Kelly Neilson, MDA RD LD
No, “Obesity” is NOT a Disease
Let’s move away from this misclassification
For the past decade, we’ve been bombarded with the message that “obesity” is a disease and that it’s detrimental to society. Schools, insurance companies, big pharma, and the diet industry have amplified this message.
But recent studies and analyses of past studies are debunking this theory, shifting thinking in a new direction.
A person’s size is not a disease or behavior. Size is a characteristic that can have many contributing factors. Medication, hormones, environment, genetics, and medical conditions can affect a person’s weight.
So how did a person’s size become a disease?
People often assume that because there are many diseases correlated with obesity, that obesity “must be bad” and causing these diseases. This isn’t true. Remember the fundamental rule of statistics? Correlation is not the same as causation.
But somehow correlation has driven bad messaging and bad initiatives, even with solid research showing that dieting and weight cycling have more to do with negative health outcomes than body size itself.
For example, the Framingham Heart Study is a 32-year study of more than 3,000 men and women that showed regardless of initial weight, people whose weight repeatedly went up and down — known as weight cycling or yo-yo dieting — had a higher overall death rate and twice the normal risk of dying of heart disease than those who did not weight cycle.
These results were independent of cardiovascular risk factors and held true regardless of a person's weight. Simply put, even a person at a higher weight who didn’t diet and weight cycle, had a lower death rate and risk for cardiovascular disease than a person at a lower weight who did diet and weight cycle.
Bad initiatives based on correlation — not science
In 2002 President Bush declared a war on fat. His initiative was based on the false belief that body weight is directly linked to health. In her excellent book, The Body Is Not an Apology, Sonya Renee Taylor calls Bush’s initiative “body terrorism.”
The fear of obesity continued to escalate and in 2010, First Lady Michelle Obama launched a campaign to solve the “epidemic” of childhood “obesity.” This ushered in a new form of parental guilt.
Then in June of 2013, the American Medical Association voted against its own scientific committee to declare that “obesity” is a disease. The vote was made even though there wasn’t enough evidence to support the assertion.
Suddenly, body size alone became the disease, based on a popular vote and financial incentives to be reimbursed for weight loss and prescriptions — not science.
The AMA thought that recognizing “obesity” as a disease would improve research into the cause of it, remove the stigma, and help people of size get better healthcare.
This didn’t happen. Weight stigma remains prevalent in society, research is misguided, and medical care for people of size needs improving.
Stigma can affect a person’s health
Weight stigma, especially in the medical setting, can have a strong negative effect on a person’s health including increased stress and cortisol levels from feeling stigmatized.
The fear of going to the doctor’s office usually leads to a late diagnosis.
Doctors often don’t prescribe diagnostic testing to people of size at the same rate they do for thin people. Instead, doctors often prescribe weight loss, which is another reason underlying health issues can go undiagnosed.
Diagnostic equipment is also a problematic area as it’s made for smaller people and doesn’t always accommodate people of size.
Research on weight can be flawed
Why? Because of human bias. Whether intentional or unintentional, bias often works its way into research justifying preconceived beliefs.
On their podcast, “Maintenance Phase,” Michael Hobbes and Aubrey Gordon talk about how one well-known researcher and subject matter expert on nutrition, chose methodologies for his studies that produced the highest mortality rate for people who were considered obese.
He essentially cherry-picked his subjects so the outcome would support his belief that fat people are unhealthy and have a higher mortality rate.
Hobbs and Gordon’s enlightening discussion about this study can be heard in the episode titled “Is Being Fat Bad for You?” Their podcast is available on Apple and Spotify. There’s a link to their website at the end of this article.
Now that you have this important information, you’re equipped to better advocate for yourself at your next doctor’s visit.
If your health care provider is focusing on your weight and trying to treat it as a disease, start a conversation with them.
Question why they’re focused on your weight if your blood pressure, blood sugar, and cholesterol are within normal ranges during annual health screenings.
People CAN be healthy at every size. Body weight is NOT directly linked to health.
Request the appropriate diagnostic testing to find underlying conditions that could be contributing to the symptoms you’re seeking treatment for.
And finally, beware of a doctor whose main focus is on your BMI. This model was never intended for clinical use. It was created by a Belgian astronomer as a statistical exercise in 1830s Europe and didn’t include observation of larger populations such as Black, Asian, or Pacific Islanders.
You deserve to have a doctor who’s committed to your health.
If this article piqued your interest and you’d like to discuss this topic, schedule an appointment. As a registered dietitian who believes in the HAES approach, I understand that a person’s size is not a disease and that health is possible at every size.
Maintenance Phase Podcast
The World Health Organization
New York Times
Intuitive Eating, 4th Edition: A Revolutionary Anti-Diet Approach
Pgs. 22 & 73