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Viewing Obesity as a Chronic Disease

Asthma, diabetes and cancer. They’re all chronic diseases. But what about obesity? Is it a disease, or something else? According to the American Medical Association and the Canadian Medical Association it is. But not everyone feels that way. The American Heart Association lists obesity as a behaviour (although this may change).

At first glance, the definition of a disease is quite simple. It’s a condition that impairs normal function of one or more parts of the body. But the medical definition of a disease is more complicated. There are definitely changes in biology and metabolism as a result of excess body fat, but the notion to label something a disease has much to do with ensuring people can be treated for it.

And for obesity, there are a number of treatments. There’s behavioural therapy, focusing on eating and activity habits. This might also include the psychological aspects of dealing with obesity. There are also medications for treating obesity along with surgery. While these aren’t sure-fire cures, the same can be said of diseases such as cancer and heart disease. Chemotherapy doesn’t always cure cancer and a coronary artery bypass graft doesn’t cure heart disease.

body shaming

Bias in Health Care

But just because there are treatments, it doesn’t mean they are easily accessible. It’s well-known people with obesity face bias and ridicule. But this isn’t just limited to the general public. Bias and stigma exist in health care as well. People with obesity report being disrespected by doctors and not taken seriously. This leads to a mistrust in the health care system and avoidance of seeking care. Something that can be detrimental to one’s health later on.

More recently, the Canadian Adult Obesity Clinical Practice Guidelines were released by Obesity Canada. These guidelines are directed to health care professionals. The guidelines received a lot of attention as being progressive and forward thinking. (I had a minor contribution in these guidelines.)

Foresight map on complexity of obesity

The Latest Guidelines on Obesity

As with previous guidelines, these ones consider obesity a complex chronic disease. This reflects the many factors involved in obesity. From biological and genetic factors to environmental and lifelong experiential factors, obesity is more than just what a person eats and how much activity they get. The guideline writing committee also included people with lived experience with obesity.

However, the guidelines differ from others by separating weight from health. Traditionally, obesity is defined by the body mass index (BMI), a measure of weight over height, greater than 30. However, the BMI was created to study populations. It was never created to be applied to individuals in a medical setting as it is being used now. This is because obesity is a concern of excess body fat, not excess weight. And as I’ve written before, weight is a poor measure of health.

Instead, obesity is defined as “…abnormal or excessive body fat, that impairs health.” Health in this case is determined by an assessment of physical and mental well-being. Therefore, a person could have a high BMI but not be obese if they are healthy. Conversely, it’s possible to have an ideal body size based on BMI but still have a level of body fat that compromises health.

The guidelines also direct the health professional to ask the patient for permission to discuss obesity. This is for two reasons. One, any successful program requires the active and willing participation of the patient. But more importantly, it’s a result of the frequent sigma and bias that people with obesity have experienced throughout their lives and within the health care system.

A key element of the guidelines is the focus on physical health and well-being. Weight loss isn’t the goal. While most suggested treatments may result in weight loss, not all do. Some instead focus on factors related to excess body fat.

cure-all for obesity

A Cure-all for Obesity?

However, these guidelines aren’t a cure-all for obesity. There are many levers of change for managing obesity and health care is just one. It’s clear the environment, and lifestyle within that environment, have a key role in the proportion of obesity in a population. But this is no different from most other chronic diseases. Cancer, asthma and type 2 diabetes all have foundations in the environment, yet are managed predominantly in the medical setting.

Despite this, not everyone was pleased with these guidelines. Some people wrote this would ‘pathologize’ people by calling obesity a disease. And not everyone with obesity would say they have a disease. And fair enough. With obesity having such a prominent appearance-centric quality to it, who wants to look in the mirror and see a diseased person. This adds a layer of complexity that isn’t found in other diseases such as diabetes and atherosclerosis. But for those people who want support from the health care system, these guidelines represent a step forward and call on health professionals to be there for their patients.

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10 responses to “Viewing Obesity as a Chronic Disease”

  1. Great article!

  2. Scott, just read the summary article in CMAJ quickly, but nowhere do I see depression and mental health as a factor of why people become or remain obese. Great to hear your thoughts.

    1. Hi Diana,
      You’re right, there’s only a brief list of recommendations in the summary (Table 1), but the full guidelines are on the Obesity Canada website. There’s a chapter dedicated to mental health, which goes over some of the things you mention. Here is the link: https://obesitycanada.ca/guidelines/mentalhealth/
      I hope that helps.

  3. My wife diabetes symptom was diabetic neuropathy. We didn’t know she was diabetic until we went to my doctor complaining about constant foot pain. After a multitude of tests for everything from rheumatoid arthritis to muscular dystrophy, an emergency room physician checked her blood sugar.After reviewing a letter written by my doctor, where I read he had prescribed Celebrex for her due to pain of Arthritis which had really messed her neck, back and knees, I found that one of the side effects of Celebrex is Diabetes, my wife was able to effectively cure herbal condition www multivitamincare org It is too much for a patient to endure such as they slowly begin to pass away if the right medication is not taken organic herbal treatment.Having a positive mind is a powerful tool .My prayers goes out to diabetes patients and their care givers.

    1. Thanks for your comments and I hope you wife is doing well.

  4. […] kg/m2), how we view obesity has changed in recent years. Many medical organizations now consider obesity as a chronic disease. And in 2020, the Canadian guidelines defined obesity not by BMI but as a disease of excess body […]

  5. […] of obesity as it relates to physical health. And indeed, people with obesity are more likely to get type 2 diabetes, heart disease and cancer. Yet obesity can also affects one’s mental […]

  6. […] measured to calculate body mass index. A body mass index equal, to or greater than 30 kg/m2 is the diagnosis for obesity. And a higher value increases the chances of getting diseases such as diabetes, heart disease and […]

  7. […] true being overweight or having obesity can increases one’s risk for a number of diseases and early death. This is concerning given nearly two billion (39%) adults are considered overweight and one-third […]

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