The new face of obesity

It’s 'official' at last. Obesity has been recognised as a disease by the American Medical Association (AMA). The decision has become a controversial topic, with many in the medical professional and outside it claiming obesity is not a disease. Most are comfortable describing obesity as a ‘condition’ or ‘disorder’, saying it is only a risk factor for other diseases. Some others argue that it should be termed a ‘lifestyle disease’.

“Recognising obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, said in a statement. She suggested the new definition would help in the fight against Type 2 Diabetes and heart disease, which are linked to obesity.

This AMA resolution argued that obesity was a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like Type 2 diabetes and cardiovascular disease. Studies have also linked carrying too much weight to an increased risk of getting some kinds of cancer, including esophageal, colorectal and pancreatic cancers.

The question of whether obesity is a disease or not is a semantic one, since there is not even a universally agreed definition of what constitutes a disease. And the AMA’s decision has no legal authority.

Still, there is no doubt that it is a landmark declaration. In a way, the AMA is a little late to the party – the World Health Organisation (WHO) declared obesity as a global pandemic 15 years ago.

The Obesity Society itself agreed that it is a disease back in 2008. Worldwide, more than 500 million people suffer from obesity and related conditions. A further 1.5 billion are classified as being ‘overweight’ which is one notch below being obese.

Uncommon

Obesity is more common in urban areas than in rural areas. Obesity is uncommon only in Sub-Saharan Africa. Obesity has indeed become a worldwide phenomenon and even in Sri Lanka, obesity levels are rising. And in case you thought it is a modern phenomenon, there had been references to obesity in a physician’s manual written in the 17th century.

What really causes obesity, even if it can be recognised as a disease? An unbalanced diet and the lack of exercise are often cited as the biggest reasons, though genetic factors could play a role. There is a raging debate now whether junk food could be totally responsible for obesity, but the diet does play a role.

There is another aspect of the AMA’s decision that should be considered by doctors and obese people themselves. If obesity is a disease, can drugs control or even reverse it ? There are already are several drugs which cater to this market and a variety of non-prescription ‘weight loss’ concoctions.

Two new obesity drugs have entered the market in the past year alone. This has raised fears that obese people would opt for drugs to cure the “disease” instead of changing their lifestyles.(They recently received an incentive in the form of a controversial article titled ‘How Junk Food Can END Obesity’ in the Atlantic Monthly). On the other hand, no one likes to have a disease, so people who are in danger of becoming obese may think twice about their calorie intake.

There is another benefit of the classification in that the society may look at obese individuals in a more favorable light if they are suffering from a disease instead of from a social or dietary condition.

There are many instances of discrimination against obese people - several airlines are considering a proposal to charge passengers by weight whereby obese people may have to pay more to travel.

At least one airline in Samoa already weighs people before they board their planes. Insurers already force them to pay higher premiums on the basis that they face higher risks vis-a-vis heart attacks and diabetes. Denmark had a so-called “fat tax” for some time whereby certain ‘fatty’ foods attracted a higher tax band. People usually associate obesity with laziness and lack of will power. Even at school, obese students are more likely to get bullied.

Flawed

Opponents of the AMA decision say that obesity should not be considered a disease mainly because the measure usually used to define obesity, the Body Mass Index (BMI), is simplistic and flawed. According to several studies, some people with a BMI above the level that usually defines obesity are perfectly healthy while others below it can have dangerous levels of body fat and metabolic problems associated with obesity.

We all know that everyone who is obese does not get sick, and many normal-weight people do not stay healthy. We have seen plenty of examples for slim people who stuck to a god diet and exercise regimen throughout their lives and yet died young.

There are others we know who had gone against every health rule, with no particular interest in getting slim and yet lived to a ripe old age. In this context, weight in itself is clearly not an indicator of health and lifespan. Moreover, food intake in itself is also not an indicator for being fat. There are many slim people who never seem to gain weight regardless of how much they eat and conversely, many fat people who do not lose weight even if they go hungry.

Some studies even suggest that a little fat can do no harm, since those reserves can come in handy in an emergency. Heavier women are less likely to develop osteoporosis than thin women. Among the elderly, being somewhat overweight is often an indicator of good health.

The debate on obesity and its effects on personal health is likely to rage on regardless of the AMA’s declaration that it is a disease. It boils down to one inescapable fact - some people are obese by default (i.e. due to no fault of their own) and others by design (due to lifestyle choices).

Thus seeking treatment for the ‘disease’ of obesity is up to those individuals. It’s matter of choice in the end.