Dispelling nutrition myths, ranting, and occasionally, raving

Licence to eat?: My thoughts on classifying obesity as a disease

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Sometimes I need a little time to percolate on a subject before I weigh in. This was one of those times. A couple of weeks ago the American Medical Association decided to classify obesity as a disease. This, of course, created quite an uproar. On one side, there are the people who are saying that this will lead to a decrease in personal responsibility for the condition as well as those who believe that it will mean those of us who are not obese will be footing the bill for surgeries and new obesity drugs (1). On the other side, there are those who believe that this will lead to increased efforts to curb rising obesity rates and may be beneficial to those who are suffering from obesity (2).

Personally, I’m not sure that calling obesity a disease will lead to any improvements in obesity rates but I certainly don’t see it causing any harm. Considering how well we’ve being doing reducing obesity rates thus far I figure that classifying obesity as a disease is worth a shot. While I agree with the point made in the Globe article that the current use of BMI to measure obesity is highly flawed I would also like to point out that there are other measurements of obesity being developed (e.g. the Edmonton Obesity Staging System) and perhaps the classification of obesity as a disease will lead to wider use of these more accurate tools.

I also take issue with the notion that classifying obesity as a disease will lead to people throwing up their hands and saying “not my fault, I have a disease” and then going for a big mac meal deal. When alcoholism was classified as a disease in 1956 did alcoholics cheer and say “now I have a licence to drink!”. No. The classification raised served to raise awareness that this was a serious medical condition and increased treatment availability and options.

Did anyone else notice the photos of headless obese bodies accompanying the news articles? I hope that this classification will lead to increased sensitivity toward those who are obese.

My concern is not with the classification of obesity as a disease (keep in mind that over weight is not the same thing as obese and that individuals who are over weight may indeed be healthier than their “healthy” weight counterparts but yes, I am concerned that this classification may detract from the notion of health at every size) it’s with our current medical model in North America. Our focus is on treatment when it should be on prevention. This goes for all diseases, not just obesity. In Canada, our system will cover many treatments once you’ve fallen ill but will not cover most preventative measures. We need to start covering (at least some of) the cost of things like dietitians, certified personal trainers, gym memberships, sports equipment, etc. regardless of disease state. In the long-run it would be a lot less costly to keep people healthy in the first place rather than waiting until they become ill to provide medical and professional supports.

Yes, there is much more than our medical system that needs to be involved in preventing and curing obesity. Our food systems, environment, and societal structure are major contributors to our current high levels of obesity. However, as we’re talking about the AMA classification today I wanted to focus on the medical side of the issue.

So, these are some of my thoughts on the subject. I’ve seen many other thoughts out there as well, mostly from medical professionals and the media. What I’d really like to see are thoughts from those who are most likely to be directly affected by the classification of obesity as a disease. If any of my readers, or anyone you know, is currently (or was ever) obese and would like to share your thoughts on the recent classification of obesity as a disease by the AMA I would love to hear your thoughts on this subject. Please email me at dmc555 [at] gmail [dot] com to let me know what your thoughts are. With your permission, I will share your thoughts in a future blog post.

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Author: Diana

I'm a registered dietitian from Nova Scotia, living and working in Ontario, Canada. My goal is to help people relearn how to have a healthy relationship with food.

3 thoughts on “Licence to eat?: My thoughts on classifying obesity as a disease

  1. You missed a side — those of us who do not believe obesity, in and of itself, is a disease and who believe that this decision will do more harm than good. My fear is that this will lead to even more overtreatment of people with no risk factors other than body size. Intentional weight loss diets rarely work long term, and can trigger disordered eating in vulnerable people. Weight loss drugs have a poor track record, and surgery carries serious risks. Every treatment has side effects. And BMI, which is what they are using, is too blunt an instrument.

    If a woman is 5’4″, 175 pounds, weight-stable, eating a healthy & varied diet, exercising, and has excellent cholesterol, blood pressure, resting pulse and fasting glucose … why would you advise her to change anything? And if good health measures can be achieved through a Health at Every Size approach, why even put a focus on the weight?

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    • Thanks for your thoughts.

      I did mention my concern that this approach might have on HAES and the importance of using a better diagnostic tool (e.g. The Edmonton Obesity Staging System) than BMI.

      I’m doubtful that classifying obesity as a disease will lead to an increase in disordered eating. However, I suppose time will tell.

      Doctors definitely need more training in how to work with obese patients regardless of the classification of obesity as a disease or not.

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  2. Still not sure how to feel about the label. Honestly, I doubt that it will be much more than just that, a label. My first thought was that it might be good to draw attention to the problem, but then I realized that it’s already a pretty highly publicized issue.

    I’ve also heard the argument that we should be focusing on the associated conditions (metabolic disease, diabetes, etc.), rather than obesity itself. I suppose addressing the outcomes would get around the problems brought up by EC, but it also seems a bit ineffective to treat numerous conditions when you could focus on prevention by tackling obesity directly. Of course obesity does not necessarily confer a slew of medical problems, but why not minimize the risk if we can?

    In the end, I think that reducing obesity will depend more on food manufacturers/providers and individual action more than government or outside institutions (i.e. AMA). I, like you, am interested in seeing the real impact this distinction will have on Americans.

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