Obesity: Disease? Condition? Should we care?

Should we call obesity a disease—or a condition?

This is a question that has become really controversial. This week, the Council on Science and Public Health of the American Medical Association (AMA) put out a report saying that obesity shouldn’t be classified as a disease. The next day, the AMA’s House of Delegates disagreed, saying it should be.

You know what I think? I don’t care. 

It’s not that I don’t care about obesity. I passionately care about it, because it is stealing the futures of far too many of my patients. Currently, one-third of U.S. kids are overweight or obese.  This is not a “baby fat” problem; current research overwhelmingly suggests that baby fat turns into adult fat. And being overweight increases your risk of all sorts of diseases, from heart disease and diabetes to cancer. Not only that, it increases your risk of social and emotional problems. This isn’t what I want for my patients.

Nobody wants it for anyone, of course. That’s exactly why this controversy has become so heated. Those who want obesity to be classified as a disease say that if we were to do that, it would draw much-needed attention and resources to the problem. It would make health insurance pay for doctor visits for obesity, which not all insurance companies do. They say that it would force us to take obesity seriously and come up with effective solutions for it.

But the people who don’t want it to be classified as a disease worry that if you call it a disease, the money would go to drugs and surgical treatments, and not into ways to make healthy eating and exercise more widely available. They worry that prevention efforts would take a back seat to the latest coolest medical treatment. They worry that obese people would say, oh, I have a disease—and not try as hard to lose weight. They worry that calling it a disease would mean that employers would have to make special accommodations for obese employees, further decreasing incentives for lifestyle change.

It’s so interesting that people equally passionate about fighting obesity can end up on opposite sides of an argument. Maybe that means it’s the wrong argument.

There’s also the problem that obesity doesn’t fit comfortably into the definition of a disease. Yes, it can affect the body in bad ways—no argument there. But it’s hard to define clearly when someone is obese; measures like body mass index (BMI) aren’t as reliable as we’d like them to be. There isn’t a clear way to say what the “signs and symptoms” of obesity are, and we should be able to do that for a disease. Not only that, while extreme obesity is clearly very bad for you, there are some obese people out there who don’t have any health problems—and some non-obese people with the health problems we associate with obesity.

More to the point for me, calling it a disease puts the attention on the patient, because that’s how we think about diseases. We might think about their environment and risk factors, but we don’t think big picture—and obesity is a big picture issue (no pun intended). We will never solve obesity if we don’t make healthy food and safe, affordable exercise opportunities available to everyone. We will never solve obesity if we don’t deal with the grain subsidies that make unhealthy foods so widely available and cheap.  We will never solve obesity if we don’t deal with the corporate and cultural factors that contribute to selling and buying super-sized sodas and fries.

I don’t care what you call obesity. Maybe it’s better not to call it a disease or a condition. Maybe we should just call it what it is: a thief. Because it is: it’s stealing the future of our children. It is increasing their risk of health problems, shortening lifespans and even taking away employment possibilities.

Maybe if we looked at it that way, we might get mad—and getting mad may be exactly what we need. Because more than anything, solving obesity is going to take a whole lot of effort and energy on the part of every single person, no matter what their weight. It’s going to take creativity, initiative, collaboration, tenacity and a whole lot of elbow grease.

Let’s stop worrying about what we call it—and start working together to fight it. Let’s not let our children’s future be stolen.