World Obesity Federation Recognises Obesity As a Chronic Relapsing Progressive DiseaseMonday, May 22, 2017
Following in the footsteps of other organisations like the American and Canadian Medical Associations, the Obesity Society, the Obesity Medical Association, and the Canadian Obesity Network, this month, the World Obesity Federation put out an official position statement on recognising obesity as a chronic relapsing progressive disease.
The position statement, published in Obesity Reviews, outlines the rationale for recognising obesity as a chronic disease and is very much in line with the thinking of the other organisations that have long supported this notion.
In an accompanying commentary, Tim Lobstein, the Director of Policy at the World Obesity Federation notes, that recognising obesity as a disease can have the following important benefits for people living with this disease:
1) A medical diagnosis can act to help people to cope with their weight concerns by reducing their internalized stigma or the belief that their problems are self-inflicted and shameful.
2) A classification of obesity as a disease, or disease process, may help to change both the public and professional discourse about blame for the condition, the latter hopefully encouraging greater empathy with patients and raising the patient’s expectations of unbiased care.
3) Recognition of obesity as a disease may have benefits in countries where health service costs are funded from insurance schemes that limit payments for non-disease conditions or risk factors.
While all of this is great, and I am truly delighted to see the World Obesity Federation come around to this statement, I do feel that the policy statement seems rather tightly locked into the notion that obesity (or at least most of it) is a disease “caused” primarily by eating too much, with the blame placed squarely on the “toxic obesogenic environment”.
Personally, I would rather see obesity as a far more etiologically heterogenous condition, where a wide range of mental, biological and societal factors (e.g. genetics, epigenetics, stress, trauma, lack of sleep, chronic pain, medications, to name a few) can promote weight gain in a given individual.
Although these factors may well operate through an overall increase in caloric consumption (or rather, a net increase in energy balance), they, and not the act of overeating per se must be seen as the underlying “root causes” of obesity.
Thus, I tend to see “overeating” (even if promoted by an obesogenic food environment) as a symptom of the underlying drivers rather than the “root cause”.
Thus, saying that obesity is primarily caused by “overeating” is perhaps similar to saying that depression is primarily caused by “unhappiness”. Readers would probably agree that such a statement regarding the etiology of depression would make little sense, as “unhappiness” is perhaps a symptom but hardly the “cause” of depression, which can be promoted by a wide range of biological, environmental and societal factors, all resulting in the underlying biology that results in the mood disorder.
Similarly, I would say that there are indeed a number of complex socio-psycho-biological factors that underly the biology that ultimately results in overeating and excess weight gain (the food environment clearly being one of these factors).
While this may seem like semantics, I do think that a more differentiated look at the underlying etiology of obesity at the individual level (rather than simply blaming it all on “overeating”), is essential for promoting a more sophisticated view of this complex chronic disease both at the level of the individual and the population.