The fiery debate on whether to label obesity a disease or not is nothing new.
In light of alarming statistics across the world, obesity is a bonafide 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 these 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 overweight and obesity kills more people than underweight.
And most importantly,
- Certain aspects of obesity are preventable.
Obesity As A Disease: The Timeline
The timeline to designating obesity as a disease roughly traces back to 2004, when Medicare removed wording from its coverage manual that previously stated that obesity was not a disease. The IRS also said that obesity treatments are tax-deductible.
In 2013, the American Medical Association made headlines by officially proclaiming obesity to be a disease, based on decades of research findings. This led to obesity being catapulted into the limelight and becoming a hot topic of discussion, from talk shows to TEDx talks.
Suddenly, everyone began coming up with solutions to tackle the problem.
What The Naysayers Maintain
The counter-argument comes in the form of a line of thought that designating obesity as an actual disease, risks reducing autonomy, disempowering and robbing people of the intrinsic motivation that is such an important enabler of change."
There is a psychological difference between having a risk factor a person has some responsibility for, and control over. Classifying obesity as a disease, critics say, puts the ball in someone else's court.
They say that calling it out as a disease undermines the importance of a disciplined diet and lifestyle, nutrition and exercise in preventing weight gain.
The naysayers argue that the bulk of the benefit, no pun intended, will go to healthcare providers and the pharmaceutical industry when health insurance and clinical guidelines promote treatment with surgery and medication.
At the lowest common denominator, obesity is put down to social pressures to “eat, drink and make merry” and an overabundance of high-calorie food.
Why Obesity Should, Finally, Be Accepted As A Disease
As we increase our understanding of the mechanics of fat, 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 does not do it justice.
The pathology of obesity is vast and varied. Its subtypes include congenital, stress-induced, menopause-related; in other words, the causes can be physical, genetic, neurological, hormonal, environmental or even psychological. Obesity checks all the boxes for a chronic disease condition.
What this also means is that the responsibility lies not just with an individual to regulate their lifestyle. It is the collective responsibility of the medical and wellness community to empower them to fight all of these factors and work on a plan that works for them.
Obesity As A Chronic Condition
The CDC defines a chronic disease as “conditions that last one year or more and require ongoing medical attention or limit activities of daily living, or both.” Three leading chronic diseases are heart disease, cancer, and type 2 diabetes. Obesity is associated with all three of these chronic diseases.
In the US, one in six adults is obese. Sometimes diet and lifestyle changes are not enough, and individuals end up gaining the weight back due to an inefficient and lower basal metabolic rate.
Weight loss efforts are stymied as their own bodies attempt to restore the obesity status quo.
There is no doubt that obesity is complex, and impacts social interactions and emotional health for those who suffer from it. It is time 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.
Doing this should also help reduce social stigmas associated with the condition.
Gut Biome Matters
Extensive research on the subject has shown that gut biome composition has a clear role to play in the development of obesity. Existing habits plus our genes decide how gut bacteria react to certain foods over others, and in processing and storing fat.
This just goes to show that 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 do have a role to play.