What is obesity? Is it a disease, an illness, a risk factor, or a condition? And semantics aside, does this really matter?
In 2013, the American Medical Association declared that obesity was “a disease”. This was welcomed by many as a chance to reduce obesity stigma and encourage fat acceptance. Yet this month, researchers concluded that obese participants in their study placed less importance on health-focused dieting and showed less concern about their weight when obesity was called a disease. They also chose higher calorie foods.
Being obese is miserable. Obese people feel depressed, have low self-esteem and are aware that the world views them as lazy, ignorant and low achievers. Such stigma can also exacerbate their unhappiness and may lead to overeating, causing weight gain – and so the spiral continues.
Obesity is a stigmatised condition because like HIV and lung cancer, it is seen as controllable and self inflicted; if people had safe sex they wouldn’t get HIV, if they didn’t smoke they wouldn’t get lung cancer and if they would only eat less and do more then they wouldn’t be obese. Stigma is always bad, will never help, and we should remove it.
So then obesity becomes a disease. And with this, like childhood leukaemia and brain tumours, obesity can generate only sympathy, compassion, a sense of the inevitable and that there was nothing that could have been done differently. The stigma is gone and obese people can feel happier in the world.
But this gives us an odd choice in tackling obesity: stigma and blame? Or disease and powerlessness?
Health and illness have two very distinct stages and I think the answer to this question depends entirely on whether we are considering treatment or prevention.
For those who are already obese, a disease model provides comfort and safety and tells the world it is not their fault. And although it may also make them feel that there is little they can do about their weight, given the evidence that this is indeed very likely to be true, they can live in a world of fat acceptance and be resigned to their fate.
But what about their children? And the future generations of those who are not yet fat? What do they need? Stigma may make fat people feel unhappy, but it may stop thin people becoming fat. Seeing obesity as controllable may make fat people feel to blame but it might also help others take control. And seeing weight as the responsibility of the individual may make the obese feel responsible, but growing up in a world where taking responsibility for your weight is the norm, may help young people eat responsibly.
Words arepowerful things and can change the way we think and behave. And for obesity we have to chose the word that reflects not what we think obesity is, but one that makes people do what we want them to do.
Treating obesity through behaviour change is really hard and mostly unsuccessful, which is why bariatric surgery is seen as a more effective treatment. Perhaps it is time to turn our attention away from treatment and towards prevention and hope that we have more success. So then this controllable and preventable “condition” (and not disease) can be controlled and prevented for the future. And although this may generate some unwanted stigma in the present, our futures can become a healthier and thinner place to live.