The American Medical Association (AMA) recently took up the question of whether obesity should be classified as a disease but deferred any decision to a later date. As noted in HBO’s The Weight of the Nation, obesity has now become the largest threat to the health, wellness and future survival of our nation. It’s an epidemic and one that needs swift action and an unprecedented public health campaign. But is it a disease? And what would it mean if we called it that? What do YOU think?
American Heritage Dictionary defines DISEASE as (1) an abnormal condition of a part, organ, or system of an organism resulting from various causes, such as infection, inflammation, environmental factors, or genetic defect, and characterized by an identifiable group of signs, symptoms, or both AND (2) a condition or tendency, as of society, regarded as abnormal and harmful.
Even doctors disagree. While some say that labeling obesity as a disease would help improve care for patients and ensure that treatments are covered by insurance, others say it’s just a risk factor for health problems and not a disease itself.
Sure, Obesity fits common definitions of a disease, because it predisposes patients to other conditions and is often amenable to medical treatment. So why should it NOT be defined as a disease? Wouldn’t calling obesity a disease stigmatize a third of our nation and label many people as “sick” who actually are quite healthy? Whose agenda would that serve? And how might we avoid the politics of this debate?
The inspiration for this article came from a LinkedIn discussion group, where I weighed in with:
- Our DNA, which evolved over thousands of years, is hard-wired for certain behaviors that, in today’s society, contribute to obesity.
- Back when we were hunters and gatherers, we’d eat all of our kill, not knowing how long it would be until we might eat again. Today we grow and raise our food and eat any time we want but still tend to each all of what’s on our plate, even as portion-sizes grow.
- Like other species, we’re naturally attracted to sweet and salty foods. The profit motive of agribusiness and the fast food industry caters to these natural tastes and desires, so much so that the most profitable foods are the ones that are least healthy for us. And their strong lobbying position has sustained that trend with little oversight.
- Shifts in the nuclear household have left us with less time for family around the dinner table, and our on-the-go lifestyle makes us rely more on fast food. Modern technology supports a lifestyle that has made us (1) more sedentary and (2) deprived of sleep, which is critical to the production of hormones like melatonin that affects our appetite and helps our bodies fight disease, including cancer.
- The widening wealth cap and increased poverty levels also contribute to obesity, since people in poor, inner-city neighborhoods have less access to nutritious food and safe places to play and exercise. It’s quite telling that, according to The Weight of the Nation, public health officials can accurately estimate average weight by zip code and notice differences in average lifespan of over 20 years between poor neighborhoods on one side of town and affluent ones on the other, just 8 miles away.
Obesity as Disease
- Could remove personal (and social) responsibility. “It’s not my fault.” “It’s inherited.” “It’s contagious.”
- Medical treatment could more easily be justified by physicians and covered by insurance.
- Insurance companies could be forced to cover treatment expenses.
- It would be subject to HIPAA laws but hard to hide the visual evidence of being overweight.
- It would be easier for policy makers to require accommodations such as wider seats in airplanes.
Obesity as Risk Factor
- This puts more responsibility on individuals and the food industry, with an implied need for more regulatory oversight.
- It could result in stronger wording on food & drink packaging, like with graphic cigarette labels.
- It could help direct more public funds directed to constructing parks and playgrounds for safe exercise.
- It could polarize political parties, as fit voters object to programs helping those who are not as fit.
- Obese people could be forced to pay more in taxes and health premiums. Many employers already have fitness programs that offer discounts on health premiums for participating.
Please comment below with your thoughts and additional tradeoffs?