The AMA Says Obesity is a Disease: But Is It Really Beyond Our Control?

obesity as a disease

This past week the American Medical Association declared that obesity was a disease. Previously the AMA used strong terms to describe obesity such as “”urgent chronic condition,” a “major health concern” and a “complex disorder,” but stopped short of declaring it a disease, according to an article in the Los Angeles Times.

Apparently declaring obesity as a disease serves two purposes. One, to allow doctors to be reimbursed for time spent discussing the implications of obesity with their patients and two, to encourage doctors to talk to patients about their weight and send patients to programs designed to help the obese patient lose weight and monitor their progress.

Dr. Keith Ablow, in an article on Fox News, says this about the declaration:

[the declaration is] “another step towards eroding people’s autonomy and making them passive participants in their health.  It is also an example of how the medical establishment is laying the groundwork to bill Medicare and Medicaid for every bad choice anyone makes, ever.”

Dr. Ablow likens the declaration of obesity as a disease to the declaration that alcoholism is a disease. He says there is “no no known gene that would make people veer off into the McDonald’s drive-through lane or direct them to choose whole milk over 1 percent milk.”

I tend to agree with Dr. Ablow that in the vast majority of cases, obesity really is a choice rather than a disease. I say that as a formerly 300+ pound woman whose obesity was absolutely a choice. I alone chose to drink a chocolate milkshake at 2:00 in the afternoon, eat a panful of biscuits during my children’s nap time, and order the highest calorie dish at the restaurant. That was me. It wasn’t a particular gene unique  to me, but rather choices I made.

Now, I acknowledge that our standard American diet does not make it easy to manage our weight. The added sugars in foods make it hard for us, the abundance of cheap fast food make it difficult for us to say no, and our sedentary lifestyle makes it challenging to maintain a healthy weight. In fact, just this weekend someone asked me if my lifestyle was second nature after 15 years of weight maintenance. I hesitated and said, “In some ways, yes. But on the other hand, I still have to be very careful to make good choices day in and day out or else I could end up gaining pound upon pound again.”

While I do think that health insurance should help pay for weight loss treatment programs, I also believe that declaring obesity a disease may make some people feel as though their obesity is not their personal responsibility, but rather something that just “happened” to them. I often tried to blame genetics, an enlarged thyroid, or some mysterious ailment on my obesity, but in the end, I had to come to the point where I could acknowledge my role, take responsibility for it, and do something about it.

If obesity was classified as a disease back when I was 300 pounds, I believe I would have felt it validated the fact that I could not seem to lose weight. It would have likely left me feeling justified and a little defeated. After all, if my obesity was a disease, then there was little I could do about it so why try very hard?

While this may not seem like a big deal in the scheme of things, this declaration could have far reaching effects on health insurance costs and health insurance coverage in the future. After all, with about a third of Americans falling into the obese category, this declaration affects millions of people.

What do you think? Is obesity a medical disease? Diane

37 thoughts on “The AMA Says Obesity is a Disease: But Is It Really Beyond Our Control?

  1. Amy says:

    Going strictly by the definition of disease at the top of your post, I think it does qualify. However, I think this could be a double edged sword. On the one hand, perhaps it will be a major wake up call for some people, and help them realize that being obese is not just a cosmetic issue, but has severe health implications, and spur them on to take action. On the other hand, it could cause others to throw their hands up and take less responsibility for their condition. It will be interesting to see if this changes the way we view obesity over the longer term.

  2. Fran@BCDC says:

    What a terrific post, Diane. I think too many people like to use the excuse that they have a “condition” when it comes to being over weight. Most of the “conditions” seem to come From being overweight. In my 26 years being associated with the Weight Watchers program and 15 years working as a leader, I could write a book with all of the excuses I would hear as to why people could not lose, up to and including that the program just didn’t work. The program didn’t work because the member wasn’t working the program. I sit in my Saturday morning meeting now and I could point out exactly who is and is not doing what they should be doing. It comes from both their progress (or lack of it) and the reasons they give for not achieving that progress. Is obesity a disease? I don’t know. I know that it is an individual achievement. I do it or I don’t do it. Whether it is Weight Watchers or some other plan, most of the time if you follow it, it works. If you don’t it doesn’t. I don’t like doctors getting too involved because many of them what to use pills to accomplish this. A good friend just wound up in intensive care because of taking pills to lose weight which were prescribed by his doctor. I don’t know how any doctor could do that. I’ll get off of my soapbox now. I think that weight is my issue and it’s your issue. We need to take responsibility for our health and managing and losing weight can make a huge difference. Thanks, Diane!!

  3. Anne @ Domesblissity says:

    Interesting post Diane. You know I’ve never been obese in my life. I put on a bit of weight when I was 21 and lost it quickly as I did in my early 30s, both times due to quitting smoking. This time, I’ve doubled my usual weight in the last 8 years since having my children and being in a sad, miserable, mentally and emotionally abusive marriage. Do I ‘blame’ the marriage or the kids or did I contract a disease in the last 8 years. I’ve been trying (half heartedly I must admit) to lose the weight since last year but I’ve got no closer instead I’ve probably put on more. I honestly think my situation is a very bad habit I got myself addicted to as a coping mechanism. I don’t know what I’m going to do. I’m missing being my usual self and feel a lot of people don’t know the ‘real’ me rather the unattractive, obese me who no one likes. Its blogs like yours that are motivating me though Diane so thank you. Anne xx

  4. Laura says:

    I too am obese and obesity is NOT a disease. I don’t have a defect in my brain or my body that requires medication, etc.

    I know it’s my choices. I think the AMA making it a disease is a big mistake. Instead of a third of folks being obese, in 10 years it could be half of us. Maybe then they will declare healthy weight a disease.

    I’m working on my weight and having success. No meds – just good old fashioned hard work and self control.

    Excellent post Diane

  5. Mark says:

    This is a great post and such an important topic. I think there is a possible addiction factor but even so, I don’t think that rises to the definition of “disease” from a medical standpoint.

    I struggle because of my choices. Any side effects I have from my weight including high blood pressure, joint pain, are side effects of choices – not because of a disease.

    Just my two cents.

  6. HappinessSavouredHot says:

    I heard that some advocate a change in approach with alcoholism for similar reasons: if it’s a disease, then you can’t possibly have control over it.

    We need our problems to be validated, but we don’t need to feel helpless about them.

    Obesity might or might not be a disease, it certainly is a HUGE risk factor for so many health conditions!

  7. Veronica says:

    Diane, this is a wonderful article. As an overweight health care professional I don’t necessarily believe that obesity is a disease per se, but there are many studies that indicate that sugar and cocaine stimulate the same part of the brain and that sugar is in fact addictive. So if sugar is addictive the same way drugs or alcohol is then yes, obesity should be qualified as a disease, regardless of my opinion. The thing that’s troublesome to me is that children who are obese generally come from parents who are obese due to food and lifestyle choices, but children have no control over what they’re being fed so the addiction can often begin at an early age through no fault of their own. Habits that are formed in childhood stay with us throughout our life. That being said I think that obesity should qualify as a disease amongst certain people. When I started changing my lifestyle my grocery bill increased by almost 30% so I understand why people choose foods that are cheaper and more convenient and that is the cultural problem at the bottom. I do also agree that making it a disease will make give people more excuses to say “it’s not my fault,” but again this comes back to the culture around obesity and people not wanting to take action and wanting quick fix miracle diets and pills. I’m a firm believer that if we change our culture of eating and attitudes about health that’s when the light will finally go off for many people.

    • Janis says:

      I agree with the characterization of it as similar to drug and alcohol use, but in those cases, we don’t call drunkenness the disease. The disease is alcoholism. The problem itself is further upstream, and if it’s being identified too far downstream, then it won’t be dealt with properly.

      Basically, by the time the mouthful of loaded nachos heads down the throat, that’s when it becomes “obesity.” But the actual problem is above the neck — why the loaded nachos ended up in front of you at 3am.

  8. Danielle says:

    Such an interesting post! I have to agree with both sides of your argument. On one hand I love that insurance is now covering costs to help combat obesity but I do agree that labeling it as a “disease” may be doing more harm than good because now will people wonder whether it is something they are “stuck” with? I would love to see more action placed on the prevention of obesity too not just what to do once we get to the point of “disease”.
    I have to say I just discovered your blog and love it! Keep up the great work!

  9. Elizabeth says:

    I feel torn about this issue 1) I know when I was extremely overweight my doctor’s never said a word about it. Why? Was it because it wasn’t a disease and they didn’t have the time to discuss it? Did they not want to embarrass me? If classifying it as a disease will make more doctors have realistic conversations with their patients about losing weight then it will be worth it. 2) I agree that my decisions were choices too: mostly emotional ones that lead to my overeating. It wasn’t something out of my control.
    There is just so much to consider when jumping on one side or the other on this topic.

  10. Dr. J says:

    I just sent in a column on this same topic, Diane, to be published this week.

    Do I need a “spoiler alert?”

    PS: I am not a member of the AMA 🙂

  11. Kyra says:

    I’m on the fence about it. I believe that it’s within our control, but I also believe that if calling it a rainbow penguin meant that there would be more tools at our disposal (actual tools, not money making diet industry machines who have as much invested in us failing as succeeding) I’m for that part of it. I think it’s like the food itself; you can look at the good in it and use it for the right purposes, or you can find the bad in it and make all the wrong choices.

    The truth is that we’re here. Our society is fat. Period. It’s not a “if we say it, they’ll all get fat” point, because most are already there (I’ve been obese, I’ve been thin, and now I’m overweight and working my way back down. So I’ve played with all the labels myself.) So, now it’s about finding solutions and making them available. If a person wants to use the label of disease as a reason for them not to make healthy choices, they’re going to find other ways to justify the behavior too. The label also takes nothing away from the results of healthy choices, so there’s no damage there.

    I think, at this point in history, we need all the help we can get. So many different people, and everyone needs their own pathway to better health. The more tools and opportunities offered, the more chances that someone will find the right combination for them and break out of the bad choices.

  12. Contemplative Fitness says:

    I tend to think obesity is NOT a disease, and is more the result of choices. However, and a systems theorist would have a field day with this, obesity, above all else, is an adaptation. Adaptation to changing business models, corporate structures, marketing strategies, social behaviors, and so much more. Obesity is just one adaptation, out of millions, that is the result of man over thinking himself as a species…

  13. Marc says:

    Hi Diane, this is a very interesting post! The Diagnostic and Statistical Manual of Mental Disoders-5 (DSM-V) authors proposed adding Obesity as a mental illness to the next edition of their manual. This was a couple years back before it was released. Word got out and due to public pressure they backed off and did not include it. I read one of the Doctor’s reasoning for including it as a mental disorder. It made sense to me. But people all across the country became alarmed that fat people would be ‘labeled’ with a mental disorder.

    Too often if you follow the money, you find the motivation for many things cause change. At the same time, had this been included…perhaps obese people would be able to get therapy paid for by their insurance company to address the mental aspect of over eating.

    Labeling obesity as a disease (IMHO) would be a good thing. Yes…it would mean that doctors would be billing insurance companies (again, follow the money). But it would clear the way for many obese people to seek treatment, rather than continue to live their lives obese and develop so many of the diseases that are cause and effect from the obese live style.

    It seems so easy to point the finger of blame at the fat person and yell…you did this to yourself!! I feel there are very often, so many other factors involved that lead to obesity, that blaming fatty for being fat is way to judgmental. We all should try to help and uplift each other, not marginalize obesity as anything less than a disease, that can lead to early death.

  14. L says:

    I don’t think that declaring obesity a disease necessarily means that people won’t try to lose weight or believe they can lose weight and get healthier. Groups that believe obesity is a disease, still strive to eradicate it. It’s my understanding that they acknowledge the compulsion to overeat as something no obese people would choose for themselves, but rather an inner imperative to not only overeat, but be obsessed with food and food issues when they would prefer to be thinking of other things. I think there are some people who are just ignorant of what their eating patterns are doing to them (or how to change those patterns), and there are those who really are beguiled by food, even though they wish they were not.

  15. Linda says:

    Excellent post. This is a complicated issue but I see exactly where Marc for example is coming from. The complications caused by obesity are extensive. If we can help to nip many of those complications in the bud by helping anyone that otherwise would not be able get help to lose weight and avoid those complications we all win. I mean I am one that has complications brought on my being obese and had to seek medication attention for it, so I am a prime example! Earlier this weekend upon hearing the label was skeptical but now realize that hopefully this change will be positive. Only time will tell.

  16. Janis says:

    More complex babblings:

    I think we’re getting caught up in the wrong issue. Is it someone’s “fault?” Who is to “blame?” In no other medical issue is the assignment of blame considered an important part of treatment. There are a lot of diseases that are definitely impacted by lifestyle, and not once has it ever helped to determine whose “fault” it is, even in cases where the connection with behavior is much clearer — like in smokers with lung cancer. The oncologist’s job doesn’t suddenly get easier once some certificate of blame has been printed and signed. It doesn’t make the chemo any more effective, and it doesn’t improve the survival rates.

    The issue to hand is how to solve the problem. And like I said above, if you wait until the nachos go down the throat and begin their metamorphosis into fat, it’s too late. It’s not a matter of whether it’s a choice or not, it’s a matter of accurately identifying where the problem lies. If you try to solve it too far downstream, it won’t work. And I’ve read far, far too many blogs written by people who have so many things in common — bad family situations, bad histories with other addictive behaviors, horrible upbringings, traumatic experiences as children, complete lack of confidence in themselves, deep-seated beliefs that they don’t deserve anything good in their lives — to imagine that “it’s a choice” is where it begins and ends.

    In all of those cases — women living with abusive husbands, people struggling against terrible childhoods, people fighting addiction in their own families, people without any trust of confidence in themselves — saying that the obesity is the problem is just flying in the face of their lives. In so many cases, I think to myself that the real problem is that someone needs a divorce, a restraining order, to get away from their families, to gain the confidence to get a paying job … and that obesity is far back in line behind many other life problems that must be addressed before thin thighs can even be considered.

    Calling obesity a disease OR calling it a choice is a gross oversimplification that will not come within a mile of solving the problem. I think it also lets people stay in denial in a way — that their problem is simply being fat, and not needing a divorce, needing to get out there into the job market, or needing to unpack their childhood.

  17. Pam says:

    At first I didn’t think you should label obesity a disease, but then I thought about how people always say the “disease of alcoholism” and the “disease of drug addiction,” and decided that obesity IS a disease. It is the result of another addiction, our love of food, and more appropriately, the WRONG kind of food. I think the most positive aspect of the AMA identifying obesity as a disease, is that perhaps it will cause the insurance companies to cover more of the problems associated with fighting it, including pills, surgery and even counseling. Obesity is a real epidemic, and the powers that be (government, AMA) need to realize it’s time to start fighting it!

  18. Kaye says:

    Absolutely not. It is not a disease, it is a problem with choices. And yes, I too see that there are addictive foods, etc., but it still comes down to choice.

    I also believe alcoholism is not a disease. It too is a choice.

    That being said, I am obese. I wish I weren’t but it is because of my decisions throughout my life. I’ve had some hard times that I turned to food for, but it still wasn’t because of a disease or genetic component. It was hard times, yes but not a disease.

    I do not have a disease. I am obese. Acknowledging that helps me move forward.

  19. Laurel says:

    I am in the “it is not a disease” camp. I don’t know what the AMA is trying to accomplish but it seems as though they want to label everything in order to control us further.

    Insurance rates will be affected, maybe insurance coverage will be affected. Will insurers have to pay more for obese people because of the disease?

    I’m tired of the gov’t interrupting in my life. My weight is my problem. It is not a disease, it is a series of choices I make. I’ve made strides toward changing things but it is a slow process. I don’t need the gov’t intervening in what my doctor “has” to say to me.

  20. MaryAnn says:

    I don’t think it is a disease either, but I do understand that the side effects of obesity are. Diabetes is a disease, high blood pressure and cholesterol cause complications, heart disease is a disease, etc. All these things can be worsened by obesity or brought about by obesity.

    I know because I too struggled with my weight (like many of your readers). I lost a lot of weight, gained it back, lost it again. Now i’m working on maintaining that loss one more time. And my pre-diabetes status has gone away, my risk of heart disease is less, etc.

    My weight was not a disease.

  21. Lisa says:

    I do not think the obesity is a disease. I think there can be underlying ISSUES that could be a disease and lead to obesity — thyroid, diabetes, etc — kind of a chicken and egg thing though. I don’t think I had a disease when I was 250 pounds. I made choices, like you, to eat whatever I wanted whenever I wanted. I was the one that CHOSE to eat an entire pizza by myself and NOT exercise!

  22. Jennifer says:

    I spent my whole childhood being obese. I did not have a disease. I see many children today who are obese. I find it hard to believe that they have a disease. Given how short their lives are, can they even have developed a disease?

    Even though I lost 100 pounds, I am still medically obese. Does that mean I am still struggling with disease? I do not have any risk factors and am healthier than ever before. I cringe at the thought of calling obesity a disease, without understanding what it means to be obese or how to treat it. Unfortunately, I believe that more weight loss surgeries and pills are on the horizon. Treating the symptom instead of the cause results in perpetuating the system.

  23. Leah says:

    No, I absolutely do not think obesity is a disease, but as you said it is a choice. It bothers me that the AMA would say this, because of exactly what you said, “If obesity was classified as a disease back when I was 300 pounds, I believe I would have felt it validated the fact that I could not seem to lose weight.”

    I used to have physicals and I was always healthy. I used to think I was one of the healthiest fat people out there, because they never found a “reason” for my being overweight. It was my own choices that lead to me being overweight and I knew it.

    I’m also concerned about the government having more and more say about these types of issues, but that is another topic for another day.

    Thank you for sharing the truth behind this subject.

  24. Joy says:

    I hear what you are saying but if it is considered a disease I would hope it would have a postive outcome to be even more proactive. Take for example if you were diagonised with diabetes I would hope people would take every action to leave a healthier lifestyle (. I know, I know in a perfect world).

  25. blackhuff says:

    Another blogger also blogged about this and like him, I say that obesity can’t be defined as a disease because it’s not beyond our control. Even though you have a medical problem which resulted in one being overweight or obese, you can still seek ways to lose the weight. It’s never beyond our control. Doctors have ways to help you should it be medical, otherwise a good proper eating plan helps a lot.

  26. Tanvee says:

    Hi Diane, I would like to believe that obesity is a choice not a disease, because when it is a choice I can take responsibility and change my choice to live healthier and eat better but when it is a disease I would have less control…

  27. Tracy says:

    Great conversation. I don’t think it’s a disease. Calling it a disease is surely getting the pharmaceutical industry excited. Diseases can be treated with medication. Selling pharmaceuticals makes those companies very rich. While I think some meds can help jumpstart a weight loss, they’re not the answer.

    I don’t have a disease. I’m not sick. I made bad choices and I suffered for making them. Now I’m trying to make the right choices – not cure a disease.

  28. BlessedMama says:

    I can understand why they classified it as such, pretty much for the reasons you stated. But, I also agree with you that people may feel justified in overeating and act as if they have no other choice.

  29. Nicole @ Adonis Golden Review says:

    Looks like the classification of obesity as a ‘disease’ will bring some more attention to the seriousness of the issue. It has spread deeply amongst the developed nations of the world, and is showing a particularly worrying trend especially in children.
    It’s so important to do everything possible to lead a healthy lifestyle. Good food and exercise is essential and so is a peaceful mind.
    Time for us all to take positive steps, especially parents with young children to tackle this epidemic before it’s too late.

  30. Stephanie says:

    I’d say it would classify as a disease under that definition, especially that it is often “a response to environmental factors” (i.e. stress, depression, whatever triggers us to eat). I think that the two reasons to classify obesity as a disease are extremely good reasons to do so. Allowing doctors to try to help patients will hopefully help reduce the problem. As far as people using the fact that obesity is a disease as an excuse not to change or be able to do anything about it – I think those people would act that way whether or not obesity is considered a disease.

  31. Charlene says:

    I don’t agree that obesity is a disease. It ‘s a choice. This is misleading and allows for more people to remain in denial and not accept responsibility for their choices.

  32. Kerstin says:

    I’ve been obese for the last 10 years, seven of which I spent in the US, permanently afraid of the health consequences of my extra weight because they are so good at fear-mongering in the States. Last year I moved to Germany and when I had my physical everything was fine and my doctor looked at me and said “Obesity is NOT a disease. Stop worrying so much. You are healthy. Enjoy your life.” I can’t tell you how refreshing that was and what a relief I felt. Now having said this, obesity is rarely caused by a healthy lifestyle and I am feeling its implications in the form of lack of energy, achy joints and a general sense of uncomfortable heaviness. I am an emotional eater who medicates with sweets and big portions but I also enjoy healthy, fresh foods. To me the statement that obesity is a disease causes fear and it makes me want to comfort that fear with food. I think it would be a lot more effective to look at the cultural and emotional causes of obesity and start addressing those in an effort to help overweight people help themselves, rather than stigmatize them by applying the disease label.

  33. NorthwoodsMamma says:

    I think obesity is exactly like alcoholism or drug addiction, only more complicated because we can’t stop eating altogether. It starts by you making choices and ends up with the choices making you. Yes you can make better choices, but to completely break the addiction to sugar, overestimating, fat or whatever the vices have ahold of you. Food has been my comfort in life through many major crisis. I have been addicted to the warm fuzzies it gives me for too long. It took the doctor telling me “at this point, with your weight going up to this level, I’m told to show patients this”. He handed me a bariatric surgery brochure. I freaked out. I knew I was more than overweight, but I had no idea I had crossed into THAT zone. So having doctors talk to people in more concrete ways about obesity and having more tools that insurance will cover (I didn’t know my insurance didn’t cover seeing a dietician for my obesity until I got a bill for two visits) can really help is out. Alcoholics may have a disease, but that means they have more resource access and therapy avenues. Hello. My name is Cynthia and I’m addicted to food ( especially sugar)

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