Traditionally, society has treated obesity as a choice. If you have been struggling with obesity for years, you have undoubtedly come across many people who believe that they believe that you have consciously decided to become and remain overweight. They let you know, tactfully or less discreetly, that they have no sympathy for you. However, obesity is a disease that requires as much attention as any other medical condition.

% Of Obese Americans Keeps Growing Every Year

The CDC, Center for Disease Control, reports the state averages for the percentage of Americans who are obese by year:

The American Medical Association’s Designation of Obesity as a Disease

The American Medical Association (AMA) officially classified obesity as a disease in June of 2013, describing it as a “multi-metabolic and hormonal disease state.” It was already common knowledge that obesity leads to unhealthy metabolic and hormonal changes, so this new classification may seem at first glance like a question of semantics that is relevant only to academics and scientists. When you dig a little deeper, though, it seems as though this decision can actually have far-reaching effects in the nation’s fight against obesity and in your own life.

Why Obesity is a Disease

In addition to the AMA, the World Health Organization (WHO), Food and Drug Administration (FDA), National Heart, Lung, and Blood Institute (NHLBI), and other respected organizations recognize obesity as a disease.

• It impairs normal body functioning.
  
• It has a set of characteristic signs and symptoms.
  
• It decreases life expectancy.
  
• It can lead to harmful conditions, such as type 2 diabetes and hypertension.
  
• It can be a genetic disorder.
  

Benefits for Society of Recognizing Obesity as a Disease

An important benefit of classifying obesity as a disease is the increased awareness. An organization as respected as the AMA is calling the nation’s attention to the fact that obesity rates are alarmingly high and increasing. The AMA is also drawing attention to the wide-ranging set of causes of and treatments for obesity. Policymakers are more likely to support community public health approaches for fighting obesity. They might promote obesity education in schools and provide funding for obesity research. Weight loss drugs could receive more scrutiny and faster approval if they are seen as necessary to fight a disease rather than unnecessary products that encourage consumers to continue unhealthy, obesity-promoting behaviors.

How Your Health Care Might Improve

The benefits of having obesity seen as a disease can hit closer to home, too. Doctors are more likely to address obesity and work with you to fight it when obesity is considered a disease. They might pay you more respect as society moves away from the current model of finger-pointing when it comes to obesity.

Also, since obesity is a disease that can be treated, it is the role of health insurance companies to pave the way for you to seek treatment. Insurance companies are more likely to provide coverage for obesity treatments from lifestyle counseling to weight loss drugs to weight loss surgery. Until now, insurance companies have rarely supported reimbursement for diet counseling and psychotherapy as an obesity treatment, and only some plans provide coverage for weight loss surgery. Often, they only allow certain types of weight loss surgery, and have more stringent requirements.

The Psychological Benefits of a Label

Finally, there can be psychological benefits when obesity is recognized as a disease. The stigma around obesity, seen in the workplace, on the streets, and maybe even in your own family, may decrease now that there is official recognition. Like HIV/AIDS and depression have already become, obesity may eventually become an accepted condition that deserves compassion and requires medical attention and support rather than a condition to be ashamed of.

The designation is a validation of the struggles you currently face and may have faced for years or your entire life. It can be infuriating when others judge your obesity as a choice or lack of willpower. Worse, these descriptions can be discouraging, and prevent you from having the strength or even wanting to continue to fight obesity. An official diagnosis of obesity lets you know that you have a specific battle to fight, and the medical field is in your corner. This can give you confidence to make tough lifestyle changes or life-changing decisions such as weight loss surgery.

You Still Need to Treat It

What would you do if you were diagnosed with pneumonia? You would not just ignore it. You would discuss your treatment options with your doctor, and follow his or her recommendations. You would get chest x-rays, lab tests, and lung fluid samples to help in determining the nature of your condition. You would aggressively treat it with antibiotics, other medications, hospitalization, and plenty of rest and fluids. High blood pressure, diabetes, cancer, and depression are just a few other conditions that you would not think twice about treating.

Similarly, a diagnosis of obesity is not a green light to ignore it, but research described in the New York Times suggests that this is exactly what is happening in some cases. In one study, individuals who were told that their obesity was a disease ended up choosing higher-calorie foods than individuals who were not told that they had a disease. That is, individuals who were told that they had a disease called obesity felt that they were victims of a condition beyond their control, and that there was no point in fighting it.

The point is that you need to address obesity, whether it is a disease or not. Not everyone will be able to use the same strategy to successfully lose weight and keep it off, but one or more approaches can work for you, whether they are specific dietary changes, exercise, weight loss surgery, or a combination of these.

Great Article Alex! Thanks for sharing this with us. It is so important not only to classify and call obesity a disease but to educate and treat it. I really believe that we need to educate and treat not just those afflicted with the disease but those who care for people who are already obese, and their family members who might have a genetic predisposition to obesity. We can't just sit back and swallow a bag of donuts or feed our children fast foods and junk foods for Breakfast lunch and dinner thinking well we are fat and/or we come from a fat family why fight a losing battle?

We should fight to educate each other and those around us about obesity to treat the disease starting at the base level of understanding and progressing to the level of intervention as necessary. We need to fight and rage against it like we do against Cancer, Heart Disease, Diabetes, and all the other diseases that obesity is an equally evil partner to.

"The 2014 Advanced Framework for a New Diagnosis of Obesity as a Chronic Disease" was very recently presented at the American Association of Clinical Endocrinologists (AACE) 23rd Annual Scientific and Clinical Congress in Las Vegas.

In a summary article published by Medscape Medical News on March 17th, the author states "The framework is the latest step in an ongoing process to develop new approaches to obesity, based on the American Medical Association's June 2013 designation of it as a chronic disease, which originated with a proposal from the AACE. The need for a new obesity definition was among the major ideas to emerge from a consensus conference on the subject, held in March 2014, which involved participants from healthcare, research, science, government, industry, insurers and advocacy, according to AACE President, Dr. Jeffrey Mechanick."

This is a powerful example of what @@Alex Brecher stated in his article - "An important benefit of classifying obesity as a disease is the increased awareness."

The AACE in conjunction with proposals from the American College of Cardiology, the American Heart Association and The Obesity Society is suggesting three classifications for obesity: Obesity Stage 0 (BMI 30 or greater with no obesity-related comorbidities), Obesity Stage 1 (BMI 25 or greater with one or more mild to moderate obesity-related comorbidities, and Obesity Stage 2 (BMI 25 or greater and one or more severe obesity-related comorbidities).

The recognition of obesity as a disease by the medical community does not mean that the stigma surrounding obesity is going to disappear. It does mean that many obstacles have been removed, and many doors opened, for researchers and physicians to formulate and pursue treatment options for the global epidemic of obesity. That is good news for the millions who suffer from this debilitating and life-threatening disease.

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Bravo! Cheering! About damn time! Applause!

My surgeon said something to me that has been very empowering and stays in my mind as I live in maintenance... "You have the disease of obesity. Right now your primary symptom of excess weight is under excellent control but never forget you still have the disease of obesity."

I think that viewing it this way, as a chronic condition that needs assertive management is the way to remind ourselves that maintenance is just as important as the losing ....

My surgeon said something to me that has been very empowering and stays in my mind as I live in maintenance... "You have the disease of obesity. Right now your primary symptom of excess weight is under excellent control but never forget you still have the disease of obesity."

I think that viewing it this way, as a chronic condition that needs assertive management is the way to remind ourselves that maintenance is just as important as the losing ....

Right on, right on!!

The issue I have with labeling obesity as a disease is that it undermines goal pursuit for many people. When we believe something is beyond our control, we are less likely to try to change it. Here is a very interesting article from the British Psychological Society that details a study that was recently done concerning the psychological impact of labeling obesity a disease.

http://bps-research-digest.blogspot.com/2014/05/if-obesity-is-disease-is-labelling-it.html

I saw that study and it is indeed a very interesting one. I did not anticipate the results they got.

The question becomes how should the results be interpreted. The study indicated that increasing self-esteem and body satisfaction resulted in less favorable food choices among obese subjects - good news/bad news. So the logical conclusion is that some who might have pursued weight loss options when obesity was a "choice", might abandon that goal when obesity is a "disease".

What is the likelihood that most folks who suffer from obesity (currently defined as a BMI >30) will ever achieve long term success with diet and exercise or any other currently available means other than bariatric surgery? Many studies have shown that 95% of folks who lose weight with diet and exercise will regain that weight, and in some cases additional weight, within two years. A study financed by Medicare concluded "It's not a question of if weight loss via diet and exercise will be regained, but rather when it will be regained."

Does the possibility that classifying obesity as a disease may encourage those suffering from obesity to make poorer dietary choices outweigh the potential benefits such as increased research funding, greater involvement of the medical community in addressing the obesity epidemic and expanded insurance coverage making surgery (and other possible options in the future) available to more candidates?

Is obesity a choice or a disease? Either option will have costs, and benefits.

I completely disagree. Type 2 diabetes and high blood pressure are "disease" conditions and yet management of the condition is very much in the person's control. I think very similar situation. For me understanding obesity as a disease made it much more logical and takes away much of the blame and shame.

Jane I think you make two critically important points...

1. Viewing obesity as a disease dramatically improves the self-esteem of those struggling with the affliction. It would be difficult to overstate the importance of this changing perspective.
2. Defeating the disease requires individual ownership of the lifestyle changes that must be made in order to be successful. It is a lifetime commitment. Many, if not most, are intimidated by that prospect. Countless attempts and countless failures make it difficult to get your head around the idea that surgery changes e v e r y t h I n g. Much of the unparalleled success of bariatric surgery is the result of making those lifestyle changes very achievable. It is very challenging for folks who suffer from obesity to understand that past failures have no bearing on future successes following bariatric surgery. It's a new day.

Good topic for discussion at a future support group Lisa (and Alex)

For me, classifying it as a disease - and a chronic disease at that - makes it clear that it is something I will have to manage for life rather than thinking I will do yet another diet, be wildly successful, and that will be that. Classifying it as a disease makes this distinction clear and makes me feel more empowered rather than less. It is not something I can just ignore. I have to actively confront it and take control. But that is just me and we all have our own interpretation of things.

@@lisacaron, imagine a Relay for Life type event for raising obesity awareness. I've lost as many family members to obesity related illnesses as to cancer.

@@lisacaron, imagine a Relay for Life type event for raising obesity awareness. I've lost as many family members to obesity related illnesses as to cancer.

Yes I love this idea and I will be looking into putting something like this together or at the very least if there is one out there participating as a local chapter BP member for NY!

I thought this ASMBS (American Society for Metabolic and Bariatric Surgery) info was interesting--- it adds information about how prevalent obesity is becoming and the progressiveness of the disease.

http://asmbs.org/obesity-and-surgery-learning-center/obesity-the-disease/

Obesity Prevalence and Rate of Occurrence

According to the W.H.O., 65 percent of the world’s population lives in countries where overweight and obesity kills more people than underweight. Approximately 500 million adults in the world are affected by obesity and one billion are affected by overweight, along with 48 million children.

In the United States, epidemiological data from an ongoing study that measures the actual body size of thousands of Americans, show that 34 percent of adults more than 20 years old are affected by obesity and 68 percent are overweight (2007-2008 data). Obesity affects 10 percent of children between two and five years of age, 2 percent of those between 6 to 11 years old, and 18 percent of adolescents.

Throughout the last 20 to 25 years, the prevalence of obesity has been increasing at an alarming rate. Since 1985, the Center for Disease Control (CDC) has supported an ongoing study, conducted on a yearly basis by state health departments, to examine changes in obesity prevalence state-to-state, and has found the following:

• In 1990, the obesity prevalence for most of the states was 10 percent or less.
• By 1995, more than half the states had a prevalence of 15 percent.
• By 2000, nearly half the states had a prevalence of 20 percent or higher.
• Five years later (2005), all but three states had a prevalence greater than 20 percent and nearly a third had a prevalence of 25 percent or more.
• By 2010, the data show that most of U.S. states had a prevalence of 25 percent and many had a prevalence of 30 percent or higher.

For view of yearly changes in prevalence, view the CDC’s online data.

Not only has the obesity epidemic increased in number throughout the past two decades, but also in severity. Data obtained from the yearly ongoing CDC-supported U.S. study found that between the years 1987 to 2005 the prevalence of severe obesity increased by 500 percent and super severe obesity (BMI greater than 50) increased by nearly 1,000 percent. According to the 2007-2008 NHANES findings, 5.7 percent of American adults, or nearly 14 million people, are affected by severe obesity.

Progressive Nature of the Disease of Obesity

Obesity is considered a multifactorial disease with a strong genetic component. Acting upon a genetic background are a number of hormonal, metabolic, psychological, cultural and behavioral factors that promote fat accumulation and weight gain.

Positive Energy Balance

A positive energy balance causes weight gain and occurs when the amount of calories consumed (energy intake) exceeds the amount of calories the body uses (energy expenditure) in the performance of basic biological functions, daily activities, and exercise. A positive energy balance may be caused by overeating or by not getting enough physical activity. However, there are other conditions that affect energy balance and fat accumulation that do not involve excessive eating or sedentary behavior. These include:

1. Chronic sleep loss
2. Consumption of foods that, independent of caloric content, cause metabolic/hormonal changes that may increase body fat. These include foods high in sugar or high fructose corn syrup, processed grains, fat, and processed meats
3. Low intake of fat-fighting foods such as fruits, vegetables, legumes, nuts, seeds, quality Protein
4. Stress and psychological distress)
5. Many types of medications
6. Various pollutants

Weight Gain

Weight gain is yet another contributor to weight gain or, in other words, obesity ‘begets’ obesity, which is one of the reasons the disease is considered ‘progressive’. Weight gain causes a number of hormonal, metabolic and molecular changes in the body that increase the risk for even greater fat accumulation. Such obesity-associated biological changes reduce the body’s ability to oxidize (burn) fat for energy, increase the conversion of glucose (carbohydrate) to fat, and increase the body’s capacity to store fat in fat storage depots (adipose tissue). This means that more of the calories consumed will be stored as fat. To make matters worse, obesity affects certain regulators of appetite and hunger in a manner that can lead to an increase in meal size and the frequency of eating. Weight gain, therefore, changes the biology of the body in a manner that favors further weight gain and obesity.

Obesity-related Conditions

A number of other conditions associated with obesity contribute to the progression of the disease. Obesity reduces mobility and the number of calories that would be burned in the performance of activity. Weight gain may also cause psychological or emotional distress which, in turn, produces hormonal changes that may cause further weight gain by stimulating appetite and by increasing fat uptake into fat storage depots.

Sleep duration is reduced by weight gain due to a number of conditions that impair sleep quality such as pain, sleep apnea and other breathing problems, a need to urinate more frequently, use of certain medications, and altered regulation of body temperature. Shortened sleep duration, in turn, produces certain hormones that both stimulate appetite and increase the uptake of fat into fat storage depots.

Weight gain also contributes to the development of other diseases such as hypertension, diabetes, heart disease, osteoarthritis and depression, and these conditions are often treated with medications that contribute to even further weight gain. In all of these ways and more, obesity ’begets’ obesity, trapping the individual in a vicious weight gain cycle.

Diets

A low calorie diet is the primary treatment for overweight and obesity, but, dieting is also a contributor to obesity progression. Dietary weight-loss causes biological responses that persist long-term and contribute to weight regain. One of these responses affects energy balance. When a person loses weight, the body ‘thinks’ it is starving and energy expenditure is reduced in order to conserve calories. The reduction in energy expenditure with dietary weight-loss requires that, in order to maintain weight-loss, the dieter eat even fewer calories than someone of equal body size who has never been on a diet. However, eating less is difficult following a diet because there are long-term changes in regulators of appetite that increase the desire to eat and the amount of food that can be consumed. Such diet-induced changes favor a positive energy balance and weight regain and, because the conditions responsible for the reduction in energy expenditure and increased drive to eat persist long-term, an individual will often not only regain all of their lost weight, but even more.

Another biological response that occurs with dieting involves changes in fat metabolism that reduce the body’s ability to burn fat and increase the capacity for fat to be stored in adipose depots (fat storage depots). With dietary weight-loss, the amount of dietary fat the body burns is reduced by approximately 50 percent. In addition, dieting reduces the amount of fat the body burns for fuel during low-grade activity such as walking, cleaning the house, fixing dinner, or working on a computer. The reduction in the amount of fat that is burned for fuel following a dietary weight-loss makes more fat available to be taken up by fat storage depots, and dieting increases the capacity for fat depots to store even more fat than before a diet. Altogether dietary weight-loss reduces the use of fat for fuel and increases the capacity for the fat that is not utilized to be stored. These changes lead to a progressive increase in fat accumulation even if the individual is not overeating.

Summary

Multiple factors acting upon a genetic background cause weight gain and obesity. Conditions associated with weight gain and biological changes in the body that occur as a result of weight gain contribute to progression of the disease, often trapping the individual in a vicious weight gain cycle. If you are concerned with your weight, please speak to your primary care physician to learn more about how to improve your weight and health.