Topic for Jun. 27. ( Thur )

[Alex !]

Is Obesity A Disease or A Behavior Abnormality?

In June 2013, the American Medical Association (AMA) House of Delegates voted to recognize obesity as a disease state requiring treatment and prevention efforts. A number of other medical societies had sponsored a resolution to support this idea.

The stated purpose for this decision is to improve research into the causes of obesity, leading to improvement in methods to prevent and treat it, ultimately improving patient health and outcomes.

The decision is controversial, since the Council on Science and Public Health in 2012 said that there was not sufficient data to support calling obesity a disease. In this article I will discuss some of the issues associated with this controversy, as well as what we know regarding the etiology of obesity. 

Obesity is recognized as a significant public health hazard, as it increases the risks for multiple diseases, such as type II diabetes, cardiovascular disease, hyperlipidemia, hypertension, stroke, breast and colon cancer, and degenerative arthritis.

It decreases quality of life, functional capacity, and increases morbidity and mortality. Treatment has been shown to reduce morbidity and mortality. Therefore, preventing or treating obesity would be very beneficial on both an individual and societal basis.

One of the controversies regarding whether to define obesity as a disease is the fact that there is not agreement as to the definition of obesity. Obesity can be defined as an excess of body fat that leads to increased morbidity and mortality.

To discuss this, we need to agree on the definition of a disease, which is not as obvious as it would seem. Historically, it has long been recognized that people who are overweight or obese were at higher risk of sudden death; this dates back to Hippocrates over 2500 years ago.

Twin and adoption studies show that variations in BMI have a significant genetic component, and it has been estimated that these genetic effects contribute as much as 70% of the variation in obesity.

Environmental influences are another major contributor to obesity. The so-called “obesogenic” environment with its reduced food costs, the especially plentiful high calorie dense foods, larger ser ving portions, reduced physical activity, and the influential food industry, are likely contributors.

Sleep deprivation, medications, social networks, stress, and changes in bacteria in the GI tract (microbiome) are thought to be contributing factors. 

There are multiple contributing factors for obesity, as well as many unanswered questions. If the environment promotes obesity, why is everyone not obese? Why do some people eat more than others? 

So is it a good idea to label obesity a disease? Overall, I think yes it is despite the many controversies associated with the disease designation. These include the controversy regarding the lack of a universal definition for obesity, and whether it fits the scientific definition of a disease.

There are also concerns that the definition of obesity as a disease will shift the emphasis towards treatment with surgery/medications, and away from prevention efforts via lifestyle changes, including behavior modification, diet, and exercise.

There are concerns that obese people will be labeled as having a disease, even if they are not sick. This could have effects on obese individuals’ efforts to manage their weight and make lifestyle changes.

In our society, labeling it as a disease would be expected to improve attitudes and financial support for obesity treatment. This would include more resources for health promotion, research into the behavioral, environmental, and genetic causes, as well as prevention and treatment (medical and surgical). This would improve insurance coverage and reimbursement for screening, health promotion, prevention, and treatment.

Obviously obesity is a complex topic. Despite extensive research, the causes for this disease are not well understood and good treatment options remain elusive. As Dr. George Bray, a distinguished obesity researcher, once said, “Obesity isn’t rocket science, it’s much more complicated.