Is Obesity a Disease?
Diagnostic Implications for Personal Responsibility
Last summer, the American Medical Association decided by an overwhelming majority that obesity is a disease. I wish I could share their certainty. Obesity is a personal and public health hazard, a risk factor for many conditions, and an indicator for premature death. Obesity enables disease, but does that make it a disease?
My friends at Merriam-Webster define disease as “a condition of the living animal… that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” By this definition, I concur that obesity is a disease, as is epilepsy and smoking, cancer and heroin addiction, spina bifida and AIDS. Yet not all of these conditions are considered diseases. Epilepsy, cancer and spina bifida are diseases; AIDS is called a disease though it’s actually a welcome mat for multiple diseases, while smoking and heroin addiction remain scorned as dirty habits. The discrepancy is not whether these conditions impair normal functioning; they all do. Rather the discrepancy arises from an individual’s ability to influence whether they develop the condition, and society’s attitudes of acceptable behavior.
People with spina bifida and epilepsy are born with their condition; they are blameless in their suffering and we universally offer care and compassion to them because there but for the grace of god we go. Cancer is increasingly linked to our environment and diet, yet it develops so randomly that no one condemns cancer patients of drinking too many Diet Cokes or breathing too much industrial air. The increase in cancer is modern life’s collateral damage, and we extend compassion without blame to all who suffer it.
AIDS is dicier. It strikes randomly among a subgroup of people with particular behaviors. From the onset, people with AIDS were simultaneously labeled ‘sinners’ by people with a particular moral bent and ‘victims’ by those who considered the HIV virus an extreme side effect of the actions that transmit it. I find compassion easy towards the men and women who contracted HIV/AIDS before means of transmission were understood, but my empathy weakens for people who contract it these days when transmission is well understood and precautions easily available. There are random cases of ‘oops, the condom broke’ and a disturbing subgroup of mentally ill known as bug chasers, but most of the recent uptick in HIV infections in this country is due to a casual attitude that HIV is a just another chronic condition treatable with drugs. Compassion is hard to muster for people so cavalier with their own life and health.
Obesity is the result of physiology and personal behavior in an even more complex way. It is not a condition triggered by a single point of conversion; obesity evolves incrementally as a person eats, time and again, more food than their body needs. And, unlike HIV/AIDS, obesity is reversible. True, there are people with metabolic dysfunction who are clinically obese, but far more people claim such conditions than actually possess them. Unfortunately our obesity epidemic has as much, or more, to do with cultural dysfunction than nutrition. Although a person with a thyroid disorder may be obese through no fault of their own, how culpable is the food stamp mom who can buy more processed food than fresh fruit for the same dollar, or the chronically depressed person who uses food as a palliative, or the twelve year old living in a dangerous and nutritionally deprived neighborhood whose mother has determined it isn’t safe to play outdoors? These people do not have a fair shot at a fit and healthy life.
My biggest concern about calling obesity a disease is not that it doesn’t meet the criteria, but that in bestowing the condition with the imprimatur of disease we condone it. If we label obesity a disease, obesity will increase because whenever we assign something a label we deflect individual responsibility. In a world of overabundant, unhealthy food, individual responsibility is the strongest deterrent to being overweight. If a person with epilepsy is not responsible for their disease, why should a person with obesity feel responsible for theirs, despite the fundamental difference that an epileptic is consumed by an external force beyond their control, while an obese person enflames their condition with every bite.
The prevalent American response to any disease is to take a pill. But the only meaningful response to obesity is for our society to make better nutrition available and for each individual to do the hard work of maintaining healthy weight. I can’t see how designating obesity a disease can help either of these conditions come to pass while it is easy to see how an obesity ‘diagnosis’ will simply provide overweight people an excuse for their condition rather than the motivation to control it.
