Is Obesity Really a Disease?

The relationship between health and body weight is not as straightforward as the American Medical Association might have us believe.
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Last week at the annual meeting of the American Medical Association in Chicago, the organization's delegates voted for the first time to designate obesity a disease. How should the rest of us respond? When we meet obese people, should we cast them a knowing glance of concern and ask how they are doing? Should we send flowers and "get well soon" cards to obese family members and friends? 

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Should the U.S. declare war on obesity, as we once did on cancer?

If obesity truly is a disease, then over 78 million adults and 12 million children in America just got  classified as sick. Their ranks have included a number of prominent people, such as actors John Goodman and Kathy Bates, musicians BB King and Aretha Franklin, politicians Al Gore and Newt Gingrich, professional athletes John Kruk and Charles Barkley, media personalities Oprah Winfrey and Michael Moore, and Microsoft CEO Steve Ballmer. Everyone has friends and acquaintances who now qualify as diseased.

It would be as false to say that everyone who is obese is sick as to say that every normal-weight person is well.

Yet many sensible people, from physicians to philosophers, know that declaring obesity a disease is a mistake. Simply put, obesity is not a disease. To be sure, it is a risk factor for some diseases. But it would be as false to say that everyone who is obese is sick as to say that every normal-weight person is well. Hence the AMA's vote raises some key questions. Why did it take this action? What is problematic about treating obesity as a disease? And how should sensible people think about obesity?

One reason for naming obesity a disease is the fact that being markedly overweight is positively correlated with a variety of health problems. Some of these problems are risk factors for diseases, such as hypertension, abnormal blood lipid levels, and sleep apnea. Others are diseases in their own right, such as heart attack, stroke, gallbladder disease, and osteoarthritis. Obesity is also a risk factor for some cancers, including those of the endometrium, breast, and colon.

Another reason for declaring obesity a disease is financial. It will nudge health care payers, including private insurers and the federal government, to pay for anti-obesity services, including weight loss counseling and programs. Why, proponents ask, should we pay physicians and hospitals tens of thousands of dollars to open blocked arteries yet refuse to spend a fraction of this amount on diet and fitness programs that might prevent the problem in the first place?

Yet everyone who is obese does not get sick, and many normal-weight people do not stay healthy. I have known slim and trim people who took scrupulous care of themselves throughout their lives yet fell ill and died young. Others who exhibited no particular interest in their health and did not watch their weight lived to a ripe old age. In most cases, we simply cannot tell from a person's weight what lies ahead for them in life.

Consider Winston Churchill. Though average in height, Churchill weighed upwards of 250 pounds. He smoked cigars. He drank relatively heavily. He did not jog or work out. Yet he became perhaps the most important statesmen of the 20th century and one of the greatest political orators in history. He served twice as Britain's prime minister, guiding his nation through a particularly perilous chapter in its history, and won the Nobel Prize for literature. He lived to age 90.

Thinner isn't always better. A number of epidemiological studies have concluded that normal-weight people are in fact at higher risk of some diseases, including cardiovascular disease, compared to those whose who are overweight. And there are health conditions for which being overweight is actually protective. For example, heavier women are less likely to develop osteoporosis than thin women. Likewise, among the elderly, being somewhat overweight is often an indicator of good health.

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Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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