Should we call obesity a disease or a condition?
This is a question that has become really controversial. This week, the Council on Science and Public Health of the American Medical Association (AMA) put out a report saying that obesity shouldn't be classified as a disease. The next day, the AMA's House of Delegates disagreed, saying it should be a condition.
You know what I think? I don't care.
It's not that I don't care about obesity. I passionately care about it, because it is stealing the futures of far too many of my patients. Currently, one-third of U.S. kids are overweight or obese. This is not a "baby fat" problem; current research overwhelmingly suggests that baby fat turns into adult fat. And being overweight increases your risk of all sorts of diseases, from heart disease and diabetes to cancer. Not only that, it increases your risk of social and emotional problems. This isn't what I want for my patients.
Nobody wants it for anyone, of course. That's exactly why this controversy has become so heated. Those who want obesity to be classified as a disease say that if we were to do that, it would draw much-needed attention and resources to the problem. They say that it would force us to take obesity seriously and come up with effective solutions for it.
But the people who don't want it to be classified as a disease worry that if you call it a disease, the money would go to drugs and surgical treatments, and not into ways to make healthy eating and exercise more widely available. They worry that prevention efforts would take a back seat to the latest coolest medical treatment. They worry that obese people would say, 'oh, I have a disease' -- and not try as hard to lose weight. They worry that calling it a disease would mean that employers would have to make special accommodations for obese employees, further decreasing incentives for lifestyle change.
It's so interesting that people equally passionate about fighting obesity can end up on opposite sides of an argument. Maybe that means it's the wrong argument.
There's also the problem that obesity doesn't fit comfortably into the definition of a disease. Yes, it can affect the body in bad ways -- no argument there. But it's hard to define clearly when someone is obese; measures like body mass index (BMI) aren't as reliable as we'd like them to be. There isn't a clear way to say what the "signs and symptoms" of obesity are, and we should be able to do that for a disease. Not only that, while extreme obesity is clearly very bad for you, there are some obese people out there who don't have any health problems -- and some non-obese people with the health problems we associate with obesity.
More to the point for me, calling it a disease puts the attention on the patient, because that's how we think about diseases. We might think about their environment and risk factors, but we don't think big picture -- and obesity is a big picture issue (no pun intended). We will never solve obesity if we don't make healthy food and safe, affordable exercise opportunities available to everyone. We will never solve obesity if we don't deal with the grain subsidies that make unhealthy foods so widely available and so cheap. We will never solve obesity if we don't deal with the corporate and cultural factors that contribute to selling and buying super-sized sodas and fries.
I don't care what you call obesity. Maybe it's better not to call it a disease or a condition. Maybe we should just call it what it is: a thief. Because it's stealing the future of our children. It is increasing their risk of health problems, shortening lifespans and even taking away employment possibilities.
Maybe if we looked at it that way, we might get mad -- and getting mad may be exactly what we need. Because more than anything, solving obesity is going to take a whole lot of effort and energy on the part of every single person, no matter what their weight. It's going to take creativity, initiative, collaboration, tenacity and a whole lot of elbow grease.
Let's stop worrying about what we call it -- and start working together to fight it. Let's not let our children's future be stolen.
According to the Center For Disease Control and Prevention (CDC), 17% (or 12.5 million) of kids and adolescents aged 2 - 19 years in the United States are now obese.
The rate among this age group increased from 5% to 10.4% in 1976-1980 and 2007-2008.
Obese kids are more likely to also be obese as adults, which puts them at risk for heart disease, diabetes, and more adult health problems.
These kids are even more likely to become obese adults.
CDC data shows that there was an increase in the pervasiveness of obesity in the American population between 1976-1980 and then again from 1999-2000, the prevalence of obesity increased.
Obesity in low-income 2- to 4-year-olds rose from 12.4% of the population in 1998 to 14.5% in 2003 but increased to 14.6% in 2008.
And only 25% of kids in this age group get the recommended three daily serving of vegetables. One way to make sure your child gets the amount of fruit and vegetables that they need is to serve them at every meal.
In 2011, only 29% of high-schoolers in a survey participated in 60 minutes of physical activity each day, which is the amount recommended by the CDC. It’s best for kids to get three different types of exercise: aerobic activity, like walking or running, muscle strengthening activities like push-ups or pull-ups and bone strengthening activities like jumping rope.
High blood pressure, diabetes and other cardiovascular issues have been previously tied to obesity. But a 2013 study found that obesity also puts kids at risk for other health issues such as ADHD, allergies and ear infections.
This number was documented by the FTC in 2008. According to the APA, there are strong associations between the increase in junk food advertising to kids and the climbing rate of childhood obesity.
Childhood Obesity Linked To Wide Range Of Health Problems Healthy Weight In Kids Tied To Strict School Lunch Standards Kids' Meals At Major Chains Fail Nutrition Test
Follow Claire McCarthy, M.D. on Twitter: www.twitter.com/@drClaire