Obesity is considered a disease. It is considered a risk factor. It is considered undesirable. It is considered, in essence, a sign that you are unhealthy, and it is treated as something to be done away with. This outlook on obesity is dangerous and needs to be revised. Keep reading to learn about the complexities of obesity and why it’s a mistake to treat body weight alone as a marker of disease.
What Is Obesity?
Obesity is an abnormal accumulation of body mass, usually 20% or more over an individual’s ideal body weight. It is associated with an increased risk of illness, disability, and death.1-3 The branch of medicine that deals with the study and treatment of obesity is known as bariatrics. As obesity has become prevalent, its association with disease has lead it to be considered a serious health problem in the United States, and bariatrics has become a separate medical and surgical specialty.
Is Obesity a Disease?
The American Medical Association (AMA) classifies obesity as a disease. However, there is some debate over this issue. In her article titled Defining Obesity as a Disease May Do More Harm Than Good, author Maia Szalavitz points out some of the problems and inaccuracies with this classification. “The AMA Council on Science and Public Health, which advised against considering obesity a disease, noted that it is more of a risk factor for other conditions, such as diabetes, heart disease and high blood pressure than a disease in itself. In other words…it’s a risk factor, not a disorder.”4 And yet, the medical industry and bariatric specialists are treating (or attempting to treat) obesity as an isolated disease state.
There are fundamental problems with viewing and treating body weight as an isolated disease.
First of all, using a number on a scale (in relation to height, weight, and age) to diagnose a disease is far too simplistic. The actual relationship between health and weight is very complex. Body weight and body fat percentage are not good indicators of health and longevity.5,6 As Szalavitz points out, “Body mass index, which is the most commonly used measure that incorporates height and weight, can incorrectly label muscular, healthy people as being overweight, while also misclassifying some people with unhealthy levels of fat and insulin resistance as being of healthy weight.”4
For example, at 155 lbs. and 5’5” you could be in all other ways absolutely healthy and feeling sensational. Despite being perfectly healthy, a doctor would still say you are at risk for obesity and need to lose at least 10 lbs. to bring you safely into the healthy range. Likewise, if you were obese and lost 10% of your body weight by adopting a healthy lifestyle, your health would improve significantly and you would have a much easier time maintaining that modest level of weight loss. Yet your doctor would recommend further weight loss, simply because the scale says you are still in the obese range. In a situation like this, maintaining weight would be the most appropriate and statistically supported course—in spite of being outside the ideal BMI.
Is Weight Loss the Cure?
No. Weight loss is not a simple cure for obesity. For one thing, saying that the number on the scale going down is always good for your health is absolutely false. There are many diseases, such as diabetes, cancer, and AIDS, as well as psychological disorders that are associated with weight loss. It’s important to note that “treating” obesity (and the associated health problems) with weight loss can lead to very dangerous effects—especially when rapid and drastic weight loss are prescribed. Such treatments lead to malnutrition and chronic caloric deficit, which in turn cause long-term health damage. Telling someone to damage their health in this way is just plain negligent. Gastric banding and gastric bypass surgery, too, are drastic and dangerous treatment methods.7 For more information, stay tuned for my next blog post, which will discuss lifestyle intervention as a safer, more effective alternative for treating obesity.
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- Froehlich-Grobe K, Lollar D. Obesity and disability. Am J Prev Med 41, No. 5 (Nov 2011): 541-545. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198028/
- Pi-Sunyer X. The medical risks of obesity. Postgrad Med 121, No. 6 (Nov 2009): 21-33. http://www.ncbi.nlm.nih.gov/pubmed/19940414
- Rubenstein, AH. Obesity: a modern epidemic. Trans Am Clin Climatol Assoc 116 (2005): 103-113. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1473136/
- Szalavitz M. Viewpoint: Defining obesity as a disease may do more harm than good. TIME (Jun 2013). http://healthland.time.com/2013/06/19/viewpoint-why-defining-obesity-as-a-disease-may-do-more-harm-than-good/
- Abernathy RP, Black DR. Healthy body weights: an alternative perspective. Am J Clin Nutr 63, 3 Suppl (Mar 1996): 448S-451S. http://www.ncbi.nlm.nih.gov/pubmed/8615340
- Robison, J. Health at every size: toward a new paradigm of weight and health. Medscape General Medicine 7, No. 3 (2005): 13. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681635/#!po=51.5625
- Worni M, Østbye T, Shah A, et al. High risks for adverse outcomes after gastric bypass surgery following failed gastric banding: a population-based trend analysis of the United States. Ann Surg 257, No. 2 (Feb 2013): 279-286. http://www.ncbi.nlm.nih.gov/pubmed/23011388