. doctors, prescriptions, and dietitians. You could get the odd professional who has actually delved into nutritional science and won’t tell you to cut out the butter and eat more whole grains, but I wouldn’t bet on it. Either way, the obese end up frustrated with the ineffectiveness of the prescribed plans or resigned to their condition. And probably still obese.

That’s too bad. Obesity is preventable. It is avoidable. And, once “afflicted” with the “disease,” the obese can cure it simply – but not necessarily easily – through lifestyle modification.

I’m torn, though. While obesity is largely up to the individual, I see no reason to make obesity a moral failure worthy of social stigmatism, and calling it a disease may help in that regard. We individuals have gotten bad advice – advice that we’re supposed to draw upon to make health decisions – from the experts to whom we bend the knee. We’re told to “eat less” and “move more,” we’re reminded about “diet and exercise” (without any useful details, as if everyone already knows what’s healthy), that you just need to flex your willpower muscle, that fat people who stay fat just “want” to be fat, that eating animal fat and red meat will make us fat and give us cancer. I assume the same advice would be given to the medicalized obese to similar (non)effect.

Now, obesity is solely a problem of the body. This could be cool if they end up exploring the physiological origins of obesity with tons of research money, but I strongly suspect it will only lead to further ignorance regarding the external origins of obesity, like corn subsidies, lobbying from the processed food industry, the emergence of dwarf wheat, the pushing of the USDA food pyramid (what, you think the AMA’s gonna stop pushing their ideal dietary recommendations?), the preponderance of industrial seed oils and the subsequent condemnation of animal fat, the evolutionary mismatch between our genes and the modern environment, chronic stress, sleep disturbances, and all the other circumstances over which we have little to no control but which have immense consequences on our weight. Until the medical community accepts – or at least acknowledges as worthy of study – these factors, I fail to see how calling obesity a disease will do the obese any actual good.

I do see how it might cause some issues, though:

Now, the overweight kid in school isn’t just fat; he’s sick and fat. That will do wonders for self-esteem.

Now, instead of checking out a free Primal blog for helpful advice, the overweight single mother might assume she has to fork over the money for a physician-sanctioned registered dietitian. Ineffective advice that comes with a co-pay (if you’re lucky enough to have health insurance)? Awesome!

Now, the obese man won’t even think about looking into lifestyle modifications. He’ll just add the next big anti-obesity drug to his daily cocktail, right between the statins and the beta blockers.

I also worry about the legal fallout from this decision. Are people writing those free Primal (or any diet) blogs full of advice on losing weight now subject to governmental regulation because they’re dispensing medical advice regarding an officially recognized disease? A similar thing already happened to Steve Cooksey, who committed the egregious sin of dispensing nutritional advice to people with another recognized disease: type 2 diabetes.

I also question the motivations of the people ultimately responsible for the decision. As Dr. Davis wrote last week, the Obesity Action Coalition, a non-profit, spearheaded the initiative in order to “change the way the medical community tackles this complex issue that affects approximately one in three Americans.” Sounds nice, doesn’t it? Until you learn that the OAC board is made up of bariatric surgeons and the coalition is funded by pharmaceutical companies with big stakes in weight loss drugs and surgical supply manufacturers with big stakes in weight loss surgery. In other words, the very people who stand to make a ton of money from medicalizing obesity are responsible for medicalizing obesity. I don’t doubt that they care, on some level, about people’s health, but their motivations appear to be clouded by other interests, and that makes me wary.

As I said before, I’m torn. I don’t think obese people should be blamed or made to feel like moral failures. Even if it were true that all obesity is caused solely by personal irresponsibility, saying “you’re fat because you’re lazy and eat too much” simply does not help people lose weight. They “know” that; it’s the implicit message all around us. But I doubt this is the right way forward.

We need a balance, not a diagnosis. On one side is “obesity as a disease,” with patients assuming it’s out of their control and a medical intervention is necessary. On the other side is “obesity as personal failing,” with the obese feeling a deep sense of shame and hopelessness, especially when their willpower fails to deliver them to the promised land. But you and I and everyone reading this know that it’s a lot greyer than either position. We know that the real story is a tad more complicated.

What do you think, folks? Is obesity a disease? What impact will this decision have on obesity in this country?

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Some very good arguments have been put forth but isn’t it inevitable that society will eventually wake up and recognize that obesity is something we have done to ourselves through our misguided eating and lifestyle habits? The big shift will occur when enough of us Primal types have produced the results that have eluded the majority of society. In the mean time; let’s just continue to quietly succeed at letting nature take it’s course via the Primal approach.

    Gord, Vancouver wrote on June 27th, 2013
  2. Mark, do you consider Celiac a disease? While it’s technically not caused by lifestyle choices (technically, one has Celiac regardless of what they eat, it’s just that some things cause the autoimmune reaction), the only effective treatment for it is dietary changes. Thinking about such parallels may help your thoughts on the matter.

    Additionally, having a disease doesn’t necessarily give you a free pass to do nothing but pop a pill. If you’re Diabetic (Type 1 or 2), if you’re content with just shooting up with insulin every time you eat, so that you can eat all the crap you want, you’re going to end up destroying your body, very likely in a very gruesome, piece by piece way, as doctors try to save you from the gangrene and necrosis eating at you from your feet up. And even then, you still have to have enough responsibility to inject the correct amount of insulin, or you’ll just kill yourself right then and there with either too much (dropping your blood sugar level too low) or too little (and having your blood sugar skyrocket).

    That said, while I agree that the decision is a double-edged sword, I think there are some positives that you’re overlooking, and I can use myself as an example.

    As much as I’d love to be a PB success story, the simple truth of the matter is that I won’t be able to until I go on what you may consider “anti-obesity medications.” This is because, despite following the PB for the past year (and yes, being very active, and keeping my carbs down, and, for the “in vs out” crowd, eating less than I should be burning), I’m still obese, thanks to polycystic ovarian syndrome. PCOS, by nature, is nearly always has insulin resistance as a comorbid, and elevated androgen levels, both of which, in women, make it very easy to gain weight, and very hard to lose it. For me, it’s proven impossible to do so without medical intervention.

    I’ve been dealing with PCOS for at least four years, now. However, both my primary doctor and my gyn had decided that my being fat and not losing any weight was entirely my fault. That I wasn’t “trying hard enough” or that I “wasn’t doing it right” (because I wasn’t on Weight Watcher’s, or because I wasn’t engaging in Chronic Cardio). It wasn’t until I went in to see my doctor for pelvic pain (which my general doctor, despite diagnosing it as an ovarian cyst, never connected it with the other outward symptoms to even so much as question whether there was something deeper) and a follow-up with my gyn, where I had to specifically request the tests that would confirm that my weight issues were caused by elevated androgens.

    I went to both of them a year ago, trying to ask for the very same tests, only to be told that my weight was my own fault and that nothing was wrong with me (despite having elevated androgens and insulin resistance in the past). Never mind the fact that both my diet and exercise regimens should have seen the weight falling off of me. It wasn’t until just last week that one of them actually listened to me and ran the tests, which did, in fact, come back with badly elevated androgens and “impaired insulin sensitivity” (and that was after being Primal for the past year, and dropping my carbs under 75g for the past month or two!).

    I’m not saying this to say that I think obesity is a disease. However, I do believe that treating it as such could make it more likely that people like me would be able to get the medical help that we desperately need (and want! I don’t want to be overweight!), before it turns into a miscarriage, or cardiovascular disease, or endometrial cancer, or autoimmune thyroiditis, or even just another upward tick of the hundreds place on the scale. Perhaps if the medical community recognizes it as a “disease,” they’ll be more willing to try to find an underlying cause for a person’s weight, instead of being so quick to dismiss someone for “not trying hard enough” or “not doing it right” or otherwise blaming a person’s weight on motivational/willpower failures, despite a good faith effort to lose weight through making lifestyle choices that should support weight reduction.

    Shauna wrote on June 27th, 2013
    • To Shauna,

      As someone who suffered with PCOS much of my life, I encourage you to seek a progressive integrative or functional medicine practitioner….quite often, PCOS is actually a symptom of poor thyroid function. Do not let a doctor tell you that your TSH ‘is within range’. As a matter of fact, the TSH is rather useless for many. I encourage you to get your Free T3, Free T4, Reverse T3 as well as both thyroid antibodies – TPO and TgAb tested. You may find yourself with a reason why PCOS is still hanging on despite treatment and proper nutrition. The book – ‘The Hormone Cure’ by Dr. Sara Gottfried and ‘Stop the Thyroid Madness’ by Janie Bowthorpe are quite eye opening. Janie’s book literally saved me life. Good luck.

      Kathleen wrote on June 27th, 2013
      • Thanks for the books Kathleen. I have found a functional medicine practitioner, due to the issues I had with my old general practitioner, but I only just had my first appointment with her (in part due to the blow to my confidence created by having both my old GP and my gyn, who was the one who originally found out about my hormonal issues, blame me for not being able to lose weight). As such, I haven’t been able to *get* treatment, and I’ve been left on my own to handle the “proper nutrition” aspect.

        And that’s the point of my initial comment – most doctors are too quick to blame the person for their weight, even if they are, in fact, doing everything “right” when it comes to nutrition and exercise. Perhaps by making a declaration that obesity is a “disease” (or medical issue, not necessarily a result of someone being lazy and eating too much and not actually trying to lose weight), then some more attention may be paid to the real underlying medication issues that are keeping many people from being able to get the help they need.

        Shauna wrote on June 27th, 2013
  3. It is NOT necessary to “medicalize” something in order to avoid blaming the person with a health derangement. To do so is a flimsy excuse to financially exploit the condition. Once you “medicalize” something, the next step is justifying a pharmaceutical intervention. Once this is done you open the pathway for new drugs with fresh patents and lots of potential for $$$.

    The AMA does NOT represent physicians. Less than 20% of physicians are members. The bulk of the AMA’s income comes from the publishing of the CPT and ICD10 manuals that are used by government payers of healthcare (with commercial insurers following suit). The more diseases classified and coded means a more solidly entrenched Big Agra-Big Pharma-Big Medicine-Big Govt. Complex.

    It is entirely possible (and preferable) to reverse obesity without ever seeing a medical professional of any type. Your success stories archive proves this. Obesity by definition is therefore NOT what the AMA says it is.

    More to come in the Primal RX

    Doug McGuff, MD wrote on June 27th, 2013
  4. I don’t view Obesity as a disease but rather a worldwide environmental pandemic. The US is not the only place on the planet that obesity exists. I would question whether obesity is purely behavioral or a matter of calories consumed versus calories expended. Obesity is an economic, political, and biochemical problem.

    Before we jump the gun and add another disease diagnosis to the list of medically treatable diseases, I would suggest that we look at the food industry first. Maybe we could regulate the cost and quality of food being offered to people, and to strive to make wholesome foods free of chemicals, high fructose corn syrup, available and affordable for everyone. People living in inner city do not have access to fresh produce, plant fats, and quality wholesome foods. After we have tackled that problem subsidize foods for low income people that are wholesome instead of giving them the only option to eat energy dense, nutrient void fast and convenience foods. That by the way, means they need a refrigerator and a way to keep foods fresh. A co-op for inner city neighborhoods to store and obtain good food, perhaps…? For the people that cannot afford and do not have access to real food, eating fast, packaged foods is survival, leading to a biochemical, metabolic disaster. How is the medical profession planning to fix that?

    If physicians have an obesity code (insurance reimbursement) will they find the root of the problem or continue to treat the symptom with medication and surgeries?
    Is obesity really behavioral or is it first biochemical? I would venture to say it is environmental, biochemical which then becomes behavioral. If I drink coke cola because I don’t have fresh water, that is environmental. If my blood sugar drops because I drank the coke cola, then that is biochemical. Then if my blood sugar crashes and I grab another coke cola, is that behavioral?
    Because we have so many obese people living in the United States doctors want money from insurance companies to treat them. If the AMA does successfully push the obesity diagnosis through the insurance companies may go bust. Obesity is a 170 billion dollar a year industry. Mind boggling….Think about it….

    Lynn wrote on June 27th, 2013
  5. A “Big Pharma” executive walks into a bar and strikes up a conversation with the bartender. When the bartender finds out what kind of work he does he asks him what he thinks of the recent statistic that now 75% of Americans take a prescription drug every day. Does he respond like you or I would? Shocked? Incredulous? Nope, he says “It’s a good start”.

    Greg wrote on June 27th, 2013
  6. I only worry that the pharmaceutical industry will be the biggest beneficiaries. A pill isn’t going to solve this problem.

    Nathan wrote on June 27th, 2013
  7. On the question of Obesity as a potential disease, Dr. Peter Attia of Nutritional Science (NuSci) presented a similar topic at TED Med , and he proposed that obesity is more like a symptom of Insulin Resistance and/or Metabolic Syndrome, the causal factor being glucose overload, and, various body types in the human population’s inability to manage this overload in an appropriately positive way. See his presentation here:

    VinChristopher wrote on June 28th, 2013
  8. It’s well established that those who have managed to lose more than 5% of their body weight with “traditional dieting” will not be able to sustain that weight loss for more than 5 years. To that end, dieting for weight loss in the name of “health” has a 95% failure rate. Getting people thin for health is not evidence based medicine. In fact, an intense effort to lose as much as possible as fast as you can is a sure way to wreck your health.

    I watched my mother yo-yo diet for YEARS. She went from one extreme to another w/ weight w/ all manner of diets (many of those diet plans were medically supervised and 2 of those plans were low-carb). She was never able to sustain any amount of weight loss. In the end, her efforts at losing weight left her with a destroyed thyroid that had to be removed when it turned into goiter (one that went misdiagnosed for years as “just an underactive thyroid”), fibromyalgia, and restless leg syndrome.

    After her thyroid surgery, I was finally able to convince her to give up dieting and go back to eating real, traditional food (eliminating grains, CAFO meat products, and unfermented dairy) in order to relieve her pain, inflammation, and try to prevent anymore metabolic damage that could leave her with diabetes. She’s doing much better now and is a lot healthier, but she will never again lose anymore weight. She will always be overweight now simply because of what those years of dieting did to her body. What she can do is keep her weight stable, and that is a MUCH better road to travel than trying to constantly lose weight.

    Being fat in itself, is no indicator of health, nor is it a predictor of future health. It is much better to keep your weight stable, even if you forever remain fat, through good nutrition, moderate exercise, and as much non-toxic living as can be found in this toxic world, than forever striving to be thin.

    I, myself, subscribe to a health philosophy called “Health at Every Size,” which focuses on healthy behaviors, not weight loss. Because the reality is, permanent weight loss can never be promised, and you will be chasing an elusive dream and putting your long term health at risk attempting it.

    My personal story w/ Health at Every Size is: Over the last 2 years, I’ve lost about 20 pounds w/ out any real focus on weight loss, just eating nutrient dense, fresh, whole foods, honoring my hunger and eating until naturally satiated (Intuitive Eating–one of the tenets of HAES), and exercising moderately (I have a physically active job, swim a few times a week, walk whenever I can, and sometimes do yoga–that’s about the extent of my exercising–I will forever hate team sports, cross-fit, and weight lifting). Even after slowly losing 20 pounds, I’m still fat, and I am okay w/ that. Why? Because I know I’m practicing healthy habits to the best of my ability. If I never lose any more weight, that’s fine. I’m HEALTHY, and I have no reason to suspect that I will not remain healthy at my current weight. I also believe in the Set Point Theory for weight, in that everyone has a natural weight set point that their body will attain to under healthy conditions, and mine just may be 180# at 5’3″. Bodies come in all shapes and sizes, and everyone has a different set point.

    Health is different for everyone, and it is not weight dependent, nor is weight an indicator or predictor of health or future health.

    Labeling obesity a disease is an EPIC failure. Calling it a symptom is not any better, either. It’s a description of a body size that has no bearing on a person’s worth or health.

    Roxanne wrote on June 28th, 2013
  9. I tend to agree with your point of view. Clearly obesity is a major health concern for way too many people, but I find it hard to accept as a disease. Great write-up, I really enjoyed reading your perspective on this topic (not to mention the commentator’s opinions).

    Mel Terrance wrote on June 28th, 2013
    • Great stories. I just finished the book Fat Chance by Robert Lustig. It is a wonderful text on the politics, environmental, genetic, and biochemical nature of obesity in the world today. Not a disease, an environmental epidemic. People are struggling to make money these days. That means finding ways to make it. Physicians and the medical community are struggling too. Physicians are having to close their doors, or get into asthetics, offering weight loss clinics, antiaging services like bioidentical hormones, selling supplements and skincare, starting the concierge services..Making obesity a disease is a financial decision.

      Lynn wrote on June 28th, 2013
  10. Obesity is a 20th century-created disease entirely. The guilty parties: medicine, pharmaceutics, “”science”, and agricultural entities all enabled by ‘government’
    and this cabal remains entrenched in the 21st century!!!

    M.J. Brady wrote on June 29th, 2013
  11. I’ve seen a lot of comments that talk about two people doing all the same things but having different results as an argument for the possibility of obesity as a disease. I’m not sure how I feel on the main question, but I think we should all consider that everyone responds to stress differently and that two people on the same diet getting different results may relate to that. Changing to a a primal diet has been more stressful for me than my boyfriend. He’s lost more weight so far but he is also a low key person while I am pretty high strung and I also handle a lot of the food preparation which can be stressful too. I think science needs to also look at the mental aspects of weight gain and how one’s mental reaction to diets, eating, weight loss, and life in general may affect one’s ability to reach his/her goals. While I think there are some people with legitimate metabolism problems, I’m not sure that’s a category that most people fall into. I think there are more people who have an unhealthy relationship with food, especially mentally, whose cycles of guilt and stress as it relates to food may be more intense than others. I may be totally off here, but I think it’s worth pointing out and considering. For me personally, during periods of low stress, I almost lose weight effortlessly but can fight to lose weight under stressful conditions with nearly every fiber of my being with lackluster results. I don’t think what I’m saying applies in every case obviously, but could be worth looking at for those that are struggling.

    tgatz wrote on June 30th, 2013
  12. Classifying obesity as a disease just sends the wrong message to people.

    It’s only going to make a lot more people obese and more drug companies a lot more money.

    We need to educate people on the benefits to a healthy lifestyle and the consequences of obesity rather than merely providing ‘drug induced’ solutions.

    Peter wrote on July 1st, 2013
    • Many fat people already know that they are doing something wrong, like buying butter instead of margarine, getting the cheap mac&cheese mix instead of the one with invisible vegetables, going for bleached bread at three for one dollar instead of getting “whole wheat enriched” at one for three dollars, getting the “anything” dressing that isn’t marked “reduced fat,” etc.

      Of course, I am in favor of “counseling with a nutritionist” being covered.

      Kelekona wrote on July 4th, 2013
      • …You’re new here, aren’t you?

        Shauna wrote on July 4th, 2013
        • Or rather…please tell me you’re just trolling…

          Shauna wrote on July 4th, 2013
        • Being stupid to make a point… It’s like trolling in its obviousness, but it’s to lead to a conclusion. It’s like untagged sarcasm.

          They aren’t sheltered from common wisdom, so why are they not buying diet food? They’re not stupid.

          I was being serious about the nutritionist. They may still get the wrong advice, but at least the clients that aren’t scarfing down tubs of ice cream will get a “hmm, that’s funny.”

          Kelekona wrote on July 4th, 2013
  13. How might this potentially effect the supplement industry? Protein powders and weight loss OTC products, etc. Are these now going to be subject to FDA approval and required to be regulated as drugs? What might be the negative economic impact on those companies and lost jobs? Good for government coffers and their profiteering cronies?

    Jim Mau wrote on July 2nd, 2013
  14. Obesity is caused due to overweight.People are eating much more than they used to.

    jaideep wrote on July 5th, 2013
  15. A great and very useful article.I am sure now i can really improve my health after implementing these.Thanks for such a useful article.

    Nitin Trehan wrote on July 17th, 2013
  16. I’ve been mulling this “obesity-as-a-disease” over in my mind since I first heard of it. I’m also divided in my thoughts. Most comments I’ve seen on a variety of sites indicate people are mostly either outraged or dismayed by that designation. In some ways, labeling obesity as a disease seems to trivialize it, to me. I don’t like that part. And, as mentioned in this blog, it seems to open the door to yet another hopeless and demoralizing aspect of a condition we’re already mostly hopeless and demoralized about.

    However.
    If obesity is classified as a disease, with its associated and approved “coding” for the insurance companies… then perhaps those people who now are faced with out-of-pocket expenses (which many can’t afford, and therefore don’t utilize “treatment”) might have the option of treatment and counseling beyond the standard annual doctor’s visit. Reputable dietitians. Bariatric surgery (for those inclined go there) on medical advice, which may or may not be limited to the “morbidly obese.” Post-weight-loss tissue reduction, which is now mostly considered a cosmetic intervention which very few insurance providers will allow outside of fairly extreme medical complications.

    Some insurance providers do underwrite certain commercial diet plans. But what if diagnosis of the disease of obesity might open that to non-commercial plans, foods and lifestyle plans on your doctor’s recommendation – delivered with appropriate codes?

    I’m still divided as to whether I like or don’t like the possibility of the “disease of obesity.” But I’m also open to the idea that there could be some good things about it which just aren’t available to us the way the condition is currently promoted. I do have to wonder though… if these things I’m musing upon might indeed be part of the deal… why aren’t the insurance companies screaming? That, in itself, gives me pause.

    exotec wrote on July 20th, 2013
  17. I think it would be ok to call it a “disease” as long as the true cause (as we Grok-ers know it) is cited. Then perhaps the needed attention can be drawn to eliminating it in the best way – aka going primal.

    Shawn wrote on September 24th, 2013
  18. Hi too all, it’s in fact a nice for me too go to ssee this
    website, it contains valuable Information.

    Latesha wrote on April 21st, 2014
  19. If it’s a disease, can the CDC shut down McDonalds?

    Robin wrote on July 3rd, 2014

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