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Is obesity a disease, or is it something else?

In the world of health, not much gets the attention or stirs up emotion as obesity. From the media telling us what to eat and how to lose weight to scientists telling us how big of a problem it is, to “entrepreneurs” wanting to make a buck off of the issue. Everyone seems to have an opinion on obesity.

The latest controversy is around what we call obesity. Is it a medical problem, a societal problem or an individual problem? Or is it all three? Is obesity a disease or a result of certain behaviours and choices?

Even though countries such as Portugal have considered obesity a disease since 2004, no one really took notice until the American Medical Association voted in favour of calling obesity a disease in 2013. Since then, the Canadian Medical Association followed. But not all organizations are in agreement, most medical associations haven’t tilted that way and the reputable American Heart Association lists obesity as a health behaviour.

This has got many individuals, groups and organizations up in arms and picking sides. A fight is brewing with the implications being how society views and manages obesity, putting a lot of money at stake.

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The definition of disease is quite simple, it’s a condition that impairs normal function of one or more parts of the body. So how does obesity fit into this definition?

While many of us see obesity as only an increase in body fat, it is much more than that. This excess body fat results in changes to how the body functions by increasing the size of our fat cells. However, if you’re obese as a child, the number of fat cells also increases. These fat cells don’t go away when body fat goes down making the person more likely to gain the weight back.

Excess body fat also leads to more fat molecules in the blood, which then prevent insulin from working resulting in higher blood sugar. All of this leads to a greater chance for diabetes and heart disease. Obesity can also lead to sleep apnea, gout and, back and joint problems.

Given this, obesity certainly fits the definition of a disease. However, many people believe that obesity is the individual’s responsibility. Or to put it in more commonly used terms; if someone is obese, it’s their fault. It’s as if a person woke up one morning and decided to be obese. This would be like calling lung cancer or heart disease a choice since behaviours such as smoking, poor nutrition and being inactive are involved.

built environment

On a basic level, how much body fat we have is a result of what we eat and how much energy we burn. But it’s not nearly as simple as that. When society constantly works to make our lives more efficient, it takes out the need for us to be active, so we burn less energy. If we live in a neighbourhood where there is no sidewalk, then we’re less likely to walk around. Likewise, if we don’t have access to, or can’t afford healthy foods, we’re left with eating calorie rich but nutrient poor foods.

While we all make choices, we can only choose from the options in front of us. If there are no healthy options, whether it be for activity or nutrition, how can we make healthy choices? An environment in which the healthy choice is the easy choice is ideal, but it doesn’t really exist.

If it was only the environment we have to worry about, that wouldn’t be so bad, but it’s not. People who are obese are more likely to have obese children. Some of this is due to children picking up habits from their parents. But we now know that women who are obese have heavier babies at birth. Obviously this isn’t due to the baby’s habits but rather changes in the child’s biology that occur in the womb.

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There’s also a whole host of medications that can lead to weight gain. The weight gain is often a side effect of the medication used to treat another condition. With many of us taking medications for one reason or another, it’s likely that a lot of people may be taking some that increase weight.

The push back against obesity as a disease comes from a broad range of stakeholders; airlines, health care professionals and obese individuals themselves to name a few.

Airlines may be worried they will have to provide large seats or two seats for the price of one for obese people. Many doctors don’t want to treat obese patients due to thinking their lazy and it’s their fault. For other doctors, it just adds to the growing list of conditions needed to be treated. Some obese people don’t want to be labelled with a medical condition and worry that calling obesity a disease will further increase fat shaming and may affect the cost of their health and life insurance.

Despite these concerns, most people may actually agree with calling obesity a disease. It may be due to the benefits such as opening the door for greater access to prevention and treatment. Medically supervised weight loss strategies (behavioural counselling, medications and surgery) are more likely to be accessible and covered by insurance.

It also draws attention to what many feel is a public health issue for individuals and society at large. At the same time it acknowledges there are factors about obesity that are beyond a person’s control. By recognizing obesity as more than an individual thing, we can begin to truly look at solutions that can prevent and treat it.

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