Split Opinions on Obesity as a Disease

Mark Gurarie
·9 min read
1

Medically reviewed by Josephine Hessert, DO

Obesity is an abnormal or excessive amount of body fat that adversely affects your health. Although it affects just over 40% of the U.S. population, obesity as a disease is still widely debated.

Long considered a self-inflicted health condition, in 2013, the American Medical Association (AMA) joined other medical societies and organizations in designating obesity a chronic disease.

Questions about whether obesity results from individual choices or a diagnosable, treatable disease are at the core of the debate. However, because obesity leads to severe health consequences and many factors increase risk, it is recognized as a disease.

This article discusses the definition and classification of obesity, the danger of viewing it strictly as a choice, its causes, and current treatment and management approaches.

Obesity: A Diagnosable Disease Classified by BMI

Healthcare providers commonly diagnose and define obesity using body mass index (BMI), a measure of the fat content of your body. You can calculate your BMI by taking your weight in kilograms (kg) and dividing it by the square of your height in meters. By this metric, weight status is classified as follows:

Classification

BMI

Morbid obesity

40 or greater

Obesity

30 or greater

Overweight

25 to 29.9

Normal weight

18.5 to 24.9

Underweight

18.4 or lower

Controversy Over BMI

While BMI can be helpful, it has significant limitations. In 2023, the AMA amended its view of this tool, noting that it’s dated, flawed, and has a problematic history. This is because BMI does not consider several important factors contributing to obesity, including race and ethnicity, age, sex and gender status, and body composition.

The AMA recommends that healthcare providers consider BMI alongside other measures of obesity, such as waist circumference and body adiposity index.

Brief History of Classifying Obesity

Excess weight was a sign of good health for many periods of history and across different cultures. But since the time of the ancient Greek physician Hippocrates, who lived from 460 to 370 B.C., obesity has been linked to increased morbidity (disease) and mortality (death) from many causes. Throughout history, our ideas of how to classify obesity have evolved.

Obesity has traditionally been viewed as a condition caused exclusively by poor nutrition and lifestyle: meaning they are matters of choice. But in 1997, the World Health Organization (WHO) recognized obesity as a chronic disease, spurring medical boards and other health agencies to follow suit. Healthcare providers consider it a complex set of neurological diseases produced by environmental, genetic, biological, and behavioral factors.



"Condition" vs. "Disease"

People often use the terms “condition” and “disease” interchangeably, but there are important differences between the two terms. A disease is a specific pathological process; it causes symptoms and impairs function. “Condition” is a more global and neutral term referring to a state of health, whether good or bad.



Obesity Stigma

Questions about whether obesity is a condition or a disease also impact how it’s viewed in the cultural zeitgeist. With rises in U.S. obesity rates, there has been an increase in negative attitudes and stereotypes about those affected. Obesity, inaccurately, is associated with being lazy or lacking discipline.

People with obesity may internalize these prejudices and face stigma and discrimination. The shame surrounding the condition can contribute to additional weight gain and exercise avoidance and impact mental health.

While some may view stigmatizing obesity as a way to “pressure” individuals into losing weight, this may have the opposite effect. Viewing obesity as a set of self-inflicted choices rather than a disease spurred by external factors hinders treatment.

Related: What Is Self-Stigma?

Causes: How Do People Develop Obesity?

Obesity is caused, in part, by an energy imbalance—when you consume more calories (energy) than your body needs to function. If unused, the excess fats, carbohydrates, alcohol, and protein in food and drinks are stored as triglycerides within fatty tissue.

Over time, this accumulation causes the development of adiposity (a term for body fat). Other factors, like the types of foods or drinks you consume, can also directly contribute to obesity.

However, other environmental, genetic, biological, and behavioral factors contribute to obesity, so it is not as simple as calories in vs. calories out.

Environmental

Your environment can significantly influence your weight, affecting your diet and physical activity levels. Studies have found that lower economic status, lack of access to fresh foods (living in food deserts, areas where healthy food is scare), and living in areas without walkability, parks, green spaces, or gyms raise obesity rates.

Residents of rural areas or those without sidewalks and bike paths are also at increased risk, as are those living in neighborhoods with an abundance of fast food options.

Genetic

Alongside other factors, genetics has an effect on your susceptibility to overweight and obesity. Studies have found genes influence your metabolism and determine between 40% and 70% of the variability in your weight.

Over 50 genes are linked to obesity. Rarely, gene mutations—mainly melanocortin 4 receptor (MC4R)—are at the root of monogenic obesity, which is obesity caused by one gene rather than a combination of genes and environmental factors.

Biological

Another factor in obesity is how your brain and body regulate hunger and energy expenditure. For instance, researchers have linked weight status to the activity of the hormone leptin, which is produced in adipose (fat) cells. This hormone, which is crucial in regulating energy balance, acts on the brain's thalamus to influence appetite and satiety (feeling full after eating).

In addition, elevated cortisol, a hormone associated with stress responses, affects metabolism and can play a role in obesity.

Behavioral

Lifestyle patterns and behaviors also contribute to obesity. Along with insufficient sleep or exercise, smoking, and alcohol consumption, a diet high in saturated fats, salts, and sugars contributes to the condition.

This includes factors you can control, such as excessive screen or technology use or eating a lot of fast food, as well as those you can't control, such as growing up in a household with an unhealthy diet. Furthermore, stress, distressing emotional states, and mental health challenges can impact dietary and lifestyle behaviors, leading to weight gain.

Obesity Risk Factors

Many health issues and outside factors increase your risk of developing obesity. These risk factors include:

  • Insufficient physical activity or not getting enough exercise

  • Excess calories, saturated fats, and added sugar

  • Poor sleep (less than seven to eight hours a night for adults)

  • Stress

  • Certain health conditions (e.g., metabolic syndrome and polycystic ovary syndrome)

  • Side effects of certain medications (e.g., antidepressants, antipsychotics, beta-blockers, birth control drugs, and insulin)

  • A family history of obesity

  • Environmental factors (e.g., where you live, where you work, and access to parks and fresh food options)



Causes vs. Risk Factors

A cause is an underlying factor that leads to the condition. A risk factor is something that raises the chances of developing another condition, without directly causing it.



Individual Treatment for People With Obesity

Several strategies and treatments are available to treat obesity, from lifestyle changes to surgery, including the following:

  • Dietary changes: A change in your eating plan can help reduce overall caloric intake, leading to weight loss. Your provider may refer you to a registered dietitian for counseling.

  • Boosting exercise: A healthcare provider may also recommend increasing your physical activity levels, aiming for 150 to 300 minutes of moderate aerobic activity or 75 to 150 minutes of high-intensity exercise weekly.

  • Getting good sleep: Insufficient sleep can boost impulse eating, which can have a negative impact on weight. The recommended amount is seven to eight hours of uninterrupted sleep a night for adults, with adolescents and children requiring more.

  • Behavioral weight loss programs: Behavioral weight loss programs focus on changing your responses to your eating and health behaviors. Trained healthcare professionals, such as psychologists or registered dietitian nutritionists, can help you develop an individualized health plan.

  • Medications: Several prescription medications can also help you lose weight when used alongside lifestyle changes and other therapies.

  • Medical devices: In cases of obesity that don't respond to other treatment approaches, a healthcare provider may recommend using certain medical devices, such as a gastric balloon, gastric band, or gastric emptying system, alongside other methods.

  • Surgery: There are several bariatric (weight loss) surgeries that healthcare providers consider in more complex cases. As with medical devices, surgery alone does not achieve weight loss; instead, it reduces the amount of food you can digest.

Long-Term Management

Obesity is challenging because it’s difficult to maintain weight loss results. A study of those who lost weight using lifestyle changes found effects peaked six months after starting treatment; in the absence of sustained management, about 50% of people returned to their original weight within five years.

Strategies that help to preserve weight loss include:

  • Long-term counseling: Keeping up with behavioral and other health counseling for at least one year after reaching your target weight helps maintain weight loss.

  • Weight maintenance strategies: Checking your weight, exercising regularly, counting calories, eating more frequent and smaller meals, cooking your own food, and keeping food diaries can help you track and maintain your weight and habits.

  • Focusing on progress: Stay focused on the progress you’ve made rather than worrying about what you haven’t been able to achieve.

  • Managing expectations: Keep a realistic sense of what you can achieve and strategies to cope with slips or relapses.



Increased Risk of Comorbidities

Managing your weight is crucial because of the risk of diseases associated with excess weight (comorbidities). These include:



Summary

When your body weight is above what’s considered healthy based on height, a healthcare provider may diagnose you with obesity. Traditionally, this was considered a result of personal choices and poor eating habits.

However, because some factors in obesity are outside of a person's control—including genetics or access to fresh foods and green spaces—researchers recognize obesity as a complex disease state.

Read the original article on Verywell Health.