Calling Obesity A Disease: Fat Acceptance Advocates Predict More Stigma

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Disease. That word carries so much weight, and as of this week, it also concerns weight: The American Medical Association decided to officially define obesity, a condition that affects over one third of American adults, as a disease.

The decision went against the recommendations of the AMA’s own Public Health Committee to do the opposite, and it means that obesity will now be joining alcoholism and drug addiction as a “condition” whose elevation to “disease” sparks controversy.

So will calling fat people diseased pave the way to a healthier society?  Members of the fat acceptance community — advocates for reducing the stigma of obesity– say that all depends on what you consider “health” to be in the first place.

“The AMA’s decision makes a body size into a health diagnosis,” says writer and fat-acceptance activist Ragen Chastain.  She is upset by the AMA’s decision and thinks that it is an affront to her movement’s mission.

“The goal is to create a world where fat people are treated with respect, free from bullying, oppression and stigma,” she says. “I think this will absolutely lead to greater stigma.”

The AMA argues the opposite: It cites the reduction of stigma as part of its reasoning for labeling obesity as a disease.

Some advocates of the AMA’s decision say that labeling obesity as a disease is the wake-up call that doctors need to start treating their fat patients using more serious weight-loss strategies, such as bariatric surgeries.

Some also speculate that obesity’s new, serious status will put pressure on insurance companies to start covering fat-fighting procedures and treatment as they would, say, smoking cessation.

Lesley Kinzel, a senior editor of Xo Jane and a longtime Boston-based fat-acceptance ativist, says she recognizes that, from a medical standpoint, it is good to address stigma attached to fat patients.

“They may have a point by asking doctors, ‘Hey, instead of looking at your fat patients as people with no willpower, let’s see them as having a disease we can treat.’”

However, she fears that “medicalizng” obesity will lead to overtreatment and the over-allocation of scarce insurance dollars to expensive medical interventions.

She has strong doubts that the AMA decision to define obesity as a disease will do anything but increase the stigmatization of fat people outside the doctor’s office.

“Culturally, disease has a stigma,” she says. “To call obese people diseased will not elevate that group in the social stratosphere.”

An article from Time Magazine explains that studies have shown that disease labels can actually help redirect pointing fingers away from moral weakness to more complex webs of causal factors outside of the indvidual’s control. However, it warns that even though the AMA has good intentions, its decision isn’t without its darker implications:

A recent review of studies on conditions like addictions and other psychological problems that can have genetic causes found that such classification generally does reduce the blame heaped on people with the disorders, both by themselves and society. But the labels also increased pessimism about recovery, probably because people assume that as diseases with biological and genetic bases, they are immutable. One study on alcoholism, for example, found that the more people bought into the idea that addiction was a “chronic relapsing disease” over which they were “powerless,” the worse their relapses were. Although the label didn’t increase relapse itself, it made it worse if it did occur — and the majority of people with alcoholism will relapse at least once.

The article also points out that classifiying obesity itself — rather than the chronic condtions that can stem from it — as the disease may miss the mark.

The AMA Council on Science and Public Health, which advised against considering obesity a disease, noted that it is more of a risk factor for other conditions — such as diabetes, heart disease and high blood pressure — than a disease in itself.

In other words, it has the same relationship to disease as heavy drinking does to alcoholism: It’s a risk factor, not a disorder. The committee also noted that there are no standard criteria for drawing a line between healthy and unhealthy weights. After a year of study, it argued:
Without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine conclusively whether or not obesity is a medical disease state. Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive.

Kinzel warns that calling a body size a disease confuses the matter, because fatness isn’t necessarily a health concern.

“Being fat has radically different consequences for different people,” she said. “Some have dramatic health issues; some have zero because they’re fat. I have trouble saying that this is a uniform disease because it doesn’t affect people in the same way.”

Chastain offers her thoughts on how obesity should be considered:

“I think we need to take weight out of the health discussion altogether. Healthy habits are better determinants of health than body size. We need a system that leads to people actually liking their bodies, and therefore believing they are worthy of care. Any interventon that starts off with the idea that certain people’s bodies are wrong is automatically a poor public health intervention.”

Readers? Thoughts? Reactions? Does calling obesity a disease increase or decrease stigma in your eyes?

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  • RJ Watters

    how is the choice to continue life with obesity any different than the choice to continue a life with drug abuse? it IS a disease; a disease of the mind. Through a decay of common sense and a sociopathic view on reality: fat people have come to the conclusion that what they are doing is perfectly fine, that there is nothing wrong with them physically or mentally, and that it’s EVERYBODY ELSE that needs to change how they feel, instead of they themselves needing to have a change of attitude.

    But, much like those who are helplessly addicted to drug use, I don’t care if fat people continue to over-eat and under-exercise; The sooner you die, the better for everyone else.

  • Bridget Kielas-Fecyk

    I have mixed feelings about this. The reason I say this is, from the time I was very young, I have been heavy. Now, you must understand I grew up poor. We ate a lot of chicken and a lot of fish. This was because we raised birds for our meat and eggs, had goats for our milk and went fishing. Most of our red meat came from deer hunting season when my father would get as many deer as he could, legally, and we’d keep it in the big freezers over the course of the year. We also ate a lot of veggies – gardens are great! I also worked very hard. I helped haul, split, and stack wood, pitch hay bales, etc. Yep, I’m a farm girl. Yet, by the time I hit middle school, I was well over 100 lb. By the time I was in high school I was almost 300 lb. Yes a part of that was muscle but I was not muscle looking, I was fat. Sometimes it is not a matter of “get off your lazy backside, work out, and stop eating so much”. This is something I hear a lot of people say about those who are heavy, by the way. That they are lazy slobs who eat all day and fear the tread mill. Sometimes true medical conditions can cause such a problem. As can some medications. Are there those who are lazy and overeat that end up fat? Yes. I love to go bike riding, though during the hottest part of the day I can’t go far because I overheat too quickly, and long walks along the river or out along woodland trails are things I find wonderful. Especially if I can have my camera with me. I am still heavy, however. I weigh 280 lb. I see it in people’s eyes all the time when I walk by or are standing near. “Slob”, “Lazy”, “Unintelligent”. Or less-than-whispered comments about my personal life. It can be very hurtful. I’ve long since stopped letting it bother me but I know I am fighting tooth and nail every day to try to reduce the weight, but it’s a tough battle, especially as you grow older. My honest opinion? Instead of judging people, how about getting to know them first. As far as the AMA calling it a “disease”? Well, their hearts are in the right place, they are trying to reduce the stigma, but the way media portrays the heavy and the way society views those who are heavy… until THESE things change, the stigma will be around for a long, long time.

  • TMeservey

    Shouldn’t obesity be a symptom of SOME diseases rather than a disease in itself? Some people have medical conditions that lead to gaining weight but most people just eat too much junk–and how is that a disease? We package it up and plop it in front of our citizens then make it difficult to get good food for some of them so why are we confused about the obesity epidemic?

  • Rebecca

    I treat the psychological sequellae of obesity. Absolutely describing obesity as a disease will decrease stigma and shame. It’s very hard to lose weight as most of us know. Now that there are surgical treatments, lets embrace them and the people who need them, as having a treatable illness.

  • rippedrooster

    calling obesity a disease will make those (and they are many)that are fat or obese

    believe that like other communicable diseases staying healthy and free from diseases some times just comes down to bad luck.

  • David F

    I went to the CDC website and entered my numbers to see where I fell in the range, here are my results:

    Height: 5 feet, 11 inches
    Weight: 215 pounds

    From the CDC website:
    “Your BMI is 30, indicating your weight is in the Obese category for adults of your height. For your height, a normal weight range would be from 133 to 179 pounds.”

    Some other notable overweight people:*
    George Clooney, 5’11″, 211 lbs, BMI 29
    Matt Damon, 5’11″, 187 lbs, BMI 26
    Brad Pitt, 6’0″, 203 lbs, BMI 28
    *Found at The Middle Manager at WordPress

    The problem is that when I weighed 170, I looked like I’d had been on a hunger strike for several weeks and was in desperate need of forced intravenous feeding, every one of my ribs was visible. True today I could probably lose a few pounds and still be comfortable. However I don’t agree, and no one who knows me would agree that I’m obese. I’m forced to believe the statement put out by the AMA that over one third of Americans are obese is a giant stinking load of baloney. The BMI which is used to calculate what your weight should be is severely broken.

    However I also agree that real obesity is a real problem and people who are obese need help to get down to a healthy weight. When your weight is leading you to diabetes, joint problems, and an inability to see your toes, then for your own health you should lose weight. No amount of “fat acceptance” is going to make you healthy. I think the fat acceptance movement is a dangerous and unhealthy trend.

    • beenwiser

      “when your weight is leading you to diabetes, joint problems, heart disease…”

      its true that obesity has been shown to correlate with several health problems. but correlation isn’t causation. as far as i know, noone has actually demonstrated that losing weight can cure any of the health problems that correlate with obesity. OTOH, scientific research *has* demonstrated that dieting itself can be a health risk, and less than 5% of dieters actually keep the weight off long term. and those surgeries are risky as well, obviously. meanwhile, healthy behaviors (like eating nutritious foods, exercising, and limiting the amount of unhealthy substances that enter your body) are good for you regardless of their effect on your BMI. “everyone knows” being fat is bad for your health, except scientists

  • parkwood1920

    Some advocates of the AMA’s decision say that labeling obesity as a
    disease is the wake-up call that doctors need to start treating their
    fat patients using more serious weight-loss strategies, such as
    bariatric surgeries.

    And here we have the real reason for the AMA’s decision—steering obesity-diagnosed patients toward the weight loss and medical sales industries. Of course, the companies who market weight loss surgery need more customers for their unscientific, expensive, and potentially dangerous surgeries. If we ever needed a reason to kick private enterprise out of public health care, this is it.

  • Dyanna Flynn

    Obesity is so much more reviled in our culture, I doubt classifying a body size as a disease will stop comments and useless attitudes like the one above. I predict more fat people will, as I (and others) have, avoid doctors until absolutely necessary, and remain unexamined, unevaluated, misdiagnosed, prescribed weight loss (up to and including WLS) for totally unrelated conditions like nosebleeds, infections, PCOS, MS and depression.

    Way to validate systematic malpractice, AMA. Don’t take my word for it–look at the anecdotal reports being collected here:

    http://fathealth.wordpress.com/

    • Anonymous

      Obesity should be reviled.

  • Diana Sours

    I think it would be okay to consider obesity as a disease in certain people under strict guidelines. If people have underlying causes, such as thyroid disease (which is not necessarily caused by weight issues), or some other problematic issue (even depression) that causes severe weight gain (or prevents weight loss) then I can see it being labeled a disease for medical purposes. However, if someone is eating fast food, not exercising and not even attempting to help themselves then it should just be called LAZINESS.

    • parkwood1920

      You displayed some critical thinking at the beginning of your comment, but then you regressed to a fat stereotype at the end. Newsflash: eating habits have very little impact on a person’s weight. There are plenty of fat people—even “morbidly obese” people—who are actually undernourished as a result of poverty and food insecurity. They’re lucky if they get one square meal a day. Meanwhile, there are plenty of rail-thin people who eat junk food like it’s going out of style.

      • Steve C.

        Parkwood – making those kind of statements “undernourished…morbidly obese” and “rail-thin people who eat junk food” are nonsensical anecdotes without the backing of serious support (widely accepted scientific studies, surveys, etc.). Please provide some back up for your comments, because the preponderance of studies and long term programs that I’ve seen/read about indicate that , in the great majority of cases it’s about calories in vs calories out. I.e. – it’s about eating habits. I just lost 17 pounds on a 5/2 eating plan (google it)…simply because the plan gave me the structure to reduce my weekly caloric intake by a significant amount. Again, it IS primarily about eating habits!

        • MITBeta

          Calories in — calories out doesn’t work (by itself). That’s why people who eat 1000 calories a day (90% carbohydrate) can still gain weight. (http://www.gnolls.org/3374/there-is-no-such-thing-as-a-calorie-to-your-body/)

          You’re right that it’s about eating habits, and unfortunately the government produced Food Pyramid cuts to the heart of the problem: refined carbohydrates. Try gaining weight by eating nothing but fat and protein — it’s almost impossible.

          I’m sad that it took me so many years to find the slow carb diet, which is the EASIEST “meal plan” (I hesitate to even call it a diet) to stick to. I eat lots of eats, meats, vegetables, nuts — basically primal or paleo eating, but no bread, potatoes, rice, or any other kind of which carbohydrate. I’ve lost 15 lbs. since January without feeling deprived for 1 second.

      • Amanda Lister

        It seems that people who are in poverty and undernourished eat the most unhealthy foods because they are more affordable – sorry, I’m not saying all people in poverty do, it’s just that it is more difficult for them to obtain more nutritious food because it is more expensive. also, people in poorer regions have less options for exercise (there are plenty of documentaries on this subject) so yea, they’re undernourished but that’s because what they’re eating might be foods that provide “empty” calories rather than a balance of essential macromolecules, vitamins, etc.

      • http://www.facebook.com/profile.php?id=541734066 Ralph McGinnis

        “eating habits have very little impact on a person’s weight.” This is seriously one of the most idiotic statements I have ever read in my life.