Obesity - a legitimate "disease," a lifestyle choice, or merely a state of being?
In light of alarming statistics worldwide, obesity is a bona fide pandemic. According to the World Health Organization’s Obesity Fact Sheet:
- Worldwide obesity has nearly tripled since 1975.
- In 2016, more than 1.9 billion adults were overweight, of whom over 650 million were obese.
- Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
- Most of the world's population live in countries where obesity and excess bodyweight carries a higher morbidity than insufficient bodyweight.
- Obesity is largely preventable.
Obesity As A Disease: A Timeline
The timeline to designating obesity as a disease traces roughly back to 2004, when Medicare, the U.S. health insurance program, eliminated text stating that obesity was NOT a disease from its coverage manual. Around the same time, the Internal Revenue Service (IRS) further designated obesity treatments as tax-deductible medical interventions.
In 2013, the American Medical Association made headlines by officially proclaiming, based on decades of research, that obesity is a disease, thereby catapulting it into the limelight, from talk shows to TEDx talks, as experts tackled finding solutions.
The Naysayers' Complaints
The counter-argument to designating obesity as a disease maintains that such a designation risks reducing autonomy by disempowering and robbing people of the intrinsic motivation that can be an important enabler of lifestyle change.
Critics claim that there is a psychological detriment to classifying a risk factor a person has some control over as a "disease," which could" put the ball in someone else's court" by undermining the importance of a disciplined diet and lifestyle, nutrition, and exercise in preventing weight gain.
These naysayers argue that the bulk of the benefit, no pun intended, may go to healthcare providers or the pharmaceutical industry as health insurance and clinical guidelines promote treatment with surgery and medication.
At a lowest common denominator, obesity is attributed to the "sin of gluttony," a vestige of a lifestyle of hedonism and excess, coupled with a cultural overabundance of high-calorie food.
Obesity Should, Finally, Be Accepted As A Disease
Nevertheless, as we increase our understanding of the mechanics of fat accumulation, it is increasingly clear that obesity is a multifactorial phenomenon. Distilling it down to a lack of willpower, poor impulse control with food, and skipping physical activity really neglects to consider much of its physiology.
The pathology of obesity is vast and varied. Its subtypes include, but are far from limited to congenital, stress-induced, or menopause-related obesity; in other words, the causes can be physical, genetic, neurological, hormonal, environmental and even psychological. The responsibility lies not just with an individual to regulate their lifestyle, but rather collectively with the medical and wellness community to empower individuals to fight all of these factors by identifying a plan that works for them specifically.
Extensive research indicates that gut biome composition and genetics have a clear role to play in the development of obesity. Existing habits plus our genetics guide how gut bacteria react to certain foods and how these bacteria process and store fat in our bodies. Obesity is simply not a case of low self-control. It is a complex condition with several influences acting on the human body simultaneously, and our genes and gut have integral roles to play.
Obesity As A Chronic Disease
Obesity checks all the boxes for a chronic disease condition. The U.S. Centers for Disease Control and Prevention (CDC) defines chronic diseases as those “last[ing] one year or more and requir[ing] ongoing medical attention or limit[ing] activities of daily living, or both.” Three leading chronic diseases are heart disease, cancer, and type 2 diabetes. Obesity is strongly associated with, and can be a precursor to, all three of these chronic diseases.
In the U.S., obesity runs rampant. Sometimes diet and lifestyle changes are not sufficient to lose weight, and for others who have been temporarily successful with weight loss, they may end up regaining weight due to an inefficient and lower basal metabolic rate. Weight loss efforts are frequently stymied as bodies scramble to restore a status quo with excess fat accumulated.
There is little doubt that obesity is complex and impacts social interactions and emotional health for those who suffer from it, so it is time that obesity is globally recognized as a chronic disease with severe complications, rather than a lifestyle choice wherein the burden of treatment rests on the individual. This recognition is imperative to combating social stigmas associated with the condition.