Last week the American Medical Association, the most influential organisation of doctors in the US, declared obesity a disease. Right or wrong?
What The Dictionary Says
The AMA’s decision made the rounds all over news sources and commentators are pretty much divided about it being right or wrong. Some say that obesity can’t be classified as a disease and is a behavioral problem, others that it impairs the body’s function and therefore fulfills the criteria.
Before discussing this we should maybe find out what those criteria are. We all, me included, have an idea what “disease” is, but when you get right down to it, it becomes rather hazy. According to a dictionary, it’s “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”
That already seems to strengthen the second group’s position, but we run into a problem: what are the “distinguishing signs and symptoms” of obesity? While many overweight and obese persons suffer from similar problems (diabetes, joint pain, high blood pressure etc.), by no means all do.
To get around that, the AMA decided that a BMI of 30 or above is the sign and spells for enough possible trouble ahead, no matter if you are otherwise healthy or not. That by itself is an entire side discussion in the larger picture.
What Will Your Doctor Do?
But, to put this in shorthand, the AMA advises its members to treat their obese patients as suffering from a disease and that they, in line with the Hippocratic oath, better address it. Now how will the doctors go about it?
On the one hand, it seems that way too many had trouble telling their patients about their weight problem. From what I read in the Los Angeles Times, more than 50% of obese patients never had their doctors ask them about their weight. Apparently for many doctors it so far was perfectly ok to tell an overweight patient that he has diabetes and needs medication, but not how he got that diabetes in the first place. If having the formal handle of “obesity is a disease” encourages those doctors to finally tackle the subject, great.
On the other hand, what is your doctor then supposed to do? How will he treat you? Take three exercise sessions and see me in a week? How many doctors are truly qualified and willing to give out nutritional and fitness advice? It would be, from their point of view, quite a deviation from their normal course of action.
What Will You Do?
Then of course the patient, you, is not simply a subject being a treated, but also a person defining himself. If your doctor goes and says “you suffer from obesity,” how will you react? Will you take it as a hint to make those lifestyle changes or will you define yourself as “ill”? If the latter, it is a small step to put obesity in the mould all of other illnesses: not self-inflicted but happening to you.
But obesity, in the very vast majority of cases, is self-inflicted – without consuming too much food, you can’t go fat, and the decision to consume too much is, after all, made by you. Defining obesity as a disease could therefore have patients see themselves as not responsible for their predicament.
Good? Bad? Who Knows?
I’m torn on what my view on this should be. Recognizing obesity as a disease may raise more awareness for an issue that is on the fast track of becoming the biggest health problem in very many societies. But it is anyone’s guess what will happen now. It could make obese patients more passive and have weight loss drug makers and bariatric surgeons rejoice, or it could lead to educating patients about their personal responsibility. All roads are open.