Is Obesity really a disease?

This issue may seem like a pointless topic to discuss, however, the classification of obesity as a disease has caused a furore, especially since it is being used at the heart of a debate about healthcare.

The two ends of this argument are:

  • Obesity is a disease. It can arise due to many different factors, and these should all be considered.
  • Obesity is the result of poor life choices.

Sadly, both of these arguments don’t answer the fundamental question, so let’s examine both sides of the argument.

What is a disease?

A good start is to define what we are talking about, the below definition is from Mosby’s dictionary of medicine.

  1. A condition of abnormal vital function involving any structure, part, or system of an organism;
  2. a specific illness or disorder characterised by a recognisable set of signs and symptoms attributable to heredity, infection, diet, or environment.

The Miriam Webster dictionary reiterates this by saying:

a condition of the living animal or plant body or of one of its parts that impairs normal functioning

These are the standard definitions for the word, and thus to have a sensible discussion, the argument should revolve around them.

Why it isn’t a disease

According to the definitions, a disease involves, “abnormal” or impaired bodily functioning. The question, therefore can be asked, “how does one become obese?”. Not counting hormonal or other complicated issues (which are the minority) the path to obesity is simple. Too much food, not enough movement. The surplus calories are deposited on the body as fat, this continues until you are classified as obese.

The argument is often made by people who have a fiercely independent world view. The attitude that you are 100% responsible for your actions is used. They claim that obesity is nothing more than a culmination of poor choices and lack of self-control. Thus, we should not be molly coddling people into making them feel that it is not their fault.

What about the other side?

Why it is a disease

The standard arguments for obesity being a disease are that depression, stress, anxiety and addiction are all diagnosable problems. Depression and addiction are classified as diseases in their own right. The reasoning goes that since people have pre-existing mental problems, or perhaps are brought up in extremely negative environments, the path to obesity cannot be blamed entirely on bad choices.

As a society, we recognise that external factors are a huge influencer in how you turn out. Abused children often have trauma as adults, people from an educated family tend to get educated too, certain neighbourhoods can produce a certain type of person. Add to this the huge role played by internal factors, and you have a fairly coherent argument that obesity is not just a series of bad choices.

Thus, the natural conclusion from this is that obesity is, in some cases, an inevitability of social and biological factors. Thus, it is concluded that inevitably, obesity is a disease.

What no one seems to be saying

The problem with both of these arguments is that we are studying what causes obesity, which actually has nothing to do with whether it is a disease or not. By saying that someone becomes obese because of lack of self-control, or because they have a chemical imbalance, you are trying to argue that becoming obese is a disease. No one is arguing that becoming obese is or isn’t a disease (aside from certain mental or hormonal difficulties people may have).

Let’s take the example of smoking. Take someone who smokes 100 cigarettes per day for 20 years, and predictably gets lung cancer. Would we claim that cancer isn’t a disease? Of course not. Can we all agree that some poor life choices, or upbringing, and perhaps some addictive trait caused this? Yes! Is any of that relevant in the treatment of the disease? No!

So the comparison is simple. How we feel someone became obese isn’t really relevant in this discussion at all. If someone is obese, their body begins to experience a horde of malfunctions like diabetes, heart failure, metabolic syndrome etc.

Thus it is reasonable to conclude that obesity is a disease, and it doesn’t matter if it is 100% self-inflicted.

What is the big deal?

The reason that everyone seems to have their knickers in a twist about this is that it all comes down to healthcare. People who say it is all self-inflicted claim that a taxpayer or an insurer shouldn’t be compelled to pay for someone’s bad choices. Aside from the fact that society is always paying for someone’s mistakes (I.e prison, politicians etc) this still doesn’t alter the fact that no matter how the person became obese, their current status is one of a disease.

This worldview isn’t completely coherent for several reasons. For instance, imagine a teenager was doing something typically stupid (as teenagers tend to do) and is severely injured. Would a civilised society claim that it was all his fault and that he deserved no empathy and no treatment? Of course not.

Secondly, arguing about causes and blame ignores the fact that there is someone who is much more likely to die who we could help. A severely obese person has the same mortality risk as a heavy smoker.  So perhaps it is time to lay this debate to rest, act like adults and try and solve the problem.

What can be done?

The responsibility for something like this must always first come from family and friends. This means encouraging and helping an obese person get themselves back to health.

The issue is much more complicated than just telling a person to “lose some weight”, or by “Fat Shaming”. If for instance, the above example of a person smoking 100 cigarettes per day was your father, would you be content in saying, “Stop Smoking!”. In the history of helpful treatments, that particular tactic tends to score pretty low.

Long term support, education. and care needs to be taken. Someone becomes obese through years of deeply entrenched habits and choices. These will not be eliminated overnight, they will require education, compassion, and hard work.

End note

An obese person is physically represented by their illness, thus, being small minded creatures as humans are, we can judge them far more harshly. Just like we would love to help someone kick drugs or over drinking, we should have the same impulses toward obese members of society.

He might be heavy, but he’s still your brother.

What do you think?

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Is Obesity really a disease?