Throwback Thursday: Obesity Is Not A Disease

Throwback Thursday, where, essentially I post old writing samples, essays and short stories that I dig up from my pile of hoarded papers and school assignments or from the depths of my computer. So everyone can see how my writing has changed/improved over the years.

---

Obesity, once merely a risk factor for diseases, has been reclassified as a disease as of 2013, as “the…AMA^[1]…endorsed further medicalization… of obesity…Obesity, once considered a risk condition for diseases…has now, itself, been classified as a disease by the AMA” (Reiheld “Aiming at Body Size”). Society understands obesity as being significantly overweight. This is not the exact medical definition, which will be examined shortly, but essentially leads laymen to conclude that being extremely overweight is a disease. However, obesity itself is not necessarily a disease, and should not be considered one. Though for some people it can cause disease, in others obesity mostly causes changes in appearance and Body Mass Index (BMI) but not in overall health. The AMA has classified other not-necessarily-diseases as disease in the past^[2]to increase availability of treatment for those who need or seek it. Obesity should be considered a medical risk condition – and treated and monitored as such – but should not be termed a disease.

The definition of obesity may colloquially be the condition of being severely overweight, but the exact definition varies. The Merriam-Webster Dictionary defines obesity as “a condition characterized by the excessive accumulation and storage of fat in the body,” while the CDC defines obesity as “BMI is 30.0 or higher…falls within the obese range”. The Obesity Medicine Association (OMA) defines obesity as “a chronic…disease, wherein an increase in body fat…result[s] in adverse metabolic, biomechanical, and psychosocial health consequences.” Though it is important to note two major distinctions between the CDC and OMA’s definitions: first, the OMA uses BMI, abdominal circumference, and body fat percentage in diagnoses, not only BMI. Second, the OMA paints a far more classical image of disease than the CDC does for obesity, but each boils down to the same medical definition of being overweight by a specific margin or greater. The Merriam-Webster definition does not define obesity as a disease, but a condition of excessive fat on the body, essentially the same definition, in less disguised language.

The language disguises the issue of conforming to western beauty standards, specifically the notion that being skinny is beautiful and the natural state for human beings. These definitions which revolve around body fat reinforce the notion that anyone not conforming has something specifically wrong with them. This is prominent in society in a variety of ways, an example being that “overweight women seen eating apparently unhealthy foods are far more likely than… “ideal”-weight women to be publicly corrected for what they eat” (Reiheld “Women and Responsibility for Health”). This shows how the focus has been shifted from health to body-type when it comes to food and extends to medical diagnoses.

There is a stigma that surrounds overweight bodies, based on a supposed choice to be unattractive. Attractiveness is not something which can be medically addressed, and so weight is used as a proxy to shame individuals, since “we know how to make overweight people miserable, but we have no idea how to make them thin” (Freidenfelds “The Problem”). It is not always about losing weight. For some obese people with other underlying medical causes, as obesity can be a symptom of other diseases such as hypothyroidism, it is about conforming to societal standards. Medical risks are used as an excuse to police fat bodies; whereas when a skinny person is unhealthy, no one’s first thought is their weight.

Though weight can play a role in disease (obesity can for example increase risks of heart disease, high blood pressure, etc.) it is not the sole cause and should not be conflated as such. Considering obesity a disease allows for outside judgement and can cause outside pressure to control factors of health or diet that are not always directly in a person’s control or directly responsible for their obesity. It is also important to note “how damaging the ‘war on obesity’ has been…turning food and bodies from sources of pleasure to sources of dread and shame” (Freidenfelds “The Problem”). The medicalization of obesity only allows for the exacerbation of these problems and shaming. We should not consider obesity a disease in and of itself, it should be considered a risk condition for disease, as “weight and fat distribution have little to do with overall health” (Klein “Body Image”).

For example, smoking increases lung diseases such as Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, but is not itself a disease, despite being considered a poor choice by society. While obesity is not a choice (though part of fat-phobia is the assumption that it is, at least in part) it functions similarly as a risk factor. Obesity, much like smoking, is not an easily changed part of a person and their body. Similar risk factors with this comparison are age, the condition of menopause, and pregnancy all of which are also inalterable, also not a disease. It is also particularly telling that being underweight is not a disease, it is still considered a risk factor. While obesity has been medicalized, being severely underweight has neither been given a name nor medicalization, which shows how “the overwhelming cultural understanding of health in our society emphasizes being slim and muscular” (Klein “Body Image”).

Some might argue that medicalizing obesity can decrease the stigma surrounding it. Medicalization can decrease stigma over some medical conditions, such as autism, but not in every instance. For example, the medicalization of HIV/AIDS has done nothing for the stigma which surrounds it and which “is highly value-laden because of its association with socially unacceptable behaviors” (Reiheld “Patient Complains of…” 83). Similarly, medicalization does not destigmatize obesity because it does not address the root concern of value attached to that condition by society. While medicalization offers acceptability to autism by putting a name to the behavior, HIV and obesity are similarly not granted acceptability because they are still stigmatized as being the result of a poor choice.

Medicalization reifies the thought that obesity is wrong or unnatural and can pin a negative label on individuals who others might not have had the stigma, as obesity visually and physiologically varies by person. This is the very definition of a reification, to make something or equate something as a fact of nature rather than a social construct (Reiheld “Patient Complains of…” 77). Reification allows for the perpetuation of current stigma and societal norms. Medicalization of a reified disease like obesity brings more aspects of our lives under expert control, allowing for the continuation of this reification, in a vicious cycle (Reiheld “Patient Complains of…”). Obesity should be treated as a medical condition, as it can carry health risks, but over-medicalization can have significant inherent risks as well (Freidenfelds “The Problem”).

In order to consider the issues with medicalizing obesity and the reason for its medicalization one must consider the definition of disease before defining obesity as a disease. A disease is defined as “a disorder of structure or function in a human… especially one that produces specific symptoms…and is not simply a direct result of physical injury.” (Oxford Dictionary). Compare this to the definition of a risk factor, “something that increases the chance of developing a disease…examples of risk factors…are age, a family history…use of tobacco products…and certain genetic[s].” (National Cancer Institute). Obesity is not a disorder to the structure or function of a human being – weight can be determined by genetic predisposition or lifestyle, but being overweight, compared to the average weight for a person of a specific gender, height, and age, is not always, or even often, due to a disorder of some kind (such as a thyroid disorder).^[3]  It is important to note here, “all adults categorized as overweight and most of those categorized as obese have a lower mortality risk than so-called normal-weight individuals. If the government were to redefine normal weight as one that doesn’t increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead” (Campos “Our Absurd Fear of Fat”). This demonstrates that the problem being addressed by medicalizing obesity is not health, it’s weight itself.

Obesity more closely aligns with the definition of a risk factor, as it can increase the chance of heart disease, etc. Boorse defines disease as “a type of internal state which impairs health, i.e. reduces one or more functional abilities below typical efficiency” (Boorse 555). Obesity in and of itself does not impede functionality of the human body, so Boorse would not consider it a disease. Only in cases such as those where breathing difficulties or heart disease developed in causation to the obesity would Boorse possibility see obesity as a disease for some individuals and not for others, depending on how functioning was impaired by varying symptoms. Obesity leads to increased risk of certain disease but does not always or even necessarily cause them.

However, one significant benefit to the medicalization of the condition as a disease is increasing access to resources and treatments, such as liposuction, therapy, and support groups. Medicalization increases access to these treatments and preventative measures such as nutrition counselling by increasing insurance coverage and encouraging patients to seek these treatments. There is another side to this though. If medicalization of obesity increases access to treatment, it increases the way treatment may be forced on individuals who may not want or even really need to be treated. In these situations, it is important to know that “baselessly categorizing at least 130 million Americans — and hundreds of millions in the rest of the world — as people in need of “treatment” for their “condition” serves the economic interests of, among others, the multibillion-dollar weight-loss industry and large pharmaceutical companies,” (Campos “Our Absurd Fear of Fat”). Medicalization of obesity may have come about from a standpoint of social stigma and economic value, rather than health concerns, which is not the reason a disease should be labeled as such.

The major issue with these definitions in medicalizing obesity is that they lose the nuances of obesity and distill it as a commonly experienced disease. Obesity does not have a singular cause nor a singular presentation. Obesity can be experienced by a person in name or appearance only, being overweight with a BMI over 30, but with no other symptoms or health issues experienced at all. Obesity can be caused by genetic predisposition and slow metabolic rate, or simply be the result of poor diet and exercise habits, neither of which distinctly must be classified as a disease, let alone grouped together as a singular disease. In fact, “we don’t know whether the small increase in mortality risk observed among very obese people is caused by their weight or by any number of other factors, including lower socioeconomic status, dieting and the weight cycling that accompanies it, social discrimination and stigma, or stress.” (Campos “Our Absurd Fear of Fat”).

Using these definitions of a BMI over 30, some conditions which are not typically seen as obesity would carry the connotation, stigma, or be misdiagnosed as obesity with this as the diagnosis criteria. Examples can include a bodybuilder, who might have a BMI over 30 due to weight in proportion to height, but would not be considered obese by any health professional or layman who happened to see him, despite the BMI being the CDC’s criteria for diagnosis. This is because the definition of obesity as a disease is about standards of beauty and fat shaming, not about technicalities over BMI. Otherwise, obesity would have remained a risk factor, not a disease, or being severely underweight also would have been classified as a disease, whereas it is still considered an unhealthy risk factor.

Another disease which may fall into the categorization of obesity is Cushing’s Disease. Cushing’s Disease, also calledhypercortisolism, is caused by overexposure or overproduction by the body to the hormone cortisol. Cushing’s can cause obesity, and its other major symptoms, high blood pressure and diabetes are easily mistakenly attributed to obesity (Mayo Clinic). To diagnose obesity as a disease in and of itself, it may discourage further investigation or diagnoses, and may lead to the misdiagnosis of diseases which can cause obesity, as solely obesity itself.While Cushing’s falls into the BMI over 30 requirements, it is drastically different than traditional obesity and can cause harm if mistreated or misdiagnosed. There is also a common history of medical professionals ignoring other health concerns because of the appearance of obesity, which can be harmful and stigmatizing to individuals with disease which could be mistaken for obesity.

Obesity should be classified as a medical condition, and deserves treatment for those who want it, but calling obesity a disease does more harm than good, as this ignores the nuances and different forms obesity can take, as well as ignoring the stigma a diagnosis of obesity can carry.

---

Works Cited

Boorse, Christopher. “Health as a Theoretical Concept.” Philosophy of Science, vol. 44, no. 4, 1977, pp. 542–573., doi:10.1086/288768.

Campos, Paul F. “Opinion | Our Absurd Fear of Fat.” The New York Times, The New York Times, 19 Oct. 2018, mobile.nytimes.com/2013/01/03/opinion/our-imaginary-weight-problem.html.

“Cushing Syndrome.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Mar. 2018, http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310.

“Defining Adult Overweight and Obesity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 June 2016, www.cdc.gov/obesity/adult/defining.html.

“Definition of Obesity.” Obesity Medicine Association, 29 Aug. 2017, obesitymedicine.org/definition-of-obesity/.

“Disease | Definition of Disease in English by Oxford Dictionaries.” Oxford Dictionaries | English, Oxford Dictionaries, en.oxforddictionaries.com/definition/disease.

Freidenfelds, Lara. “The Problem with Fat-Talk at the Pediatrician’s Office.” Nursing Clio, 13 July 2016, nursingclio.org/2016/07/13/the-problem-with-fat-talk-at-the-pediatricians-office/.

Klein, Ula. “Body Image, BMI, and the Continuing Problem of the Standards of Beauty.” IJFAB Blog, 15 Apr. 2014, www.ijfab.org/blog/2014/04/body-image-bmi-and-the-continuing-problem-of-the-standards-of-beauty/.

“National Center for Health Statistics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 May 2017, www.cdc.gov/nchs/fastats/obesity-overweight.htm.

“NCI Dictionary of Cancer Terms.” National Cancer Institute, www.cancer.gov/publications/dictionaries/cancer-terms/def/risk-factor.

“Obesity.”Merriam-Webster, Merriam-Webster, http://www.merriam-webster.com/dictionary/obesity.

Reiheld, Alison. “Aiming at Body Size: How Medicalizing Obesity Changes the Very Notion of What It Is to Be Healthy.” IJFAB Blog, The International Journal of Feminist Approaches to Bioethics, 16 June 2014, www.ijfab.org/blog/2014/06/aiming-at-body-size-how-medicalizing-obesity-changes-the-very-notion-of-what-it-is-to-be-healthy/.

Reiheld, Alison. “Patient Complains of . . .: How Medicalization Mediates Power and Justice.” International Journal of Feminist Approaches to Bioethics, vol. 3, no. 1, 2010, pp. 72–98., doi:10.2979/fab.2010.3.1.72.

Reiheld, Alison. “Women and Responsibility for Health: Food, Physical Activity, and Feminism.” International Journal of Feminist Approaches to Bioethics, 8 Oct. 2014, www.ijfab.org/blog/women-and-responsibility-for-health-food-physical- activity-and-feminism/.

---

^[1]American Medical Association (AMA)

     ^[2]Boorse argues minor ear deformities and the like fall into this category, as his definition of disease boils down to: that which impairs normal function, according to a reference class of the same species, age, and gender (Boorse, 555). Some which considered autism as a different way of living rather than a true disease would also apply autism to this statement.

     ^[3]It is important to note that, if this idea of a reference class of specific age, gender, and height is being used to classify what the line for overweight is, the percent of adults aged 20 and over with obesity is 39.8% (CDC).