Why treat obesity as a disease?


In the United States, it has been estimated that almost 35 percent of all adults and 17 percent of children ages 2-19 years have obesity. As such, it can be considered one of the greatest public health challenges of our time. Obesity is a condition that has often been stigmatized because of the perception that it is caused mostly by the modifiable behavioral factors of diet and physical inactivity. Nevertheless, a rich body of literature demonstrates that obesity is a complex disease condition mediated through the interplay of multiple genetic, biologic, metabolic, behavioral, social, economic and cultural determinants.

In 2008, an expert panel was commissioned by The Obesity Society to review the evidence implicating obesity as a disease. The panel concluded that, "obesity is a complex condition with many causal contributors, including many factors that are largely beyond individuals' control; that obesity causes much suffering; that obesity causally contributes to ill health, functional impairment, reduced quality of life, serious disease, and greater mortality; that successful treatment, although difficult to achieve, produces many benefits..." Indeed, obesity has been shown to causally relate with or to raise the risk for multiple medical conditions including type 2 diabetes, hypertension, dyslipidemia, coronary heart disease, cerebrovascular disease, sleep apnea and other respiratory problems, gastrointestinal conditions such as reflux, non-alcoholic fatty liver, or gallbladder disease, osteoarthritis, reproductive disorders and some cancers.

Acknowledging the epidemiologic burden of obesity and its associated adverse health outcomes, in June 2013, the American Medical Association's House of Delegates voted to recognize obesity as a disease. It was anticipated that such a declaration by the nation's largest physician group would broaden the prevention and treatment efforts for the disease and improve access to therapies for obesity. Similarly, in 2013, the American Heart Association and the American College of Cardiology joined The Obesity Society in publishing the Guidelines (2013) for Managing Overweight and Obesity in Adults. These guidelines address how to identify patients with obesity, to assess for cardiovascular disease and other obesity-related co-morbidities, to assess the need and readiness of the patient to lose weight, to provide counseling and support for dietary and activity modifications, and to use behavioral, medical, and surgical therapies for management of the disease.

Given that one out of three adults have obesity, and many more at risk of developing obesity, and that this condition is associated with more than 30 other diseases that reduce quality of life and increase morbidity and mortality, obesity should be treated as a disease. A comprehensive multi-pronged approach, addressing the many determinants of obesity, and utilizing a team of multi-disciplinary health-care providers and social support, should be used to reduce the medical, psychological, social, and economic burden of the disease.
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Jensen MD, Ryan DH, Donato KA, Apovian CM, Ard JD, Comuzzie AG, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ,
Wadden TA, Wolfe BM, Yanovski SZ. Guidelines (2013) for managing overweight and obesity in adults. Obesity 2014;22(S2):S1-S410.

TOS Obesity as a Disease Writing Group: Allison DB, Downey M, Atkinson RL, et al. Obesity as a disease: a white paper on evidence and arguments commissioned by the Council of the Obesity Society. Obesity 2008;16:1161-1177.