By Melinda J. Watman
When the American Medical Association declared obesity a disease last year, most of us — advocates who work to help those with obesity — were thrilled.
We saw the new definition's potential to change how medical professionals regard people with obesity, increase society’s focus on obesity, push insurance companies to cover obesity treatments, reduce social stigma and moderate the anxiety and depression often afflicting those with obesity.
Already, we see some of those hopes being realized. Just last week, the federal government's Office of Personnel Management issued a ruling that health insurers who cover federal employees may no longer exclude coverage of weight loss drugs on the basis that obesity is a "lifestyle" condition or that obesity treatment is "cosmetic." This is one more significant step in the recognition and treatment of obesity as a disease.
But nothing is that simple or easy.
The high-fiving was barely over when the first study came out saying "not so fast." It would seem, according to an article published in the New York Times, no good deed goes unpunished. The article presented a summary of a research paper titled "'Obesity Is a Disease': Examining the Self-Regulatory Impact of this Public-Health Message."
The three authors concluded that labeling obesity a disease led their subjects to want to eat more, eat worse and care less about their weight. They suggested that labeling obesity a disease leads to the belief that it is futile to try to manage one's weight.
Whether one agrees with the study’s findings and conclusions or not, the underlying question of whether obesity should be accepted as a disease is the critical point. The authors certainly question its validity based on the findings that their subjects suffered an “undermining of beneficial self-regulatory processes.”
What is interesting is that if it were any other chronic illness with comparable results, we would not be questioning whether the illness should be classified as a disease. Rather, we would be trying to find better ways to engage, educate, support and treat those patients as we continued to work on new therapeutics to manage the disease.
As is often the case with obesity, it would appear this line of thinking and research has the potential to further marginalize the problem and those affected by it. This is completely counter to what the AMA policy strives for – the same medically accepted framework to diagnose, treat and support patients as exists with any other chronic illness.
Ironically, the authors suggested that one's weight is a fixed state, like a long-term illness. Maybe I'm missing something but isn’t that exactly the purpose of classifying obesity as a disease? Because it is, among other things, a long-term illness.
We must abandon the shame and blame game, adopt an objective medical model and accept those with obesity as we would those with cancer.
This leads us to the obvious question, “What is a disease?” If you look at the various dictionaries — Oxford, Merriam-Webster, AMA — there are common threads across all: It is a disorder, caused by the result of one or more influencing factors, interfering with normal functioning, manifested by distinguishing signs and symptoms, and it can cause harm or morbidity. To put obesity into this category does not seem a far reach, which leaves us with the authors’ suggestion that nonetheless, it isn’t a good idea.
I can’t help wondering whether this is really about obesity as a disease or about obesity itself. Across the board — medical professionals included – those with obesity are generally treated with less respect and consideration than those of normal weight. By labeling obesity a disease, we must abandon the shame and blame game, adopt an objective medical model and accept those with obesity as we would those with cancer.
While we’re at it, this also means patients deserve the same consideration when being described. I’ve never heard a medical person say “I saw a cancerous patient,” only “I saw a patient with cancer”. Unfortunately, it is all too common to hear “I saw an obese patient” or, as the study references “obese individuals” instead of “I saw a patient with obesity”.
The paper's authors say the term "disease" refers to bodies, physiology and genes malfunctioning. Further, they stated, by using these explanations for obesity, those affected by the disease are encouraged to perceive their weight as unchangeable. This logic suggests those with obesity should be kept in the dark about the very real physiological and genetic components that contribute to the diagnosis in order to improve their chances of managing their weight.
This seems fraught with its own set of problems, not the least of which being the “eat less, exercise more” behavioral approach, which has never been a particularly successful or appreciated tactic for those with obesity. This way of thinking is completely inconsistent with how we manage any other chronic illness. Healthcare providers have an obligation to their patients to disclose what they know about a condition and then are equally obligated to manage whatever comes as a result. That is the expectation of comprehensive, responsible patient care.
A suggestion about future research: This initial study did not include a group that also received information about treatment options. Next time, there should be one.
At a time when obesity research is rich with exciting discoveries ranging from how gut microbes contribute to weight control to the discovery of an obesity gene to the success of new weight loss medications, my hypothesis is that any sense of futility goes way down once there is understanding that obesity is being taken as seriously as any other chronic illness.
Melinda J. Watman is president of THE F WORD FAT, which provides education and consulting to organizations on identifying, understanding and preventing the occurrence of fat shaming, weight bias and discrimination. She is on the National Board of Directors of the Obesity Action Coalition and the Board of Advisors of the BU School of Public Health Spotlight on Obesity Initiative.