What is obesity? We all know it when we see it but do we know what causes it? Many people think that obesity is down to laziness and greed. Obesity is, however, more serious than someone carrying a few extra pounds. It is a medical, life limiting condition and people who suffer from it deserve help and support.
Obesity is an issue for one in three Americans and the AMA took the decision in order to impact on the way doctors and other medical professionals approach those suffering from the disease. Many other health issues (Type II Diabetes and Heart Disease) are linked to or made worse by obesity so treating and preventing obesity should have a positive effect on instances of many other conditions. In Sweden it has been accepted that obesity is increasingly prevalent, particularly amongst young people and as such policy makers need to look at targeting the problem and its associated social, personal and economic costs.
The American Medical Association (AMA) took the decision, on June 18, 2013, to classify obesity as a disease. This was a controversial decision that is still being debated today. The debate gives rise to strong feelings on both sides. Here are our 10 reasons why obesity is a disease.
- Obesity Has Always Been Treated As a Disease
As far back as the Ancient Greeks Hippocrates defined obesity as a disease noting that it could case impotence and sexual problems. Plutarch exhorted people to avoid indulging in delicacies and Galen invented the ‘fat camp’ when he ‘reduced a huge fat fellow to moderates size…by making him run every morning until he fell into a profuse sweat’.
By the 17th Century English Doctors were calling obesity a disease. They thought it was caused by a malfunction of the internal organs. Obesity has always been identified as a problem; however, historically it has been a problem that is the preserve of the rich. As Oliver Twist says in the song ‘Rich gentlemen have it boys…indigestion!’ Today many parts of the world are, by historic standards, incredibly rich and have a food security that is unparalleled. With this improved food security come related food problems.
- Doctors Say It Is
Doctors are experts in disease and how to cure it. If they say something is a disease we should listen to them! The AMA decided it was a disease in 2013 and the FDA, American College of Gastroenterology and the American Heart Association, amongst others, all agree. Nor is the US the only country where doctors make this claim. In Malaysia Dr Tee E Siong o the Nutrition Society of Malaysia and Professor Dr Mohd Ismail Noor of the Malaysian Society for the Study of Obesity say it should be referred to as a disease ‘so that the public can be more aware of the dangers of the condition’. Obesity Australia is also campaigning for formal recognition of obesity as a disease to ‘remove stigma and reduce obesity rates.’
- The World Health Organisation Says It Is
Obesity was already formally classified as a disease by The World Health Organisation when it was founded (back in 1948). Obesity was, however, ignored for a long time as it was seen to be a problem of the developed world. By 1988 the World Health Organisation Obesity Report showed that obesity was becoming a worldwide problem. WHO’s factsheet ‘Obesity and Overweight’ gives advice to individuals, society and food manufacturers on how to combat obesity and other related ‘noncommunicable’ diseases.
- Obesity Can Be Inherited
No matter how healthy a lifestyle, how well people eat, some people are simply predisposed to be obese. People who suffer from conditions such as Prader-Willi Syndrome or a congenital condition such as hyperthyroidism are likely to be obese – sometimes from a young age.
Even if you do not have markers for any particular syndrome it is possible to be predisposed to obesity. If both your parents are obese you have an 80% chance of being obese yourself. There are more than 41 genes that predispose people to obesity. Why is this? There are survival benefits to obesity – if you can store up energy in the good times you are more likely to survive a period of famine. This so called ‘thrifty gene’ was a great benefit in century’s past.
A modern day ‘paleo’ diet may be all very well but it is not the answer for everyone. Even in prehistoric times there were some people who were predisposed to be obese. Many of the ‘Venus’ figurines recovered from the time show women with large breasts, stomachs and buttocks. These figurines may demonstrate the ‘desired optimum’ i.e. large is beautiful but even if that is the case the optimum had to exist for the artists to be aware of it. Put simply some cave men were obese and that genetic predisposition has been passed on to their descendants – us!
- Obesity Has an Impact on Life Expectancy
If someone who is not obese suffers from a condition that reduces their life expectancy most people would be comfortable labelling that condition a disease or illness. Lung Cancer is a disease whether or not the person who has it was a smoker. Cirrhosis of the liver is a disease whether or not the sufferer is a drinker. WHO states that 3.4 million adults die from obesity each year. Shockingly 65% of the world’s population now live in countries where obesity is more of a health risk than being underweight. The sad fact is that obesity is one of the leading causes of preventable death worldwide by as much as 10 years in the most extreme cases. If any other condition had this type of major impact there would be no debate about whether or not it should be classified as a disease – indeed there would be an outcry if it was not.
- Obesity Impacts on the Proper Working of the Body
Ask a child what happens when you are sick or have a disease and the likelihood is that they will say that the disease stops ‘some body part’ working properly. Heart disease impacts the heart, lung disease the lungs etc. Obesity also impacts on the proper working of the body.
This impact on the body comes in two separate but connected ways. Firstly the increase in body mass can cause mechanical problems such as osteoarthritis, sleep apnoea and mobility problems. These will often be alleviated if the sufferer loses weight. Secondly the increase in the number of fat cells within the body can be the cause of a range of medical problems such as Heart Disease, Fatty Liver Disease, Infertility, High Blood Pressure etc. Such medical problems may not be easily reversed by a loss of weight.
- Obesity Works like Type II Diabetes
When a person becomes obese their body starts to produce more of a hormone called Leptin than the bodies of people who are not. Leptin is responsible for telling the body when it is full in the same way that Insulin controls the body’s response to Glucose. When a person produces too much Leptin they become resistant to it in the same way that someone with type II diabetes is resistant to Insulin.
As a person puts on weight their body secretes more Leptin – they are then no longer able to tell when they have eaten enough and so their body allows them to over-eat. Type II Diabetes is treated as a disease whether or not a person develops it as a result of genetic predisposition or as a result of a particular lifestyle. If this is true for Type II Diabetes then why not for obesity?
- The Body Adapts To a Specific ‘Set Point’
Most people will have a stable ‘set point weight’ – the weight to which their body defaults. The scales may go up or down but they generally sit at or around this point. As a person puts on weight the body becomes used to a new normal – the set point changes and creeps up. When a person tries to lose weight the body will default back to its set point – it ‘defends’ the weight. This is why diets are often inefficient unless the person concerned is able to make a wholesale lifestyle change. Even then the body will often try to revert back if the person ‘slips’. Not unlike an alcoholic who is never cured a person who does manage to lose weight is not able to give up on their new regime at any time.
- Obesity Meets the Definition of ‘Disease’
There is no single definition of disease but Webster’s dictionary defines it as ‘An alteration of the state of the body or some of its organs, interrupting or disturbing the performance of the vital functions and causing or threatening pain and weakness; malady; affection; illness; sickness; disorder…’
Obesity meets this definition in all respects. It alters the body– not only by increasing the size of the person suffering from the disease but by affecting the way in which the body produces or metabolises substances; by altering how efficiently some of the organs work or how well the person affected can move. It can cause the sufferer pain, discomfort, embarrassment. It exacerbates other underlying problems and is often, in its causes and effects beyond the control of the sufferer. Obesity has an effect on the physical and mental wellbeing of the sufferer and causes sickness or even death.
- Obesity Is Like Alcoholism or Depression – Once Seen As Lifestyle Conditions but Now Accepted As a Disease
One hundred years ago alcoholics were given very little support. Not much was known about the psychology, physiology and mechanics of addiction and it was seen as a lifestyle problem – an addiction gone wrong. In years gone by people suffering from mental health problems were stigmatised, marginalised and told to sort themselves out. In these, more enlightened times, we look back at such attitudes with horror and compassion. People suffering from alcoholism or mental health problems have access to a wide range of support networks and treatments to assist them in dealing with their disease.
There is no reason to view obesity in a different light. Even if obesity in a particular person is connected to lifestyle instead of genetic issues there is no reason not to treat it as a disease. Alcohol or cigarettes are optional – we do not need them to survive. All people need to eat; even those who are obese. It is difficult to change a relationship with something that is a fundamental constant in life. You can say no to a glass of wine or beer every day for the rest of your life – you cannot say no to breakfast, lunch and supper.
Obesity, as opposed to just being a little overweight, is a condition that is often beyond the means of the sufferer to fix without assistance. It is a disease that has been with us as long as people have been on the planet. Obesity can be inherited from family – if your parents are obese the strong likelihood is that you will be too. While obesity can cause or exacerbate many other health conditions such as heart disease or diabetes it can also be caused by underlying health problems.
Once an obese person’s body gets used to the weight it will work against attempts to lose it – our bodies are designed to ‘defend’ the highest weight we reach. Obese bodies become resistant to the hormone that tells us when we are full, in much the same way that a person can become resistant to insulin. Obesity limits life and the sufferer will most likely need medical assistance to deal with the problem. If Alcoholism, Lung Cancer, Cirrhosis, Depression are all diseases then so is Obesity.
Obesity is a growing problem worldwide it is a complex issue with many underlying causes that require complex, multi-party solutions. If obesity is considered a lifestyle choice, it can be palmed off as the personal responsibility of the sufferer. If it is a disease with a social and economic impact it becomes a wider problem. The medical establishment can legitimately look for new and innovative ways to treat this disease. Governments will have to make conditions favorable for investment in treatment and ensure that it is accessible and affordable for all. They will promote healthy living; make sure that the urban environment is exercise friendly. Society needs to stop victim blaming and stigmatizing sufferers. Categorizing obesity as a disease is the first step in making these solutions possible and available to all.