Is Obesity a Disease?

I left readers with photos of three incredibly fit men on Friday - each is an elite athlete in the octagon, practicing mixed martial arts, at the top of their game.

I asked one question, aside from the UFC, what do they share in common?

Many answered they all share the common BMI classification "obese" - although that is correct, the answer I was going for was they're all "diseased" and in need of medical treatment for their obesity according to the authors of a new white paper published by the Obesity Society.

That's right, if the opinions expressed in this white paper are adopted, the men pictured would all be considered suffering a chronic, debilitating disease which needs treatment by healthcare professionals.

The committee that drafted the position paper took the unusual step to discard the evidence-based (forensic) model and opted for a philosophical argument from a utilitarian perspective.

While they credit themselves for taking this approach because "there can be no higher authority than reason," they ignore the important qualification for something to be declared a disease - is it a disease?

This abandonment of evidence, data and scientific inquiry undermines their approach by simply skirting the true purpose to determine if something is rightly, indeed, a disease state. To get around this wee inconvenience, instead they argue "...the utilitarian argument can address the question "should obesity be declared a disease?" as opposed to "is obesity a disease?"

The ramifications of this mind-bending mental-gymnastics are far-reaching, the authors ignore the moral and ethical can of worms opened if their position is adopted, with their beliefs trumping evidence as they remain steadfast in the belief that it doesn't matter *if* obesity is a disease, it should be declared one anyway because,

"Many obese people are desperate for treatment - the number of people who self-treat and those treated by commercial programs is larger than the number currently treated by the medical establishment. If obesity were considered a disease and entitled to the same considerations given to other diseases, treatment paradigms would change fundamentally...If treatment were covered, more physicians would be likely to engage patients in treatment protocols. The FDA would come under pressure to approve obesity drugs, and physicians would be more likely to use obesity drugs in treatment...With this increased attention, medical treatment options, especially drug treatment, likely would become more aggressive. Medical treatment and obesity surgery would be given more attention by physicians, health administrators, insurance companies, and employers, resulting in greater access by patients to higher quality care."

For those unaware of the various philosophical approaches, Utilitarianism is the idea that the moral worth of an action is solely determined by its contribution to overall utility, that is, its contribution to happiness, satisfaction, preferences or pleasure as summed among all persons affected. This is a form of consequentialism - the moral worth of an action is determined by its outcome - the ends justifies the means.

Because it is an 'ends justifies the means' line of thinking, it can be characterized as a quantitative and reductionist approach to ethics. And to be sure, this issue has far reaching ethical and moral implications - in the stroke of a pen, this perspective potentially takes 1/3 of our population and defines them as diseased, in need of medical intervention and treatment, by way of the crudest measure of obesity - the BMI.

As the three men in Friday's post highlight, obesity as defined by BMI is unreliable, thus flawed as a measure to determine if one is obese. This flaw isn't news, it's well established in the medical and research community as problematic, which is a reason why many continue to suggest the utilization of more refined measures, like waist-hip ratio and/or an actual measure of body fat percentage.

But even this well known flaw does not stop the authors from even suggesting the BMI standard be LOWERED to classify obesity! That's right, not only do these folks think we should abandon medical standards and wax lyrical about how obesity should be declared a disease, they also feel the BMI needs to be lower too!

Sandy Szwarc at Junkfood Science has a well written article about the paper already, so I'll skip the points she already made. I'll note here that one sentence bears repeating about why the philosophical approach in this paper is wrong, "By this logic, or course, poverty could be a disease... Black or ethnic minority a disease... Old age a disease... Homosexuality a disease... Ugliness a disease... Low intellect or literacy a disease."

In addition to the points made by Sandy, a big issue remains - what about the legal issues and medical ethics involved if obesity were declared a disease?

First and foremost is that should obesity be declared a disease, therefore a chronic medical condition, it would then follow that only licensed healthcare professionals would be qualified to treat obesity. The treatments would, of course, include a handful of diet pills, lifestyle interventions and/or bariatric surgery. Fully medicalized as a disease, obesity would no longer be 'treated' outside the licensed medical community because anyone offering services to the obese would be practicing medicine without a license since all disease treatments are the protected domain of licensed healthcare professionals.

More importantly however, is the problematic position "declaring obesity a disease" becomes for the healthcare professional. We'll explore these issues throughout the coming week.

What do you think? Should obesity be declared a disease? Why or why not?