Obesity: Moral Failing or Disease?

The Obesity Society (TOS), the leading organization of top scientists and health professionals devoted to understanding and reversing the epidemic of obesity, has just updated its 2008 statement on obesity, and it’s going to cause ripples in the health and medical communities.

Rather than treating obesity as a moral failing, the TOS is calling for obesity to be classified as a worldwide, non-communicable chronic disease.

The organization released the following statement on the classification change: “The science of obesity has advanced over the past decade, leading TOS to affirm, update and strengthen its position on obesity as a disease that afflicts all age groups.”

TOS President Steven B. Heymsfield, MD, FTOS, professor and director of the Metabolism and Body Composition Laboratory at the Pennington Biomedical Research Center in Baton Rouge. Heymsfield and TOS Vice President Cathy Kotz, PhD, FTOS, both noted that multiple health societies and organizations have recognized obesity as a disease since the initial TOS position statement. Kotz, however, added that a large degree of misconception remains.

“Obesity meets all criteria for being a disease, and therefore, should be characterized as such,” said Kotz, professor and director of graduate studies at the University of Minnesota’s Department of Integrative Biology and Physiology in Minneapolis. “This recognition impacts how individuals are viewed and should reduce the stigma associated with it. The updated statement is needed so that the public and policymakers can make informed decisions regarding the healthcare of obesity.”

For those of us who follow obesity research, it has long been known that the battle of the bulge is neither as simple as calories in/calories out nor a moral failing in the area of self-control. Rather, obesity is a multi-causal chronic disease recognized across the lifespan resulting from long-term, positive, energy imbalance with development of excess adiposity that, over time, leads to structural abnormalities, physiological derangements and functional impairments.

It is also why long-term weight loss is so difficult to achieve and why draconian diets that alter a person’s metabolism may cause more harm in the long-term. I’ve written more about this is my previous article Why Are You So Fat?

According to Aaron Kelly, PhD, past chair of the TOS Pediatric Obesity Section and co-director of the University of Minnesota Center for Pediatric Obesity Medicine, “One important feature of this updated statement from TOS is the position that obesity, even in childhood, is a disease. Too often pediatric obesity is chalked up to ineffective parenting and/or lack of willpower on the part of the child. In fact, when obesity surfaces in childhood, it may actually demonstrate an aggressive form of the disease likely being driven by strong biological components. Therefore, pediatric obesity should be taken seriously.”

But there are plenty of skeptics who don’t want to see obesity classified as a disease. Critics main concerns seem to center on the belief that by classifying obesity as a disease it will encourage individual’s to minimize their role in managing their own health and activity levels. Or in more simpler terms, cause fat people to just give up—and make them much sicker.

TOS has outlined 13 objectives, including recognizing the need for research funding, reducing stigma and discrimination, educating healthcare providers, and promoting the need for increased obesity prevention and treatments, in addition to structural and environmental changes in workplaces, schools and communities. For more information, you can read their position statement in the January 2019 issue of the scientific journal Obesity.

The human body is a complex machine, and the theory that obesity is a simple energy equation seems far too simplistic to be a good measure of why some people get fat and others do not, particularly if diet and activity levels of obese people are nearly identical when compared to slim people. And certainly there are a small percentage of people who just eat irresponsibly and without thought. But a half century of telling people to just eat less hasn’t worked. Surely, we are missing something here.

Dr. Christopher Ochner, assistant professor of pediatrics and psychiatry at the Icahn School of Medicine in New York said, “In those with chronic obesity, body weight seems to become biologically stamped in and defended.” Few individuals ever truly recover from obesity; rather they suffer from ‘obesity in remission,” he said. “They are biologically very different from individuals of the same age, sex and body weight who never had obesity.”

But until science unlocks this complex disease, put down the holiday sugar and do what you always do, continue to watch your intake and activity levels and try not to let others make you feel morally inferior. #Reignwell