Obesity: Disease or Choice?

             Last night I was watching another episode of “My 600-lb Life” (see my review of the first episode here), when my boyfriend asked me an interesting question: “Do you think obesity is a disease?” It reminded me of the many discussions I’ve seen floating around the web about Whitney Houston’s untimely death and whether we should mourn given that she chose to use drugs. I think people have a similar ambivalence about calling obesity a disease- many think it’s a choice that certain (misguided) people make.

            Well, first let’s define the terms. I want to be clear that I’m not talking about people who are overweight or want to lose those last ten pounds. ‘Obese’ generally means having a body mass index of greater than or equal to 30[1].  A disease is “a condition of the living animal or plant body or one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”[2]

            Based on the definitions above, obesity certainly seems to fit into the definition of a disease, doesn’t it? When someone is obese (not just overweight), it often impairs their normal functioning; basic physical functioning (walking, standing, breathing etc.) and even more complex physical functioning (heart disease, high blood pressure, diabetes, etc). And there are certainly signs and symptoms leading up to obesity- obviously weight gain but more specifically increased body fat.

            So why do we as a society have such a hard time considering obesity a disease? I think it’s because we have a view that a “disease” is something that happens to someone- it’s completely out of their control. A person is “struck” with a disease, without warning and through no “fault of their own”. Weight gain on the other hand, is widely viewed as completely controllable- it’s a choice, one that an obese person could have (and should have) avoided. Finally, I  believe there is a certain disdain that society has for obese people as undisciplined and weak-willed, so that the idea of calling obesity a disease seems to be letting obese people “off the hook”.

            But consider the fact that not too long ago we had the same attitudes towards alcohol. It wasn’t until the 1980s that the American Medical Association adopted policies to treat the abuse of alcohol as an actual disease.[3] Alcoholism, as it is currently understood, is a disease with both a mental and physical components: we now understand that one can be genetically pre-disposed to becoming an alcoholic but that you can also become an alcoholic as a result of mental problems (depression, poor impulse control, etc.) And, as my friend pointed out, while you can commit to stop drinking alcohol to guard against alcoholism, you can’t stop eating food to guard against over-eating.

            So obesity, in my view, is a disease. To me, it’s a form of ‘food abuse’ much in the same way that alcoholism is a form of drug/substance abuse. I think society is reluctant to call obesity a ‘disease’ because we think doing so would in some way mean that obese people shouldn’t be held responsible for their abuse of food. But to say that obesity is a disease does not diminish any individual’s responsibility to eat healthy; acknowledging that obesity is a disease just properly defines something that we as a society have been reluctant to define for far too long.

            I would go even further to say that we must treat obesity as a disease, if only because it forces us to take the issue more seriously and tackle it in an urgent and nuanced way. Much in the same way that we have come to understand that alcoholism requires medical treatment (eg. rehabilitation centers) and ongoing support (eg. Alcoholics Anonymous, support groups, etc.), perhaps understanding obesity as a disease would create a clearer conversation about what methods would be most effective in treating it. As seen on “My 600-lb Life”, simply losing the weight often is not enough; the underlying psychological causes for the abuse of food have to be explored and treated for any real progress to be made. I think that the moment society treats obesity as a disease, and not grounds for shame/ridicule, we move closer to solving the obesity problem and saving people’s lives. What do you think? -CFC

Do you think obesity is a disease? Why or why not?

What do you think the impact would be of the medical community (and larger society) treating obesity as a disease?

Governor Chris Christie has long been scrutinized for being obese. Do you think that obesity is a sign of a lack of discipline? Hear Christie’s comments here and sound off on chicfitchef.com! (http://www.oprah.com/own-oprahs-next-chapter/Governor-Chris-Christies-Weight-Video)

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About ChicFitChef

My "deserted island" checklist: a BCBG dress, a healthy & diabetic-friendly meal and a few workout DVDs. ;-)
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5 Responses to Obesity: Disease or Choice?

  1. Asha Smith says:

    It’s a disease, if by that you mean, something caused by a chemical imbalance within the body. Obesity, then would be caused by a metabolic imbalance. It should be treated as a medical condition, and it is recognized (depending on who your insurer is) as such. Some plans recognize the need for assistance by paying for nutritionists (who can help those afflicted understand how food works within the body and portion sizes, need for water). Walking is free, and so is water, mostly.

    The thing is, and I have no proof of this, but in a capitalist society such as ours, there is really no incentive to decrease obesity for citizens. There is however an incentive for pharmaceutical companies to treat the disease with all these new expensive medicines. I’m convinced McDonald’s owns a big pharmaceutical company that makes diet pills (i.e. anti-fat absorbing drugs), though of course, there’s no paper trail.

    Also, why is it so expensive to eat organic (pesticide and hormone free)? This obesity epidemic was planned. There were no studies done before lacing our food with high fructose corn syrup, and whatever else they put in stuff since we were young? Of course there was.

    • ChicFitChef says:

      Thanks for bringing in the economic angle of this! My post focused on the social reasons why we don’t want to treat obesity as a disease (but as more of a self-control issue), but it didn’t touch on the economic reasons (eg. insurance, fast food industry and big pharma). Do you really think it’s a conspiracy though? Even if it is, what about the personal responsibility argument- that once you understand what these kinds of foods are doing to your body you should choose to avoid those foods? Is big bad business to blame or is it the individual? -cfc

      • Asha Smith says:

        I don’t necessarily believe medicine to deal with obesity is the way to go…unless the case is extreme. And yes, there is a personal responsibility aspect to all that we do. However, many bad eating habits start in childhood, infancy even, these decisions were made to introduce foods that were not the most nutritious for the body in the system. So, bodies have grown into adulthood with a metabolic disease. That’s hard to cure overnight. Do I think it was a conscious conspiracy on the part of all? No. Do I think the dangers of introducing high fructose corn syrup into the Western diet and putting that toxin into nearly everything we eat were known? Yes, to some extent. I don’t think the fda just one day said to food manufacturers “do whatever you want.” I think there was data that showed that there were some negative metabolic effects – but that initially the long term data was not known – and the results provided might have seem “tolerable” to FDA officials.

        But think about why it was even added to food in the first place: to make a profit; to decrease the amount of natural food in the market, and replace it with artificially flavored food that people would eat over and over again because the additives manipulate the human taste bud and feeling of satiety by eating those foods. But the body isn’t satisfied by these foods because they lack the nutrition that we need – so people keep eating more and more, starting a cycle that creates obesity. People are food addicts. And just like drug addicts, they need help.

        The first step is acceptance that there is a problem. But how many people don’t even dig that deep. Another problem is the obstacles placed in our way of having access to healthy, AFFORDABLE food options.

        Now, walking is an exercise that we can all do, and it’s an exercise that doesn’t require a gym membership. But I truly believe that life does get in the way for some people – even us when we’re busy – and that it takes a concerted effort to eat healthy. Shopping, preparing, eating it…it’s a lot of work and everything possible occurs to prevent the process from becoming easier, or affordable.

  2. While I understand your point that, if society would accept obesity as a “disease”, treatment options might be more effective, I do not think that the nomenclature matters all that much. In the end, obesity is recognized as a “problem”, and steps are being taken in the medical community in order to address it. I think that, for society at large, the most important prescription is to (a) emphasize that, no matter what someone weighs, each person is entitled to being treated with common decency and respect (something that rings even more true after watching the Chris Christie video) and (b) educate people about all of the new research that shows that obesity is much more involved than the simple equation of calories in being greater than calories out.

    While I do not agree with Asha that the “obesity epidemic was planned”, I do think that our economic policy (i.e., subsidizing foods made with HFCS such that these foods are cheaper than healthier alternatives) contributes to this problem. As for pharmaceutical companies, treating obesity as a disease leads to the conclusion that medical intervention is appropriate, and that brings with it its own set of issues. For example, the FDA just approved Qnexa (http://jezebel.com/5887451/fda-panel-votes-to-approve-scary-diet-drug), a drug that has “helped many patients lose 10% of their body fat”. On one hand, this could be considered a bad thing because the side effects of the drug include “cardiovascular problems…, birth defects [(e.g., ‘an increased risk of having a baby with a cleft palate that persists even if women stop the drug before they get pregnant’)], kidney stones, decreased bone mineral density and memory impairment”. On the other hand, one doctor (caveat: he has financial ties to the pharmaceutical industry) makes a convincing point: “Back in medical school, I was taught that when the risk of not treating the condition exceeds the risk of treating it, we should treat. We have an obligation to change how we measure obesity. Qnexa addresses an urgent and substantial unmet medical need for our patients.” In short, does the medicalization of obesity mean that more people will get the treatment that they need, or is this just a never-ending cycle that will lead to even more drugs being needed to deal with side effects of obesity treatment?

    There’s a lot to unpack here–great, thoughtful post!

  3. Pingback: 3 Reasons Why Government Should Regulate Sugar (CFC Opinion) | ChicFitChef™

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