We’re not sick, we’re just a bit fat

Last Tuesday, members of the American Medical Association (AMA), the body that represents US doctors, voted to recognise obesity as a disease in its own right. The notion that a third of the US population is now to be designated as sick is daft – but daft ideas are not exactly new ground for the elite of the medical profession.

Trying to help people tackle weight problems seems like a good idea. ‘Recognising obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans’, said AMA board member, Dr Patrice Harris, in a press release. ‘The AMA is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and type-2 diabetes, which are often linked to obesity.’

Over the past few years, a number of doctors and researchers have pressed the case for declaring obesity to be a disease. In the journal Obesity Reviews in 2004, for example, Conway and Rene argue: ‘Given the excess mortality, substantial morbidity and the economic toll of obesity, this is a disease that warrants serious attention by the medical community. Obesity’s status and acceptance as a disease is pivotal in determining its treatment, reimbursement for treatment and the development of widespread interventions.’

In 2011, Dr Scott Kahan argued that obesity easily fits the medical-dictionary definition of a disease: ‘An impairment of the body or one of its parts resulting from various causes, such as infection, genetic defect, or environmental stress, and characterised by an identifiable group of signs or symptoms.’ Kahan also notes: ‘The National Institutes of Health, the World Health Organisation and numerous other scientific organisations regard obesity as a disease, yet most people continue to dismiss obesity as a “willful misconduct” and label people who have obesity as lazy and weak.’

It is certainly true that the AMA is not exactly ahead of the game on this one. And Kahan is right that simply labelling anyone who is overweight as lazy, greedy or weak-willed is rather offensive. If changes to diet and activity reliably succeeded in removing those excess pounds in the long term, without leaving people famished or knackered, there would be far fewer chubbies. And for those who are very obese, their weight can become a significant impediment to their lives.

But there is a fundamental problem with the argument: most people who are obese are not sick (and there are plenty of skinny people who are). They may prefer to be slimmer from the point of view of vanity, but their weight has no other impact on day-to-day life. Those who are obese may have an increased risk of a variety of conditions – from coronary heart disease to type-2 diabetes – but for most who fall into the ‘obese’ category, the increased risk is small. Moreover, it’s more likely that the things that cause those diseases – whether it is the kind of food we eat or genetic differences between people – also create a predisposition to gaining weight rather than body fat itself causing disease.

In short, obesity is a body morphology. It is not, in itself, a sickness. There is certainly a range of opinion on the matter. Some researchers, for example, have argued that obesity is a ‘biological adaptation’, and those expanding waistlines are merely a natural response to an environment in which food is plentiful and vigorous activity is unnecessary.

A paper from 2001 in the International Journal of Obesity specifically considers the obesity-as-disease issue: ‘While it might nevertheless be possible to achieve a social consensus that it is a disease despite its failure to fit traditional models of disease, the merits of such a goal are questionable. Labeling obesity a disease may be expedient but it is not a necessary step in a campaign to combat obesity and it may be interpreted as self-serving advocacy without a sound scientific basis.’

If a slightly increased risk of certain diseases, or an awkwardness with certain physical tasks, were the markers of disease, then being tall, being short, or possessing testicles could equally be regarded as diseases.

In many ways, whether or not obesity is ‘recognised’ as a disease is not the real problem. For years now, everyday medical practice, government policy and popular culture have treated fat people as sick and in need of intervention. Indeed, there is little escaping from the notion that ‘obesity = disease’. The AMA vote is really a call to allow even greater intervention. Medicalising a substantial minority of the population can only increase anxiety about weight and prompt draconian action against obese people and the parents of obese children, including the denial of healthcare services. No wonder there is a counter trend for a ‘fat acceptance’ movement.

Instead of slapping inappropriate labels on millions of people, and re-categorising them as chronically ill, maybe doctors would be better off finding more effective ways to help the small number of people for whom weight gain is a serious problem. Perhaps, then, they would leave the rest of us in peace.

Rob Lyons is deputy editor at spiked.