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June 26 2013

Is Obesity a Disease?

By Mark Sisson
217 Comments

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?

TAGS:  Big Pharma

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217 thoughts on “Is Obesity a Disease?”

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  1. It’s certainly going to put an extra burden on health insurance premiums and it’s not going to make the doctors any smarter or ethical about accepting the truth. Low fat, high grain intake here we go again!

    1. It’ll make doctors far more unethical… obesity-related disease is the top health concern in this country, and now it’s s disease.. here come the major pharmas coming out with obesity cures, and treatments.

      1. Yes indeed. A huge untapped market to exploit.

        How very sad and scary.

      2. Nothing MAKES a doctor unethical if he or she didn’t start out that way. An unethical doctor is unethical independent of the interests of pharmaceutical companies.

        I won’t say that there aren’t unethical doctors, because there certainly are, but most doctors are still doctors because they want to help make people healthier. Magic pills became the answer with the advent of antibiotics in the forties, and physicians truly believed that the new pharmaceuticals would soon cure every disease: infectious diseases that killed more frequently than anyone in the US today can fathom. The notion of self-healing was shunted to the side of medical education when children were still dying regularly of tetanus infections, to make way for antibiotics and vaccination as the saviors of mankind. The pattern has unfortunately persisted (except in osteopathic medicine, which does promote the idea of self-healing) but the resistance of medical education to change doesn’t make all doctors inherently unethical. It urges a change in the way that medicine is taught, learned, and practiced.

        1. I agree. A system can also be inherently unethical though. And the system we have whereby vested interests pervert scientific investigation and corrupt political process to manipulate public health policy as well as honest and intelligent individuals is inherently unethical in my opinion.

    2. First thing that entered my head too when I heard that report, great another preventable illness my healthy butt gets to pay for. I think they should offer health insurance refunds (even a partial refund) for those of us who take care of ourselves and don’t drain the system.

      1. Some insurance companies have “wellness” programs. At an old employer, the insurance company offered up to a $300/year refund to anyone who bothered to take the right steps… it was really basic, i.e. go to your Dr for a healthy check up, and have your FBG, cholesterol, BP, and maybe a couple other factors tested. IF your results fell into specific ranges you’d get various credits back (healthier ranges = more $$).

        1. Ahh Josh, here’s the problem with company Wellness Programs- the qualifying factors for the refund…do your cholesterol levels, etc, fall into AMA guidelines ? ( that was a generic your

          Aka -where big Pharma would like to medicate your levels to? A lot of primal people who are perfectly healthy, indeed optimal, have total cholesterol over 200/ LDL over 100 ( 70 for some guidelines)

      2. Careful, Teri, that’s a slippery slope. I’m sure the folks I work with (and share our pooled premiums) would say that my hit and run bike accident was preventable if I had just driven to work. I don’t mind covering the cost of my coworkers blood testing strips as long my hospitalization is also covered!

        1. Good point, Kate. A lot of things could be considered preventable. Malaria? Sorry, you shouldn’t have vacationed in Africa! Food poisoning? Sorry, you shouldn’t have had that salmon! Yeah, let’s not go down that road.

    3. That is the point of designating it as a disease – insurance. Now that it has been classified as a disease, the cost of treatment, dietary items, visits to the gym, can be submitted to insurance. Watch costs skyrocket there.

    4. Almost all chronic disease emerges from the interaction of three variables: genetic vulnerability, lifestyle choices, and environment. At this point there is little we can do about genetic vulnerability. For many diseases, like diabetes, ideally we follow advice to make the best choices, but over time much of that advice is simply wrong or we don’t respond to the standard intervention. Finally, we have limited ability to alter our environment: among other things, we live in a culture that promotes and rewards risk-taking and ignores stress.

      To me it is important and useful to look at these chronic health problems from the disease perspective. We cannot eliminate chronic disease, so it must be managed. Using diabetes as an example, there is not a single intervention that can guarantee total remission in a specific individual – not one!

  2. is it true that this new obesity disease is diagnosed based on BMI? Since many of us believe that BMI as a true measure of “fatness” is flawed, and also many people here are pursuing a muscle building philosophy for exercise which leads to a high BMI, does that mean we’re going to be diagnosed as obese? This worries me.

    1. Body Mass Index should not be a determinant of body fat. mass does not equal fat. fat = fat. there should be a BFI (Body Fat Index).

      1. But actual fat body is hard to measure. BMI is a quick and easy division problem that Doctors can charge $200 an hour to calculate.

        True story: We got WII fitness a few years ago despite telling my in-laws we didn’t want it. We gave it a whirl. It weighed me and then I punched in my height. The “Me” that appeared in no way resembled my body shape. (Yes, I’m short and not a petite woman. 🙂 ) Anyway, it was a “delightful” demonstration of the hazards of BMI.

        1. Body fat is actually really easy to determine – it just takes a simple water displacement test. In other words, getting in a tank of water. How much would it cost for clinics to install giant measuring cups?

        2. Mantonat – I know it’s actually pretty easy, but it does require that tank of water. And the patient getting undressed, etc, etc. 🙂 The Docs have all the equipment they need right now to do BMI and no one has to get wet. And the tank would only have 1 use, unless it was also an emergency cistern. Thus body fat measurements look hard compared to BMI.

    2. And yes, you can have a low BMI and a high fat index. These people are in more trouble than the obese people.

      After all we know how to reduce weight, just disable or block the production of insulin and the fat just melts away. Probably better than bariatric surgery.

    3. Me too.
      I have long thought things such as insurance premiums should in no way be determined by BMI, yet they are.

      Every doc does a BMI on you and into your electronic health record it goes….and carries a lot of weight! Pardon the pun . Lol

  3. Referring to the beginning of your article, and the terminology of disease, I want to label the toxic food environment as a ‘disease’ of society – it might not be accurate but it feels right to me.

    1. Then just about everyone in this country would be diseased. Yea, sounds about right.

    2. I was actually going to say something along those lines but you beat me to the punch. Obesity is a symptom; not a disease. Very well put, Primal-V.

      1. I agree – obesity is a symptom; a symptom of bad nutrition. I’ve come to think of most of our modern “diseases” as symptoms of bad nutrition. The changes in my own health from changing what I eat is reflected every Friday by the story of the week and the major changes in their health from just changing what they eat. I tell people that my “health insurance is my diet”.

      2. I agree that it’s a symptom, and no more of a disease in it’s own right than “nausea” would be. I believe this points to the tendency of the mainstream medical community to treat symptoms, and the general failure to look at root causes.

        My husband has chronic pain, and sees lots of doctors. Their universal knee-jerk reaction is to give him pills to treat symptoms rather than do any root cause analysis. He told one he wasn’t sleeping well. He came home with a scrip for Ambien. The doctor hasn’t asked any questions about his sleep or routine. If he had, he’d discover that the man I love (who doesn’t listen to me nearly as much as he should!) drinks Red Bull after noon, is glued to a screen until bedtime, and eats a ton of sugar, all environmental factors that I think should be addressed well before jumping into pharma-land.

        Think if manufacturers worked this way. They see that they’re making a widget meant to hold fluid, but the machine pressing it puts a hole in the bottom. An efficient manufacturer would find the defective machine and stop the holes- a crap manufacturer would slap putty on the hole and call it good for market. Our doctors are masters of filling holes rather than preventing them.

  4. For me it boils down to the out of my hands comment. Here is my scenario. I am overweight….i struggle with it every day. I am losing and getting to where I want to be…again by my own decisions. I am in my mid 30’s and this is my life so far, by my choice. No one or nothing got me overweight but me. However at age 28 my wife was diagnosed with cancer. It was not a result of a lifestyle (we do not drink, smoke etc. healthy active folks yadda yadda yadda). Up until this she was the picture of health according to all CW charts, graphs etc. To me she was struck with a disease. something went wrong within her body that resulted in cancer. Not something she chose to do, partake in or not do (such as eat right and exercise in the case my weight change)…she had no derect control over the formation of the cancer cells the proliferation within and the resulting tumor….we did take control of the results and I am happy to say she is nearly 7 years cancer free….ahhh did you catch that?? is she really cancer free…no. because it is still there, lurking…and she could relapse, but she hasn’t, thank goodness.

    Not sure if any of this is making sense…but I do not think obesity is a disease because I can choose to be obese or not, in fact i feel i HAVE to choose to be obese or not. Until science can show me that no matter what I did i would have ended up overweight because of the conditions inside my DNA that are beyond my control I feel that obesity is a result of choice, not a disease.

    BTW my wife is now the mother of wo beautiful twin boys and we are pregnant again…most likely with twins again!! aint science grand!!

    1. I agree with this “until science can show me no matter what i did I would still be overweight because of conditions beyond my control.” I think that level of control needs to be looked at as a determining factor for something being a disease.

      Congrats on your wife getting healthy and the babies on the way. Sounds like your gonna be busy.

      1. Respect, but I don’t think I agree. For example, lung cancer is a disease but in most cases it’s very much preventable. As is asbestosis. AIDS. To name a few. They are caused by preventable exposure to substances or viruses. While, I totally agree with Mark’s post, I think obesity IS a disease whether it is helpful to view it as such or not.

        1. You don’t get rid of lung cancer or AIDS by changing your behavior. “Preventability” is only 1 factor named in the article.

        2. There are a number of self-inflicted diseases, such as those you name, although sometimes they aren’t preventable. Lung cancer, for instance, isn’t always caused by smoking or breathing second hand smoke. Smoking causes breast cancer too, but sometimes it’s the result of a genetic vulnerability.

          Alcoholism is considered a disease, although in reality it’s far more of an addiction. Does that mean the users of cocaine, meth, and heroin are also “diseased”? I don’t think they’re categorized as such. Mostly they’re called addicts. Maybe that’s because the use of alcohol is more socially acceptable; therefore it gets a kinder label.

          IMO, obesity is also more of an addiction than a disease, but is also more socially acceptable than drug addiction. Sometimes there are extenuating circumstances for being obese, but more often than not it’s a case of eating too much of the wrong kinds of foods. The various reasons for obesity don’t matter; the end result is always the same regardless of how or why a person got that way.

          Labeling it a disease is giving the obese person a crutch. Many of them will never make an effort toward weight loss if they think they have no control over their “disease”, so in the long run, the label isn’t a kindness at all.

    2. awesome Dan – glad things are going better for your wife- and I agree with your statement
      “Until science can show me that no matter what I did i would have ended up overweight because of the conditions inside my DNA that are beyond my control I feel that obesity is a result of choice, not a disease.”

  5. Can we label the AMA a disease?

    Obesity is NOT a disease, but rather a symptom–the most obvious symptom of carb overload. Metabolic syndrome is a collection of symptoms pointing to carb overload. This decision is more political than medical, and it will now allow doctors and Big Pharma to start profiting from people with carb overload.

    If it weren’t for the BMI scale, we would just be using the word “fat” and not the politically-correct term “obese.” Now we have people caught in the snare trap of obesity who aren’t even obese–just muscular.

    In their usual fashion, doctors will sell pills and procedures rather than find the root cause of the obesity and deal with that (like they know how!). They aren’t paid to teach people how to eat correctly–we have RD’s for that…and oh how they’ve done such a good job, right? Even their annual conventions are sponsored by fast food chains.

    1. This is exactly the first thing I thought when I read the news – Obesity is a SYMPTOM. It is a symptom of possibly dozens of ailments: depression, anxiety, PTSD, poor work-life balance, the list goes on.

      This isn’t rocket science. Most people become obese because they are addicted to food (more specifically, addicted to carbs and processed food-like substances). Addiction is most often a reaction to some sort of stressor in a person’s life. The medical community needs to learn to go upstream and treat the true cause of these conditions.

      1. Yep! My thought too. Obesity is a symptom of a constellation of other ‘diseased’ aspects of our society. Remove the ‘diseased’ life aspects and the obesity goes too. If you fix the food and the lifestyle, health follows.

        1. I go along with this in principle but not in practice. I have online friends also battling obesity, who, being completely primal/paleo in very strict ways can only lose a certain amount of weight before stabilising. Now it is much better to be 200 lbs than 400 lbs, but if your frame should only carry about 140 lbs then something is still wrong.

          I have to say that for these people it is rocket science – there is no logical reason they can find as to why their weight shouldn’t become ideal. They do detoxing, stress relief, meditation, IF from time to time, using amino acids and try anything that is suggested to make that final breakthrough, but to no avail. I’m not prepared to say they aren’t trying and it is somehow their fault for not improving their lifestyle.

          It isn’t that simple if one has a disordered metabolism.

      2. Dont forget many medications have the side affect of weight gain.

      1. Bing!
        I was hoping the article would go into what the fiscal consequences might entail; each decision similar to this (like declaring a place a disaster area) results in some change in where money flows and how non-government agencies can act. The Cooksey Condition was mentioned, but what does this mean on a larger scale? Since most government action is nested wholly in conventional wisdom (made from the mainstream opinions of the masses, most of whom are not fat because of their lifestyle choices, but because now it’s a disease they’ve mysteriously contracted) I don’t see things getting better.
        Government using more fingers for the prostate exam?
        No, I don’t see much good coming out of this.

  6. From the viewpoint that obesity alters hormonal processes I can understand how it is recognized as a disease. Hopefully – and I’m doubtful on this – it will open up funds for prevention like personal training and nutritional coaching but I fear funds will be mostly for medical interventions.

    Here is what I don’t want: people using the excuse of “I have a disease” for their bad habits.

    1. Even if there is funding for PT or nutritional coaching — those instructors are only as successful as their training. We have Nutrition Coaches that come in once a month to our office that speak to our entire staff to get us all on the “Healthy Track.” They have said: “calories is, calories out,” “sugar isn’t that bad” “wheat crackers are a healthy snack, as is peanut butter, graham crackers, cereal…” They tout the importance of cardio and as much of it. I shake my head at the preposterousness of it all and my coworkers eat it up — and have stayed fat, stressed, tired, irritable, etc.

  7. I view obesity as a symptom.

    It’s like “bleeding”. Neither a disease nor a personal failing, it is simply a result. Viewing obesity as a symptom will help us all discuss the potential causes of the symptom without presupposing what those causes are or assuming the same cause is true for each individual.

    1. I could not agree more.

      Sometimes it is a symptom of poor choices. Sometimes a symptom of impulse control. But a symptom it is.

      Cancer. That’s a disease.

        1. “Is lung cancer caused by smoking not a disease?”

          You don’t get rid of lung cancer by changing your behavior.

        2. Well, once you have the lung cancer, it’s rather harder to make it go away by quitting smoking…

      1. One could argue that cancer is a symptom of a weak immune system, since the bodies immune system is fully capable of preventing cancer when it functions properly, and our lifestyle choices have a huge impact on the state of our immune systems.

    2. +10

      Some of y’all seem to expect fat folk to KNOW that everything we’ve been told by the “experts” is dead ass wrong.

      Having been morbidly obese, I know from first hand experience that medical types blame the victims of GLUTEN INTOLERANCE (yes, many, if not ALL of us!) and low fat dieting for their own obesity.

      Since Hugs and I rejected medical advice, we’ve both attained “healthy” weights, better health, less pain.

      And family who are MD, and nurse practitioner have told other family that we are dying.

      The fat and the very unhealthy professionals.

  8. From Dr. Davis’s blog post: “After all, “healthcare” is nothing of the kind: It has nothing to do with health. Consistent with much the way healthcare is conducted nowadays, I call the healthcare system “The system to maximize profit from sickness.”

    So true.

  9. Will insurance now cover things like gastric bypass, liposuction, lap banding, and excess skin removal?

    When are they gonna decide AGING is a disease, so I can have coverage for plastic surgery and hair dye? 😉

    One day, they may even get around to declaring Paleo and Primal a disease, and then we can get our grass-fed, pastured protein/fat courtesy of our insurer…and then our policies would probably cost us around $10k/year just for our paid portion. And why not? Nobody else would ever DREAM of subsidizing our food!

    1. Insurance already covers lap band and gastric bypass for those that are diagnosed as morbidly obese.

  10. If Dr William Davis (Wheat Belly) is to be believed, modern wheat produces chemicals that act like opiates. Thus there could be an element of addiction to wheat-based obesity.

    Hence, I would categorise obesity in the same class as tobacco addiction, or any other drug addiction, with different side-effects.

    It is thereby subject to the same criticisms of the disease model as alcoholism.

    However, since the hunger can be satisfied by eating sufficient quantities of meat and fats, it is an addiction easier to break than tobacco, alcohol or opiates.

    My opinion: this is not so much a disease as a syndrome imposed by bad government recommendations based on junk science, similar to global warming – the saturated fats = heart disease theory, followed by the complex-carbs(grains) are good for you theory.

  11. It just kills me that the exact foods that cause obesity are first subsidized by our government to make us sick, and now the health insurers (through Obamacare) are going to be subsidized, as well as given other incentives, to make sure it never occurs to us to quit eating them!

    We’re all caught up in the middle of this Bermuda Triangle: Government at the top, Big Pharma on one side, and Big Food at the other. We’re floundering in the middle, and expected to sink or swim–maybe even swim well enough to find our way out of this triangle. Meanwhile, all three sides are throwing bloody CAFO meat into the waters to stir up sharks.

    1. Can’t get out of it. The big companies Kellog’s, Monsanto etcetera are selling at 20-50 * profit$ and there is little or no earnings beyond salary for real food. So if the profits diminish by 10% the value of the stocks goes down 2-5 times the profits or probably a lot more as investors get nervous. That’s a lot of money that just vanishes like the value of houses in 2008.

      Now real food employs more people, but profits not so much.

      Anyway the dogma is supported by social proof (everybody in the in crowd believes it so it *must* be true) and most of the pushers actually believe it and try to follow it in their lives.

  12. It is not a disease. Now, there could be other factors that contribute to obesity that are inherited and you do not have control over. But, I have friends that are overweight/obese and they would like to lose weight, but they don’t want to put forth the effort. A pill is so much easier than effort. By labeling it as a disease it further discourages individuals from taking their health into their own hands and making a change. And this is exactly what the medical and pharmaceutical industry desires.

  13. I got fat at seven years old. I didn’t suddenly change my diet. I didn’t suddenly quit playing outside. I just got fat. And I’ve been fat ever since.

    In a right-thinking world, someone would take a diagnosis of obesity and try to figure what it was about my metabolism that broke at seven years old. Certainly, years of CW diet and unending shame and guilt over being obese haven’t fixed it. Even now after being sincerely primal for over a year, I still haven’t successfully lost a pound. Yes, many things are better, much better, but I am still obese.

    Disease? Symptom? Cause? Effect? I personally don’t give a s**t. I just want to fix myself because if I haven’t learned anything in all my obsessive research in the past year, I do know this — my metabolism is broken.

    So here’s to going so strictly paleo it may make my teeth hurt — but I’m going to supplement with vitamin K2 by eating lots of liver. I’m going to be dunking myself in cold water and watching my circadian clock like a hawk. (Guess who I’m reading now??) I may have to just move to the rain forest and live in a hut to reclaim my inner hunter/gatherer.

    All I know is that I am obese. I have been obese for 40 freaking years. I am to the point where I truly wish I never had to eat again because food has caused me nothing but misery for my entire life. I am tired of being fat. I am tired of being ashamed of my appearance. I am tired of being so damned tired all the time.

    Diagnose what you will. I just want to fix myself.

    1. Rhonda, I can understand how you feel. I’ve also been one of those “big since a kid” people. You can literally see the weight gain once I entered the public school system, from kindergarten to first grade. I’ve been overweight ever since, and despite my best efforts, could not lose weight and keep it off.

      A first grader is not making the choice to be overweight. They’re a freaking first grader. And first graders get overweight because what is considered healthy by CW standards is actually make us sick and fat.

      Personally, I’m unsure of whether I agree with the disease label. And like Rhonda I honestly am not sure I care. What I hate seeing are all the comments from people who have NEVER struggled with being overweight (and I mean REALLY overweight) saying that it’s a choice to be fat and it’s easy to fix. I would think most of us here know that it’s actually NOT that easy, and it’s not always our choice to be overweight.

      Anyway, I really appreciate this comment, Rhonda…”Disease? Symptom? Cause? Effect? I personally don’t give a s**t. I just want to fix myself…” Exactly. I think you’ve come to the right place. Best of luck to you.

      1. “What I hate seeing are all the comments from people who have NEVER struggled with being overweight (and I mean REALLY overweight) saying that it’s a choice to be fat and it’s easy to fix. I would think most of us here know that it’s actually NOT that easy, and it’s not always our choice to be overweight.”

        In fairness, we all speak out of our own experiences. For most people, it *is* a choice, because their metabolism isn’t messed up. Their metabolism is responding in a normal way to carb overload, which is to pile on the fat. (Although it’s totally possible eventually to mess it up with this course of action.)

        That’s why this decision to call obesity a disease is so unfortunate. As usual, the AMA is all about treating/calling the symptom the disease. The unchangeable issue here is that you and Rhonda have metabolism disorders. The expression is body fat and a host of other issues (Rhonda mentions tiredness).

        If you’ve never read it, I’d encourage you to read Dr. Atkins New Diet Revolution. Not for the diet — skip that part and read about resistant metabolisms. Quite often he’d have do something more with his patients than just stick them on his diet plan. He discusses, for instance, a combo of supplements and using a “fat flush” etc.

    2. Rhonda,
      My heart breaks for you. I too was a perfectly-sized beautiful little girl until the 3rd grade, and then I became fat, like, overnight. Funny how this was the exact year that HFCS was introduced to the U.S. Coincidence? I think not. I think that crap ruined my system forever.

      At five feet tall, my heaviest was 213. Did I enjoy getting there? Partly. I love food. But I hated what it was doing to me. Being big was never a social issue for me, but medically, it was becoming one. I was smart enough to know I was doing it to myself by overeating, but I also felt like it wasn’t just my lack of self control around food or my genes that was hindering me. It had to be something more. Then in 2010, I found MDA, and I knew that this guy was on to something.

      When, at 44, I started having knee pain, I was done. I knew that if I didn’t do something, I was going to end up disabled like my sweet mother by the time I was 50. I lost 19 pounds following Mark’s advice, but when I started gaining it back, I knew I needed additional help. I turned to Weight Watchers. My insurance paid for it, and I liked the supportive environment. With WW, you really can eat whatever food you choose, so armed with Mark’s advice, and watching my portions, I have lost 66 pounds in two years. It really can be done, Rhonda.

      So, in reality, it was a combination of taking responsibility for my own past behavior around food, the fact that this behavior put my body in a dis-eased state, and learning/knowing that I truly was “helped along” by food companies who wanted my food addiction to line their pockets that helped me cure my own dis-ease. Just this week, my doctor put “morbid obesity-resolved” in my chart. And I cried.

      I still have 25 pounds or so to go. But I believe I can do it. I know I am no longer a slave to bad food, but the compulsion to enjoy too much of good food will always be something I will have to watch.

      Rhonda, never give up. Find what works for you. Thank you for allowing me to share my story after so many years of enjoying this blog. I have learned so much. It is nice to feel like I finally have something to contribute. Sorry so long.

      1. Patti –

        What a wonderful story!!! Congrats!!

        I’ve felt for a while that if Paleo/low carb was effective in weight loss and calorie counting portion control was also an effective weight loss tool, then possibly the most effective of all would be controlling portions of high quality Paleo food.

        I thought I’d also throw out this speculation out to those folks who found themselves gaining weight for no reason. I have read in my travels around the Net the theory of a catching a virus or bacteria that changes people’s metabolism response. It seems far fetched, but then again it seemed far fetched that bacteria would cause ulcers.

        It doesn’t help today’s treatment, and it’s speculation only, but it might help validate the observation of reacting normally to food at one point and then finding it very difficult to lose weight.

        1. Thank you, Amy. I, too, believe that our collective health crisis may have many causations, affecting individuals to a greater or lesser degree. And who knows? Viruses? It is possible.

    3. I lost 65# a few years ago, and have kept it off. Primal, or close to primal is the best diet. I’m 5’8″ (was 215#, now 150#). It took me a year to lose this weight. Now, for the kicker. I bet the reason you’re not losing weight is because you are eating enough primal so that you aren’t hungry. This is a mistake. Hunger is the body’s way of telling the brain to go find some food because the body is being forced to consume reserve fat. Let this sink in. No hunger = No consumption of fat reserve = No weight loss. You’re lab numbers are probably much better, but the accumulated fat is still there. What to do?
      I believe that to LOSE weight, one must be hungry much of the day. Learn to enjoy this sensation. You will be satisfied to know you must be losing weight. Eat breakfast (biggest meal) only to no longer be hungry. Eat lunch (smaller meal) to just almost not be hungry. ~3pm, you will start to get hungry. Skip dinner. Go to sleep hungry. Drink some Cabernet instead of dinner. Go to sleep hungry. You will lose weight. There were hungry people in Auschwitz, but there were also no fat people.
      There is no easy way. You must want to lose weight and be determined to do it over a long period of time. Also, don’t do exercises aside from walking while you are losing weight. Exercise is OK and good once you have lost the pounds.
      There is no need to count calories. Hunger means you are losing weight. With primal/ paleo, you will not regain the weight you have lost.
      Weigh yourself everyday at the same time on the same scale. Keep a log and monitor your progress.

  14. My BMI is 32.4. That’s obese, and to be “not obese” I would need to lose 17 more pounds to nudge myself into the “overweight” category. My current weight is 206, so yes, I have some weight to lose. But I guarantee if you saw me your first thought would not be “obese” (I have a picture on my blog, my current before/now photo). Do I think I have a disease? Absolutely not. I’m the healthiest I’ve ever been, and could probably run circles around a few of my non-obese friends.

    BMI is a poor indicator of health, and if that’s what we’re using to measure whether a person essentially has a disease or not, then we are definitely in trouble. Regardless of labels, though, I think we can all agree that the road to health is a difficult one, especially when we are constantly bombarded with CW and personal attacks on weight (ie. “It’s easy, just eat less and exercise more!” Um…it is actually NOT that #$%@#%$ easy!). I really appreciate this post and how it explores the many gray areas when it comes to obesity. Now if we could only get others to stop saying the overweight are fat by choice….

    1. Good points! And furthermore: Some people may be fat by choice, some may not. Some obesity may be a cause of other problems, some may be caused by other, sadly not often diagnosed, underlying metabolic problems. Some people may be fat and be quite satisfied with being so. Some are lean and miserable about their bodies anyway. Why the belief that there is only one way to look at it, that’s right for everyone? It makes sense to me to start with where you are, go after what makes you feel better, and don’t worry about what others tell you. If you weigh 400 lbs and can’t stand up for more than a minute at a time, then being able to stand up for ten minutes is probably a better feeling. Figure out what would feel better than that when you get there.

    2. BMI is an atrocious indicator of health.
      Sir Steve Redgrave trained for 30 hours a week for 25 years and won five consecutive Olympic gold medals for rowing. He’s been called “the fittest man in Britain”, yet at his physical peak he had a BMI of 29 so according to these stats he’s obese.
      As you American’s would say “Go figure”!

  15. Follow the money and you’ll find the answers. AMA gets another disease, hummm. That national organization of Civil Engineers finds our nations infrastructure is D-,hummmm. I wish it were only those two self serving groups making these pronouncements but they are only the tip of the ice burg.

  16. I think obesity is a symptom and not a disease. I also think that classifying it as a disease is a way to get insurance to cover bariatric surgery and pharmaceutical treatments.

    As for what it will do to the psyche of individuals, that may vary.

    A few years ago I was diagnosed with major depression. Before the diagnosis I believed my problems were a personal failing. I didn’t try hard enough to cope with life. The diagnosis was hard to accept because I had to accept that I was mentally ill. But with the diagnosis came medication that really did help me.

    After a while I quit the medication and have been fine ever since.

    Then I found paleo/primal and my mood improved even more. I suddenly knew what it felt like to feel confident and optimistic all the time. I’m a little angry that the medical establishment made me go through pills to find help when diet would have had fewer negative side-effects (I have permanent tinnitus.) But they had no idea and it’s not like their way was completely ineffective.

    Now I believe depression is also a symptom, probably of the same thing of which obesity is a symptom.

    1. OMG, I have tinnitus also it started when I quit taking my anti-depressant, when I talked to my doctor about he said “well, well just put you back on the anti-depressant!!!!! Thank you, NOOOO!!! End of story, no other tests or solutions, he just said “oh”!
      I wouldn’t wish this on anyone but I’m so happy just to hear someone else had this problem, I feel I’m not making this up now! Thanks for you post!

      1. Quitting Effexor took several months of gradual decreases in dose and hearing creaking noises every waking minute. I cry more easily now but otherwise I can’t see that going without it makes any difference. Low carb high fat diet has perhaps improved my mood. It’s certainly helped with my type 1 diabetes.

  17. Watch for the inevitable lawsuits as more people fall under the umbrella of the Americans with Disabilities Act. If BMI standards are used, entire parking lots could be re-designated as disabled/ handicapped parking. Remember the passengers on the animated movie WallE?

    1. Si-FI can be really scary……
      I can already see earth becoming a garbage dump.

  18. I have been discussing this with my co-workers for a bit now and have come up with some interesting…to me..counter points perhaps. As I stated before I am overweight…however I do not feel i live a lifestyle that supports being overweight. I am primal 90-95% of the time. I exercise daily….moving between leisurely walks and bike rides to climbing, mt biking,mountaineering, back country snowboarding, snowshoeing, weights, ultimate etc etc etc….a great mix of movements and exertions…yet I am still overweight. A co worker is Primal 90-95% of the time and although his activity is different…gardening, tending livestock, more of a manual labor type of activity base his weight is much much lower. we are of the same height, same race, same socio-economic background even the same religion that has the same dietary laws that we follow….yet he has become thin while I have remained overweight….I feel better but still overweight. so does this mean that there is something different inside of my make up that perhaps diet and exercise alone cannot stop, change or alter? just as someone that doesn’t smoke, drink etc can develop lung/throat/liver cancer and those that do partake in those activities can go through their lives without the “disease” of cancer?

    again not sure what i think about these counter points, just wanted to make them.

    again I may be rambling….but there may be some other sides of the coin that could be discussed.

    1. I think some of the thoughts here are about obesity being a symptom are dead-on. The disease, which is unchangeable, is a metabolism disorder. The symptom is too much body fat.

      You may need to do something more, such as count carbs/calories, switch to an extremely high fat diet, and/or change your exercise patterns. Semi-constant manual labor will do much more to encourage weight loss than periods of high intensity exercise.

    2. Dan, eating too much fat can keep you from losing weight, whether you’re 95-100 percent paleo or not.

      My son was on a medically supervised ketogenic diet (ultra low carb) for seizure control years ago. He lost weight like crazy. Unfortunately, he didn’t need to lose weight. He was beginning to look like a concentration camp survivor. The nutritionist at Children’s Hospital added a LOT of fat (butter, oil, heavy cream) into his diet plan and the weight-loss freefall stopped immediately.

      Good fats are essential, but going primal isn’t a license to go overboard with it. My advice: Since everybody is different, forget about what your co-worker does. Instead, take a close look at how much total fat/fatty foods you’re eating. It might be way more than your body needs or can handle, in which case it will get stored as–guess what–excess body fat.

    3. Fats doesn’t cause you to gain weight, shary’s sons probably stopped losing weight for another reason. For someone who has been overweight and probably has some metabolic damage, it isnt the same.

      I agree with Amy, you may need to adjust your fat. Its possible your eating more fruit and nuts than your system can currently handle. Maybe your having some honey or the occasional sweet Potato and that may simply be too much. Also Protein creates insulin response too, maybe your eating too much protein. It is such a delicate balance, you gotta play with it a little till you get what YOU need. You may need a Ketogenic diet, just look at Jimmy Moore, he seemed to fail in a low carb paleo diet. What he ended up needing was a more aggressive low carb solution, he found that in a ketogenic diet.

      1. Brandi, my son was a child on a carefully regulated diet for medical reasons. “Something else” didn’t cause him to stop losing weight because he didn’t have access to anything else. Also, he didn’t gain weight until after he went off the diet; he simply stopped losing it with the incorporation of the extra fat. Everything depends on a person’s individual metabolism, and anything can be overdone, including fat.

        1. Medical ketogenic diets do require lots of fats in order to stop weight loss. All fats do is add calories.

          However, there is nothing magical in fat that “stops” weight loss.

          In a ketogenic diet, almost everything you eat has extremely high satiation factor with low calorie density. You feel full on significantly fewer calories. (One slice of white bread ~66 calories. To get the same number of calories from celery, you would need to eat a little more than a full pound of celery stalks).

          Adding fat to a ketogenic diet adds calories. Any time you add more calories than your body uses, it will store the excess. It isn’t “eating too much fat”, it’s “eating too much”. Primal/Paleo does a great job (for most) at retuning your body to be more efficient at metabolizing food and signalling when to stop eating, but you can freely choose to ignore those signals and still overeat.

    4. check out the podcasts on youtube from smarter science of slim, specifically the ones about exercise. Jonathon Bailor suggests a very different method, safe and only a short amount of time required.

  19. I am new to the “Paleo Diet” and though it took me a year and a half of watching my daughter and her husband eat this way and the tremendous results they had from this lifestyle it took me that long to try this, 3.5 months later and can’t believe my own results! I have found that people who talk all the time about how they can’t loose weight and how depressed they are about it (I’m a hairdresser and talk to a lot of people during the day) the most common thing I hear is I could never give up my sugar, crackers, bread, pasta, ice cream, etc…ect…ect!!!! I believe like the other poster’s that it will take the responsibility out of obese people hands and into pharmaceuticals hands who stand to gain so much more money from this change!
    I also believe the AMA and such are going to try to squash the paleo trend, we’ll see how!

  20. The problem is that the medical establishment gives out advice that makes a LOT of people even fatter. I tried my hardest to lose weight on whole grain, lots of small meals and a ton of cardio. The second I added back in the fat that they demonize, weight fell off WITHOUT EXERCISE. Sure, I avoid the junk food etc., but I eat a whole heck of a lot more meat than they want you to. Their “diet” for certain body types is a formula for obesity. To be blunt, I took their advice, starved, worked out like a fiend and at best stayed fat and at times gained weight. So I don’t take their advice and lose while feeling like a glutton at times.

    I think a subset of people will continue to eat crap for a lot of reasons. Meanwhile, all the people that have tried and failed at low fat will probably now try even harder and have more resources to fail them. I think we will see more surgery and drugs that work until people go back to old ways even “healthy old ways”. Hopefully Primal/Paleo will grow as an effective alternative.

    BTW, I thank god that I found this way. Without Mark Sisson, I would undoubtedly be morbidly obese.

  21. Thinking about the motivation behind calling obesity a disease empowering the medical industry and drug companies with more prescriptions and therefore money), I have to pronounce against the “disease” term. Not sure it is going to help with self esteem either anyway…

  22. This might be trite but, I’m hoping this will eventually allow me to write off my gym membership and anything related to disease prevention like the purchase of kettle bells.

    I’m sure my doctor could write me a prescription for these since he can prescribe massage and acupuncture.

    1. “I’m hoping this will eventually allow me to write off my gym membership”

      This was pretty much my main thought, but you can’t even write off money spent on healthcare unless it reaches a high threashold that I personally never reach. I don’t even think going to the most expensive gym in town will get me there.

      As for the actual topic, I’m leaning towards obesity being a symptom of an underlying disease, whether that of fat regulation or hormonal hunger regulation but I’m kind of torn on this one too. Either way, BMI will probably be the standardard and it is horribly flawed so if we’re going to go this route can we actually start using some meaningful measurements?

  23. It has always bothered me that over-drinking is considered a “disease.” From the medicial community’s point of view if you can call over-drinking a disease (alcoholism) then you can call over-eating a disease. It’s not even a small leap. The only surpise is they hadn’t thought of it until now. What shall we call it? Foodism? Calorism and its victims Carbonites?

    Like the psychological industry the medical industry has to constantly invent new things to treat or the income does down. And it is not ironic that those creating the problem with lousy advice will be there with a lousy solution… for a price. It is very difficult not to be cynical about anything psychologists and doctors do.

    1. “It is very difficult not to be cynical about anything psychologists and doctors do.”

      No joke. Most people hide it better than I do, I think. My experience is that most providers are surprised when you express some skepticism or ask meaningful questions. They are probably smart enough say, “Sure, Doc” and totally ignore what was said.

      I do try to keep my negative opinions in check with issues that can be cured or improved with surgery or immunizations. Western medicine absolutely excels in those areas. The chronic issues without a single, clear cause/effect…no so much.

  24. I remembered the first time I went to an AA meeting were they told me I had an incurable deasise and the only course of action was to keep going to meetings for as long as I lived and wanted to be sober.
    As alcoholism obesity is not a deasise but a conjunction of factors that need to be addressed by oneself and worked preferably with information and science not by profiting entities like AA or hospitals and bariatric surgeons.
    That is my piece of salt as a FORMER alcoholic and obese person.
    I lost 110 pounds and been sober 5+ years no AA meetings or doctors just the knowledge of what is good for you and the desire to do so

    1. I went to a few meetings (AA/NA) just to please someone who wanted me to go with them and when it was court-ordered. I never, ever want to hear a repetition of those slogans again (“One day at a time!” “Keep comin’ back!” How about, “Gimme a break!”), and I find it ironic that before and after the meetings all these people talking about conquering their addictions stand around smoking like fiends.
      And when I got my three month chip to a chorus of applause.. hah, I lied.

  25. This is nuts. Is everyone forgetting that twins separated at birth and reunited later in lif are always within 10-20 lbs of each other and have the same pattern of fat distribution?

    I have twin aunts and I’ve known them for 53 years. They have always had similar appearance/fat distribution/weights despite one of them always “watching her weight”.

    There is way more to obesity than calories in minus calories out. NO ONE has all the answers. If you are skinny just be thankful that you weren’t born with whatever biological roll-of-the-dice causes metabolic disorders!!!

    Sheesh!

    1. p.s. One of my grandmothers was a skinny little thing all her life and still developed a raging case of Type II diabetes. Had to have both legs amputated and lost all of her vision. So much for being skinny!

    2. But those twins can successfully treat their obesity through behavior! Or so people say.

      The reality of course is different. About 5% of people who lose less than 35 pounds and about 1% of people who lose more than 35 pounds keep it off for 5 years or more. With numbers like that, failure isn’t about a person it is about being a person. The fact is that we do not have good treatments for obesity, not even primal eating.

      1. Where are you coming up with these stats? Why would *anyone* even bother trying to lose weight giving the stats you’ve given? Going down this road of treating people who have lost weight and kept it off as just freaks of nature is completely self defeating.

        At any rate, this line of thinking ignores the evidence that most people in places that lack a steady food supply are not obese. (Although if they have a steady poor food supply, interestingly enough, (ie cheap starches and little else) they will be. Gary Taube’s Why We Get Fat is an excellent even handed look at the issue of metabolism disorders/obesity.)

        We do have some excellent treatments for obesity but you have to look. It’s not at the local Doc’s office, that’s for sure. It might require traveling to clinics and finding providers with proven track records. And maybe sometimes calories or carbs have to be counted.

        And yes, some people will have a harder time losing then others. A very few with true metabolic disorders it may come off slowly or an extreme case not at all. But that’s not 95% of people.

        Ultimately, most people can work at it and lose weight. My father has been obese all his life. At age 64, in the last year, he’s lost 40 pounds, mostly with just walking a whole lot more. *shrug*

        1. 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 wroth or health.

    3. Would like to know just how many sets of twins there are who are separated at birth and reunited years later. Seems like it would be difficult gather a meaningful sample size. Calling BS on this.

    4. Hey Lauren,
      I can’t say I am an expert at nutrition or weight loss or anything along those lines!! However I did watch a show a few months ago studying identical twins and their body shapes. Previously researchers believed that identical twins would have similar body weight and fat distribution throughout their lives, until they found sets of identical twins that had very different weight ranges. Research was early but after interviewing each overweight twin about the time of their weight gain, they had in common an emotional trigger eg, moving into socially isolated areas.

      I agree that it is way more complicated than calories in & out but I think this also applies to identical twins! The show was Horizon: The Truth About Fat, if you were interested. 🙂

  26. So when are they going to add an “Obesity” Vaccine to the newborn schedule?

  27. What if obesity is an effect rather than a cause? I recently listened to a TED medical talk by a Dr. Peter Attia. He tells of having to amputate the foot of an obese diabetic person, and his belief that her negligence allowed this–diabetes–to happen. Subsequently, he developed a metabolic disorder himself, and began to gain weight despite a highly disciplined diet and exercise regimen. This shifted his work and his passion to asking the question, “What if the metabolic precursors to diabetes results in obesity, instead of obesity causing diabetes?” He had blamed and judged this woman, and he learned that if you blame and judge someone, regardless of whether your opinions are right or wrong, you can’t help them. As the medical community begins to include more people asking the right questions, like Attia, everything will change in health care. Mark Sisson is asking essentially the same question from within his knowledge and experience. I suppose medicalizing obesity is a way to stop blaming people, just like medicalizing schizophrenia is a way to stop blaming people, but making it a disease is the wrong way to go. It feels wrong, and if Attia and his team are right, it may be literally wrong.

    1. Kay – You have it backwards. If Attia is right then obesity = disease.

  28. I agree with the equation “Obesity = Disease = Big $” in our world. Sad about it but it seems to be how it works out there.
    Personally, I would like more people to see the word disease as what it really means, Dis-Ease. Our body is not at ease, running well on the fuel we put into it, running on the level of stress, etc. If we see it as that we can then take responsibility for what we are doing to contribute to that uneasy situation. Seems as though most of us here are doing that, kudos!
    However, to those of us that are trying to responsibly remove our dis-ease by changing our lives and are still struggling with moving into more ease, well maybe a label will help to fund further research to see what’s broken with the system.
    Like you Rhonda the Red, my neice went from a normal kid at 7 to an obese one by 8 years old. What happened? That’s what we all want to know. It’s NOT overeating, her dad did not allow that. They were too poor to buy the fancy schmantzy processed food so it wasn’t that. She’s still in her 20’s and I’m sure she’d say the same things as you, frustrating to be stuck where neither one ever intended to go (obese) and not knowing why or how. Glad you are at least on the right track with primal, hopefully it will give you some more good results as time goes on.

  29. Obesity is the same as alcoholism as a disease. You are born with it. It will never be cured. It is not your fault. But it is your responsibility to manage it. In the alcoholics case, never take another drink again. For the the obese person, healthy food choices and movement. It really is that simple.

    1. I’d say it’s more a genetic predisposition to alcoholism, and yes,it’s something you have to manage.

        1. LOL – I poised idea of a virus up further. It doesn’t really help treating it, though because metabolism disorders have to be managed the same way regardless of it’s origin. The only thing that might help is just to give a bit of sympathy to those for whom it’s hard to lose weight. If such a thing actually exists, right now it means the people who have it need to work harder at managing their weight. It’s not really a “free pass”.

    2. in theory it is that simple….I assure you I make very good food choices, I move more than many people I know that are skinny and I am still overweight. Here is another example. My usual backcountry snowboarding partner and I had almost the same weight at the end of the snowboarding season. we both decided that dropping 30lbs would sure make the season easier….so we set out to do so. while I have increased my fitness level and have built muscle mass…he has done the same. my weight has stayed withing the same 5-8lbs up and down while his has dropped over 25lbs….so in theory making correct food choices and movement should work…but I am growing increasingly aware that there may be something else at play as well. I am not sure, but it doesn’t compute to me.

    3. I have read that alcoholism is due to the way our body processes alcohol, we are born that way. Over drinking does NOT cause it, it’s just a physical issue. I like what you said about it. How our bodies process food, alcohol and stress is what it is and we all get to manage what we’ve got.

    4. RE: “Obesity is the same as alcoholism as a disease”

      I agree up to the point where the cure is for alcoholics never to take another drink. But at this point the two problems become different. That solution is not an option for the obese, since they have to “let the tiger out of the cage” three times a day, and thus cannot completely get away from their “kryptonite”. So while it may be true that they are the only ones who can manage their problem, it is not always as simple as “just eat less.” And contrary to what some have stated, the rate of recidivism for those who have lost then regained weight is very high—about the same as that for drug addiction.

  30. When I think of disease, I think of something you can’t control, so in that sense I don’t agree with obesity being labeled that way. For the folks that switched over to living primal and didn’t lose ANY weight, the first thing that comes to mind is some sort of thyroid or hormonal imbalance. Getting your levels checked might be helpful. Just my 2 cents.

  31. Obesity hasn’t been “medicalized.” Only if that were true. It’s been “politicized” like every other choice in America. So, to answer your question, I think the impact of calling obesity a disease will be negative since most people think politicians are smart.

  32. I think the fact that it is a “gray” area is preeminent. Just like a lot of health issues there may not be one true root cause, but an accumulation of several factors. Obesity may or may not be a disease, but I believe it is due to comorbid factors. It is likely multifactoral problems that lead to obesity. Having struggled with being overweight myself, I can only imagine the depression, hopeless feeling, and lack of understanding, compassion, or kindness to yourself. While we can do the right things nutritionally and physically for our bodies, I believe a large part of the equation is also our mental and emotional outlook, reactions or response. Therefore, it is the responsibility of the medical industry to treat the individual more holistically, not as just a medical experiment. Advances are being made to integrate nontraditional, alternative therapies with traditional medicine, but much remains to be done. However, as long as the pharma has their hand in the till, it will never be profitable to cure disease, but only to “treat” it. Something to ponder – with all our advancements in science and technology, no disease has been “cured” since polio.

  33. Just a quick two cents to those who have commented that it is a disease and that no matter how primal they were they still didn’t lose weight; (1) I don’t see many mentions of any exercise regimen being included in the lifestyle, which is critical, and (2) have you considered the possibility of thyroid issues? If hypothyroidism or Hashimoto’s is the case then that is the ‘disease’ or rather ‘condition’ and not the obesity (check out Robb Wolf’s site and book for specific paleo diet variations to help alleviate these conditions). Overall though I feel that weight or BMI alone is a poor indicator of relative health…there are more important factors like relative strength capacity, blood pressure, heart rate, blood sugar, etc. to consider among others.

    1. well I commented that I live primal but have not seen weight loss…but you must have missed where I talk about my active lifestyle…unless of course you weren’t referring to me. I am very active. always have been.

      I have had my thyroid checked, no problems at all.

    2. How about estrogen dominance, we got phytoestrogens and xenoestrogens out the kazoo in the environment and the food supply. Just a perfect storm.

  34. In part, I’m glad to see obesity labeled as a disease because of the stigma thrown at those who are battling it day in and day out. I hope it’s going to give some legitimacy to obesity as a psychological issue much like bulimia and anorexia (granted, this isn’t always a factor in obesity).

    Labeling obesity as a disease doesn’t necessarily preclude the “sufferer” from personal responsibility. In 12-Step programs, addictions and compulsive behaviors are labeled as diseases but they do require action on the part of the individual. There’s no free pass.

    The big factor in this is going to be how the medical community proceeds with treatment. Their foundation of bad nutrition advice and pharmaceuticals doesn’t give me much hope for successful treatment. Can they be astute enough to determine what is at the root of an individuals obesity? Can they recognize emotional issues and refer patients on to a therapist or support group? Will they prescribe better food choices over the latest designer pill? Can they determine that stress or poor sleep is a major contributing factor and determine a plan of action with their patient?

    Honestly, I don’t think the typical doctor has time to ask the questions that would lead to an effective plan of action so I don’t hold out much hope. And I see them being more time-squeezed in the coming years.

    On a side note, how great would it be if “food for medicine” became the best and most widely used prescription?

  35. Is heroin addiction a disease of the body? Can anyone catch heroin addiction? Does a sudden replication error during cellular division cause us to seek out heroin?

    Obesity neither seems to be an infectious disease nor a genetic malfunction disease.

    Obesity arises from mind disorder and thus mental illness, more than likely.

    Physics cannot be escaped. The only way for any mammal to increase body mass whether muscle tissue or adipose tissue is to consume more calories than burned through time, consistently.

    Obesity is an effect, not a cause. No one should lose sight of this reality.?
    The problem has become one of talk and specifically between something that is a versus something that causes.

    It might be right to say that obesity causes other diseases, that is uneasiness in the body, but never would it be right to say that obesity is a disease. It’s not.

    Obesity is an effect and not a cause. Gluttony might be the cause. Thus gluttony might be the disease agent, but obesity, an effect, never can be its own cause.?

    So all need to ask and discover what causes gluttony? Stupidity? Immorality? Biochemical addiction?

  36. This situation sounds familiar to the Diagnostic and Statistical Manual of Mental Disorders including things like “Hoarding” and “Sex Addiction”. Although this could aid in providing services to people with disabilities, who consequently become obese because of preexisting conditions, I believe it will act more in favor of big business.

    I think the most important thing to remember, as most on this blog have noted, is that environment, upbringing, habits, and social influence play a much greater roll than genetics. Viewing obesity in a deterministic context is limiting. Empowerment and autonomy are key in the Primal Blueprint and could be very helpful in a rehabilitation setting. Great post to get everyone thinking!

    -Tay

  37. Very interesting reading, I have been fat my entire life I actually can’t remember a time when I haven’t been. I remember my mom putting me on ‘diets’ in grade school, being 120lbs in the 4th grade, always being picked last on the playground and contantly being picked on…When I was in 10th grade I went into starvation mode and lost a few pounds, but would pass out from not having enough food… My point is I’ve ALWAYS struggled with my weight and probably have lost/gained the same 30 pounds 100 times. It is not a choice for me, I’ve done it all..Weight Watchers, Body for Life (which I had the most success by the way), low fat etc. I have worked out regulary (4-5 times a week sometime more)for years. Played organized Volleyball for years. I’m 5′ 9′ and sit around 220 most of the time, however, I’m as healthy as they come according to numbers Cholosterol is 148, BP is 120/70, tris are good, no diabites…with the exception of some back and knee issues (which have gotten better since switching to Paleo 8 weeks ago)!! I’m sick and tired of being consumed by the number on the scale. My goals are to eat good quality foods and enjoy a healthy lifestyle. Sad thing is my husband who is 5’3 125 lbs suffered 3 strokes and a heart attack in 2010…(very unhealthy habits) but I’m the one with the disase!!! Our government at it’s best again!

  38. Ok, so does this mean I can call in sick to work if I eat too much pizza or drink too much beer?

    You know that people are going to start doing this, this is an incredibly bad idea.

    1. “Ok, so does this mean I can call in sick to work if I eat too much pizza or drink too much beer?”

      Can you call in drunk? If so, then yes.

  39. I was recently reading about the GAPS diet and gut bacteria. Based on all of that research, our bad gut bacteria, which most of the population probably has, is responsible for a host of diseases. And I think there was a recent study about populating overweight people with good gut bacteria and how it helped with weight loss.

    Might be something to look into if you are really struggling with weight and other conditions.

  40. Maybe it’s just me, but I think this might do some good for nutrition and fitness research. And in all reality, it’s probably going to blow over quickly and people won’t think twice about it. Kind of like climate change/global warming–people freaked out about it, vowed to cut their CO2 exhaust, and those same people still use the same amount of CO2 as before and now don’t believe that climate change/global warming exists. There will be people who want to define obesity as a disease and not do anything about it, but there will be people who want to make a difference in their lives by improving their health too.

  41. Richard Dawkins coined the word meme to mean an “an idea, behavior, or style that spreads from person to person within a culture.” He meant it to be analogous to a gene. Gene’s carry physical characteristics that are passed on through reproduction; memes carry ideas that spread from brain to brain. A defective meme is like a defective gene – it can lead to dysfunction and personal or social malaise just like a defective gene can lead to physical disease. The SAD diet and the current consensus on health and nutrition are the defective memes causing real physical maladies in humans. Richard Dawkins is pretty smart. What we need is meme therapy.

  42. Here’s a similar question. Is anorexia nervosa a disease? I knew a girl who had it, and she always made a conscious choice not to eat. In a way, it was her decision each time. She could have chosen to eat at any time and ended the disease. Similarly (most) obese people become so by choosing to eat too much or the wrong food. A smoker chooses to to light that cigarette each time. He can just choose to never pick up a cigarette again.

    While it is clear that the anorexic, the obese person, and the addict all can decide to stop perpetuating these wrong choices, I’m not so quick to dismiss them as diseases. The willpower to do so is too much for most people, and they do need help. Physical changes have been shown to take place in the brain in addicts, affecting the ability to access this willpower. A lot of these people have troubled lives and addiction is a source of comfort, an oasis of pleasure in a day of suffering.

    I can certainly sympathize, but ultimately, they’re not diseases.

  43. The AMA’s decision has nothing to do with actual disease in the realm of such ailments as diphtheria or influenza. Because you either have or you don’t have diphtheria or the flu. There is no wiggle room, no arbitrary numbers. The way “obesity” (like cholesterol and diabetes) is determined is according to a largely arbitrary set of numbers that somebody made up. in the case of weight, these numbers were invented while some guy was creating an actuarial chart. No. The AMA made this decision for either political or economic reasons. Or both.

    The question is not whether obesity is or isn’t a disease. The question is who has a vested interest in the AMA’s (or any of these so called professional associations) pronouncement? It is a sad situation indeed when so much our culture has become so blighted by economic interests that every bit of expert advice must be viewed though a jaundiced eye and taken with a grain of salt. Pun intended.

    So now, when your doctor gives you a sidelong look, rubs his chin and says, “Hmm. You are obese. Let me refer you to the bariatric surgery division of our hospital.” There is an ulterior motive — since many physicians’ practices have been bought out by hospitals — having to do with the almighty dollar.

  44. Obesity is a symptom, not a disease. It is the result of a disease. MDs need to find and treat the true cause of the obesity, which may be emotional, physical, the habit of overeating, etc. As mentioned by so many here, pills and surgery should not be the treatment of choice. Let’s try diet, exercise, emotional support, counseling, homeopathy first. I agree with those who are fearful of big pharma and big medicine.

  45. I don’t see obesity as a disease, Its a condition that comes from what we are taught by the main stream medical world and the government.
    Take out all the information that has been put out there in the last 50 years and go back to eating what grew locally, leaving out processed foods. We would be fine.

  46. Obesity is often a symptom for an undiagnosed medical problem. Clearly if a person has dramatically altered their diet (aka eat less, exercise more) and the excess weight does not normalize or even go down, then it’s a medical issue, not a lifestyle issue, and it needs to be addressed as a medical problem.

    Lifestyle obesity results from bad food and exercise choices and diet modification usually results in weight loss. Most people who go from an SAD diet to Paleo will see their weight normalize and will feel great.

    Medical obesity is where the person is making great food and exercise choices (like Paleo) and getting all the wrong results. Often, things get medically worse along the way.

    Lots of us who have gained unwanted weight have made dramatic changes in diet and lifestyle, yet see no weight loss. We remain obese or morbidly obese despite eating very, very modest amounts of clean wholesome organic food and exercising as much as feasible.

    The failure to lose weight when really making an effort to do so, is a symptom of some underlying systemic problems not a lack of willpower and the plate. And it’s frustrating and discouraging and having bouncy athletic 20 somethings tell me all I have to do is “x” when I’ve already done “x” without results. It is unkind.

    It’s really, really, REALLY difficult to get the medical pro’s to grasp that I became metabolically sick and as a result gained 100 pounds in 2 years and haven’t been able to drop any weight over the last 13 years despite major changes in lifestyle.

    It’s a big difference in approach to treatment if the doc sees you as a person who makes bad choices or a person who has a metabolic imbalance. Declaring obesity a disease is not going to help much because doctors, too, only see a ‘fat person’ as someone who eats too much, not as a person who gained weight because of an underlying problem.

    I’m sticking with the Paleo diet because it’s an easy way to avoid problematic foods. But I am an obese Paleo person and without some sort of dramatic breakthrough in obesity or metabolic research, I am likely to remain an obese Paleo person.

  47. Yup. Obesity is a disease. LOL

    The pathogens that cause this disease line the shelves of supermarkets across the country…

    1. See those two letters that Dave proudly claims after his name? RN?

      Yup, the pathogens that line the Road to Bad Medicine that this country has traveled.

      Arrogant sumbeach. Thinks he knows it all – thereby ensuring that the patient feels worse, AND gets no help.

      Shame on you – true healers WANT to help. Judgemental @$$es don’t.

  48. I agree – labeling it as a “disease” may take the responsibility out of some people’s hands. They will think there’s not much they can do about it and leave it up to the doctor to “treat or cure” them. However, some dietitians will provide great, more primal-focused advice. I think there is a shift happening in dietitians towards no only more whole, real foods but also eliminating gluten and changing their mind on saturated fats, etc. There’s even a great Facebook group (“Paleo RDs”) if any other RDs are out there. 🙂

  49. A lot of people seem misinformed that the AMA decision has an effect on insurance. There was already a billing code for obesity and obesity was already recognized by the FDA as a target for treatment.

    The AMA recognizing obesity means nothing. It doesn’t even mean anything to the AMA, which has been running articles about the disease of obesity in their Journal for years.

  50. I think it is all a big power play by the feds and big pharma. They now will have the clout that they need to keep people sick while they profit from it. 🙁

  51. While still a concern, it’s not my biggest concern how the medical establishment and big Pharma will have a hardon for all of the new ways they can make money off of this new disease. I don’t like the label for the simple reason of: ACCOUNTABILITY.

    Former fatgirl here: I was FAT because I chose to eat the wrong things, not move my body and drown myself in all of the things that were wrong for me. I self-medicated with food instead of doing the HARD WORK of looking inside myself and dealing with the issues that prompted the eating. I was not a victim to the tragedies of a freak accident or cancer – I chose to consume foods that would cause weight gain and health issues. I was responsible for my actions and the outcome.

    I just see obesity becoming the new scapegoat. I see people not owning their responsibility for their own health and I see labeling it a disease allowing more people to shift the blame elsewhere and I see obesity becoming a larger epidemic than it is — just with this one action.

    1. Thanks for your comment, Kathleen. Such honesty is rare when it pertains to such a touchy subject. I fully agree that accountability is the element that’s lacking in most cases of obesity. Labeling it a disease will hurt more than help.

  52. I have mixed feelings about this but feel the need to comment that for many people food is their drug of choice. Drug & Alcohol addiction is easier to hide.

  53. I agree with most of what Mark says and I’m similarly conflicted. On the one hand, a classification as “disease” may help to overcome the stigma that fat people have in our fat-shaming culture. Right now it’s mostly believed to be due to bad behavior, failed willpower. People really do believe that fat people are there by choice or have some mental failing.

    Saying it’s a real medical thing may make the doctors more likely to try “science” instead of repeating the old wives’ tales about it. Sadly, most of the science is paid for by drug companies who have an agenda, and nobody is paying the same millions to research the health effects of reducing grains and bringing back fats. I truly believe “low-fat” diets are killing people, and not just people on low-fat diets, but everyone who is exposed to the popular media message that “low-fat means it’s good for you”. I hope science gets us out of that mess, but probably many thousands still have to die before we “get it”.

    I really wish there were some other “markers” that would confirm the “obese” diagnosis, like certain blood panels or whatever. Just looking at BMI doesn’t cut it scientifically. Hopefully they can use more actual science and address that down the road.

    I have personally lost 100 pounds following a paleo plan (look for my story soon 🙂 but I have been the fat kid / fat guy all my life and fat shaming still has an effect on me. So I still see “fat” as part of my identity. We need to stop blaming fat people and shine the light where it needs to go-big agri-business and our failed health-care systems. We have let the “war on obesity” become the “war on obese people”.

    1. That is a really excellent concept- the war on obesity has turned into the war on obese people. Well said!

  54. I want to help fat people lose weight. I am pretty sure it’s going to be easier with a coach to motivate, encourage and keep you accountable. If you are serious, can afford to pay me, and live in SF Bay California, I am interested to start a new career as a Weight Loss Coach. I train regularly in Thailand with MMA fighters, these are guys who know how to cut weight. The relationship I intend to establish with you is coach, friend, taskmaster, advisor, and benevolent drill sergeant. If you do what I tell you to do, you will cut weight. I will work with you to increase your metabolic rate, have fun, sweat, and burn calories. I will hold you accountable to eat clean and advise you on all things wellness related. If you think the cost is too much, consider the cost of obesity.

  55. I do not think obesity is a disease. Things caused by it are – diabetes. Just like lung cancer is a result of smoking – another bad habit. Is it easy to reduce body weight? No, but that does not make it a disease.

  56. I am a doctor who specializes in obesity treatment with low carb whole foods. This decision by the AMA will help patients get access to care and reimbursement for doctors that address it. Right now for most insurances a physician can not get paid for seeing someone for their obesity. Trust me, no doctors are getting rich from treating obesity (well maybe bariatric surgeons). This is a good thing for patients and will hopefully motivate other doctors to get some extra education. ASBP is a great resource to share with your doctors.

  57. When a person discovers they are an alcoholic, then they are told alcoholism is a disease. Is it? Or is it that alcohol is a poison that they were addicted to and they just can’t ever drink it anymore or they could become addicted to it again. Obesity is caused by sugar. Plain and simple. like alcohol, it is metabolized in the liver the same way and causes insulin resistance. insulin resistance is the disease the medical community need to be worried about. Obesity is a side effect of insulin resistance. and then people who have insulin resistance BECAUSE of having it, they become “sloths” and “gluttons” because the biochemistry of the disease drives behavior, not the other way around. If the AMA and FDA weren’t in the pockets of the sugar industry (and wheat, corn and soy) they would BAN sugar as a toxin. Sugar is made in almost the same way cocaine is made and that is a banned drug. People just need to eat REAL FOOD. Meat, fruits and veggies basically and little of anything else. Doing that can reverse insulin resistance and then people actually FEEL like exercising.

  58. Hi all, great posts. Mark is right on as usual. “Torn” is a good way to describe it. I think obesity is a disorder more than a disease per se. Doesn’t matter what you call it, the medical establishment is going to profit big time and that is what will become foremost.
    I want to express sympathy for those who have struggled all their lives with overweight/obesity. I too was born too chubby for my height and have tried everything there is to fix it with varying results. Paleo has helped the most with weight loss, but here is a very stubborn problem: Low/normal triglycerides but very high (225) LDL. Should I worry? I recently read that people with the gene ApoE (3 or 4) can’t metabolize fat very well at all. They can metabolize carbs better. Boy, I didn’t want to hear that! Has anyone ever heard of it. Good luck to all.

  59. I didn’t bother reading all of your comments (there’s so many of them!) so I don’t know if anyone else has said this, but… what about all of us who are “overweight” but not sick? Fat but healthy? I’ve already lost 100 pounds, and my body has decided that it wants to stay at this weight range. I’m happy with that because I’m healthy and strong, but my doctor would probably look at me and tell me that I was diseased and that I need a pill or surgery.

    Obesity isn’t a disease. It’s just a marker for disease. And sometimes people are just built bigger than others!!

  60. I, too, wish we could place more responsibility on the patient and it’s distressing to have one more excuse at the ready. My hope is that this was done to encourage insurance companies to cover nutrition and physical/exercise therapy over surgical options.

    In my part of the country nutrition counselors recommend vegetables, protein and fat, with daily carb intake between 60-145grams. This is in-line with what is taught in med schools as well…or at least that’s what we were taught. Now, I would love to see the next step of eliminating breads, pastas, etc..but cutting back significantly is better than recommending a high carb diet.

    Many of you seem unaware that the AMA represents less than 20% of practicing physicians. The view of the AMA does not in any way reflect the views of most physicians.

  61. Obesity is a disease in the same way that alcoholism, drug addiction, and yes sex addiction are a disease. It has as detrimental effects on the body. The nature/nurture debate will continue in terms of root causes. I tend towards nurture by and large.

    Lets be clear on what we mean by obese though. I know that the BMI is contested but it is one measure that, in the main, can be useful. We also need to account for body type and “normal” variations in size across the population. However, even controlling for those factor, there are people who do have this medical condition. And it is a medical condition insofar as it is a contributing factor for a lot of diseases.

    I agree obesity as a condition/disease/health issue needs to be treated. The issue is how should it be managed and treated. Clearly, a more comprehensive approach is necessary. That includes diet (specific on kind), exercise (type), and psychological counseling.

    My fear is that this is going to open the gates for increased bariatric surgery as access is going to be made easier through insurance and medicaid. I still think this should be a last resort but already it is growing in popularity and I can see it increasing notwithstanding that I am not aware of any longitudinal studies on the effectiveness of it that would make increasing access justifiable.

    There is a lot of shame and social stigma associated with body image in general and handling obesity is challenging for that reason. I think Mark’s approach has been sensitive and on target.

  62. If obesity is classified as a disease, then you take the means to heal it out of ones hands and put it into the hands of Medicine / Pharma. It could be a trap for many people, giving them the impression they can’t do anything actively against it, because they are struck with it. No more self responsibility, no more awareness how it came about, no more research what onself can do about it. Medicine would like that scenario, helpless people whom they can prescribe drugs for a lot of money. I’m glad I discovered the Primal/Paleo diet already, before they stop people getting access to the knowledge of how we can heal ourselves. And I made use of it, changed my life to the better. Don’t need medicine or dietitians to tell me how to lose weight and get healthy. Got it all in my brain and genes now.

  63. Why don’t primal/paleo people have the same amount of disdain for obese people as they have for “establishment” people who “knowingly” dispense bad advice? Those people are expected to know better, but obese people are not? And even if they are, then why are some “non-establishment” people able to turn away from “expert” advice while other (the obese) are not? Don’t they at least deserve our disdain for that failure?

  64. Being overweight/borderline obese from my mid 30’s and trying different things to get to normal weight again I was happy to discover Paleo half year ago and hoped to find some answers in this approach. Lot of answers and ‘aha!’ moments I did find, my overall health has improved, my (for long time resisting) husband lost some weight – but I remained the same…Mind you, not too many people know about paleo approach in South Africa (books are not available in bookstores, only via internet). Also it is very difficult to find out if you are purchasing right food (meats, veggies, fats…) and I am worried that many of the foods we buy are not what they are supposed to be, and that they are not really helping…As far as my weight is concerned – I have NEVER been a glutton, I always strived to prepare (daily!) fresh healthy meals, but my lifestyle changed and become sedentary, my stress levels skyrocketed, depression kicked in, etc…And I am certain that the whole of chemistry and metabolism in my body went wrong way..and, even if obesity was treated like a disease in South Africa I do not believe that I could find a doctor that will know the ways to check what is really ‘off’ in my body and give me straight advice how to fix it. ..It is just too complicated and very different for each person, and there will not be simple, same approach for it any time soon.
    We, overweight folks, can give up – which I’m not – or go ahead and patiently keep trying to mould dietary/lifestyle approach that is going to help our body regain proper proportions and great health. It is lot of work, but I believe I ‘ll get there, and I ‘m grateful for MDA and blogs alike that are source of advice, information, support and inspiration.

  65. I think obesity is a disease in the sense that AIDS in a disease. In other words, obese people may be affected by ailments as a direct/indirect result of being obese: atherosclerosis, myocardial infarction, diabetes, hypertension etc. One does not die of ‘obesity’ in the sense that one does not die of ‘AIDS’. One dies of the complications of these diseases.

  66. Thanks for the information. I think obesity has been increasing at a higher rate in people along with sugar and B.P. We should control it before it become worse and result in laziness. .

  67. “Now, obesity is solely a problem of the body.” Worst sentence ever to appear in a Mark’s Daily Apple post. Following that thinking, so is “cutting” (the cut’s on the body are the only problem), so is heroin addiction (before the heroin enters the body there’s no problem, so heroin, like obesity, is solely a problem of the body–after all, before the food enters the body, there’s no problem). The real problem here is that in many, many, many, obese people (including myself at one time), there absolutely IS an addiction element present in their relationship to food. And that carries with it a significant, mental component. It’s a component that processed food manufacturers take advantage of in many ways, from advertising and packaging, all the way down to the manner in which the processed ingredients act on the brain. Keeping this primal: we evolved to have pleasurable (mental) reactions to certain tastes: salty, sweet, and fat. Why? Because the foods with those tastes carry so many of the nutrients we need. Primal ancestors with a natural/genetic attraction to those foods would survive and thrive better than those that didn’t have that attraction; they then reproduced offspring who also inherited a natural predisposition to those foods, and thus the virtuous cycle of evolution led to more and more positive/healthy ends–healthy homo sapiens attracted to healthful foods. But highly nutritious foods in nature also deliver satiety. On the other hand, modern junk foods trigger our pleasure centers (salty, sweet, fat) but are stripped of nutrients, so we don’t experience satiety and simply keep on eating. That is by design. It is the MENTAL, pleasure response in the brain that keeps us going despite all the PHYSICAL evidence we should stop–why would an otherwise sane 300-pound person eat an entire bag of Doritos? Lots of physical proof that it’s bad–yet the behavior continues. Thus, Mr. Sisson has it almost completely reversed. For many obese people, the problem is primarily mental. Remove that mental, pleasure-searching component from our food intake, and we can eat sanely. That’s my experience, and I hope that is helpful to someone.
    Now, the question arises, why would Mr. Sisson make such a demonstrably false assertion? After all, I just demonstrated with ease that his assertion is false. I’m sure I know the answer–and it’s not just about on which side his (coconut flour) bread is buttered. It’s not just economic. It’s a bigger issue than that.

    1. I’m pretty sure that it’s a typo. Reading the following sentence(s) I get the impression that he meant to write “isn’t solely”

      1. I don’t think it’s a typo. There’s nothing following it that talks about the mental aspect. There’s nothing following it that would support the statement “obesity isn’t solely a problem of the body.” He immediately starts talking about how cool it would be if the idea of obesity as a disease led to greater research into the “physiological (not psychological) origins of obesity.” I’m certain he meant to write what he wrote. And in two seconds I’ve shown that he’s just plain wrong on that. If he didn’t mean it, if it is a typo, he can certainly come in here and fix it. Then I’ll happily stand corrected (at my standing work station!).

    2. I think Mark means that in the eyes of the AMA, and therefore the public obesity is now considered just a body disease.

      Of course Mark himself doesn’t believe that; he’s been writing about the mental aspect for years. Mark is just giving his interpretation of what OTHER people think.

      1. I can see how it can be read that way now that you point it out. I didn’t read it that way at first. It’s unclear at best. I want to think that you’re right. That’s why I responded as forcefully as I did. If he’s making that statement in earnest, it would be truly mind-boggling. I guess he’s saying that “Now,” meaning once you define obesity as a disease, “obesity is solely a problem of the body.” If that’s right, then my response was misguided (still true, just aimed at the wrong target). I hope so. Thanks!

  68. I don’t think it is a disease, it is a coping mechanism against a dysregulated metabolism (could be hormones, energy use, bad gut flora, whatnot, going completely beyond reasonable limits). I tend to think that becoming obese is actually what keeps people from being completely screwed by this dysregulation, it is a safety valve. To me the standard collective response to obesity IS the disease, which is a COMPLETE LACK of empathy.

  69. Obesity is not a disease, it is a potential combination of a number of issues. Some people are genetically predisposed to storing fat more easily than others and so need to either eat a very low fat diet or increase exercise.

    The problem is that for many people they are too busy trying to earn a living and look after their family than go out of their way to eat a healthy and nutritional meal. How cheap and easy to fast food outlets make meal times these days?

    Obesity needs to be tackled with knowledge and encouragement rather than a dismissive categorization of calling it a disease. Just my 2 cents worth!!

  70. Love this quote which pretty much sums up my opinion on this topic: Medicine is not healthcare–Food is healthcare. Medicine is sick care. Let’s all get this straight, for a change. source unknown

    Obesity is not a disease. Sorry.

  71. An interesting article. I’ve enjoyed reading the articles and they spurred me to get my lifestyle back under control. I dont think obesity is a disease and calling it so will probably make it harder to deal with because it is another excuse.

    We are blessed with the ability to learn, to read, to discover and to exercise free will. We choose what to put in our mouths and can just as easily choose not to eat something. We often choose not to eat something because we don’t like its taste so we are clearly able to exercise restraint in given circumstances. Fat people also believe that diets work ergo they accept that modifying their food intake can help weight loss.

    In the UK we have an obesity problem just as severe as the US. However it is difficult to deal with; the NHS as well as being the largest employer in Europe, provides our primary and secondary healthcare and principal point of contact for people with health issues including obesity; yet it is acknowledged that over 50% of NHS workers are overweight or obese. Not a great example!

    I saw an NHS dietician after suffering a heart attack 13 years ago; her knowledge and advice was woefully inadequate. watch your calories,eat 5 portions of fruit or vegetables a day, eat whole grains and exercise. I was already doing that but the advice was non specific.What sort of exercise? I was doing 3 gym sessions a week, aerobic for about 60 minutes each time, sailing at the weekend, walking the dog 3 times a week. It kept my weight stable for a while but it crept up again.

    I discovered the Paleo diet about 3 years ago and started it in eanest when my wife and I separated. I chose what I wanted to eat, not what I was presented with, I ate a cooked breakfast every day, I had lunch every day and I had a hearty dinner every night. I lost about 40 pounds in 8 months. I slept well every night, i had plenty of energy, my blood pressure fell from 138/90 to 122/80 and my cholesterol levels dropped too. I never felt hungry and if i did i had a snack. It works.

    Last year I lapsed, the weight went back on! 6 weeks ago I started eating primal and the weight is falling off once again.

    Obesity is not a disease, it is the product of ignorance and misguided though well meaning advice from the health service.
    however, there is another factor at work here. There probably aren’t enough resources available for the whole world to eat Primal, the popuation has grown too big. Bread and starch keeps the masses quiet and their bellies full and in former times it killed them off, now medical intervention keeps them alive with drugs, gastric bypasses etc at enormous cost and they receive disability payments.

    We are born with free will but it isn’t neccessarily convenient for governments if all of us exercise it. And amazingly most don’t.

    My friends ask me how I have lost so much weight, I tell them and their response is “i couldnt do that”, “isn’t that unhealthy” or “i dont really need to be that extreme” Even my doctor who congratulated me on the weight loss, lower blood pressure etc when he asked how I had done it didn’t really want a website or link for other patients.

    I tell everyone who asks how Primal or Paleo works and how healthy it is but most people dont seem to want to exercise freedom of choice.

  72. Ladies and Gentlemen, I am obese, weighing in at 500+ lbs. This article hits home. I have looked into the “bariatric” surgery and other dietary/surgical means to lose weight, which scares me to death. I do not want to take pills for the rest of my life. This site alone has literally started me on a path of recovery. I know that there is a long road ahead of me, but this eating primal/paleo has made a huge impact. Right now I am on week 3 and I can definately feel the difference. I am limited to what I can do right now, but I am making progress. The whole point here is, lifestyle change for the better, I will not let doctors give me pills or do surgery for my obesity, I will do this myself, one step at a time. There will be more to come in the future.

    1. Good luck! Please visit the forum and let us know how you’re doing. You will find plenty of support. 🙂

  73. 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.

  74. 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.

    1. 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.

      1. 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.

  75. 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

  76. 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….

  77. 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”.

  78. I only worry that the pharmaceutical industry will be the biggest beneficiaries. A pill isn’t going to solve this problem.

  79. 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:

    http://www.youtube.com/watch?v=_V37zFVVkVI

  80. 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.

  81. 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).

    1. 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.

  82. 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!!!

  83. 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.

  84. 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.

    1. 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.

        1. 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.”

  85. 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?

  86. 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.

  87. 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.

  88. 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.

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