Is Not Calling Obesity A Disease Discrimination?
Monday, September 21, 2015
In the many discussions I have had about calling obesity a disease, I have often heard the argument that calling obesity a disease somehow discriminates against larger people.
Indeed, there are people who consider “obesity” to be largely a “social construct” invented by the “medical establishment” to “medicalize” something that is simply a natural part of the spectrum of human shape and size.
Funnily enough, some of the most passionate opposition to calling obesity a disease, comes from that very same “medical establishment” – doctors who don’t want to see providing obesity care as part of their job, hospital administrators who think providing obesity treatments takes resources away from dealing with “real” diseases, and payers who fear having to shell out millions of dollars for expensive obesity treatments.
Indeed, if I had to point to one single factor that has in fact stopped the “medical establishment” from finding better treatments and providing access to effective and compassionate care for people struggling with excess weight, it is their refusal to consider obesity a disease.
The paradox in all this would be funny if it were not so sad – it turns out that many in the very same “medical establishment” that is being sharply criticized by social scientists and the size-acceptance crowd for “medicalizing” obesity, are in fact fighting as hard as they possibly can to NOT have obesity declared a disease.
So oddly, the people who appear so concerned that labeling obesity a disease could somehow discriminate against people of size, are widely supported by the general public, many of who would think the notion of obesity as a disease ridiculous, given that in their view, being large is simply a matter of poor choices. Sounds to me, like a rather uncanny alliance between the far left and the far right.
While I fully understand that for some people, being “labeled” as having a disease may be traumatic, I see this as no more or less traumatic than being “labeled” as having hypertension, diabetes, arthritis, sleep apnea, or for that matter, cancer.
Does this mean some people for who their excess weight poses no medical risk will get mislabeled? Sure it does. But there are also many otherwise healthy folks “labeled” as having hypertension, diabetes or even cancer, who will live to a ripe old age – good for them!
I am also the first to celebrate size and shape diversity and readers may recall that I invented the Edmonton Obesity Staging System to deal with the issue of “healthy” obesity.
However for those, struggling with the health consequences of excess weight, if calling obesity a disease gets them better access to treatments – so be it!
Case in point – the American Medical Association‘s declaration of obesity as a chronic disease has been one of the key drivers of policy decisions to include obesity treatment in various care plans across the US.
So before we accuse anyone of discriminating against larger people by calling obesity a “disease”, let’s dare ask the question – who do we harm by refusing to do so?
@DrSharma
Edmonton, AB
Monday, September 21, 2015
The best reason for not calling obesity a disease is that it isn’t one. Rather it’s a symptom. It’s all well and good to treat symptoms to relieve discomfort but mistaking that for having addressed the disease can leave the underlying problem unsolved. Calling obesity a symptom rather than a disease avoids ignoring the underlying problem. It also avoids the discrimination question. My sense of why it was labeled a disease is to get medical systems to deal with it($$). Cart, meet horse.
Monday, September 21, 2015
The distinction between symptom and disease is fluid and a matter of interpretation – heart failure is a symptom (of a failing heart) but is often labeled a disease as it has very specific signs, symptoms and pathology. The same goes for dementia, which is a symptom but is often labeled a disease. It should be noted that there is in fact no “official” or “legal” definition of “disease” – it is nothing more that a thought construct that describes a cluster of (sometimes diverse and unrelated) issues that present in a clinical context. Thus, depression, type 2 diabetes, osteoarthritis or even heart disease are not actually “diseases” as their causes and clinical manifestations can vary. Yet, we diagnose and treat them as “diseases” for want of a better system. Ultimately, the matter of what is a disease or symptom or risk factor is a matter of semantics – what ultimately matters is whether or not people presenting with these “conditions” receive the help they need or not. Quibbling about what we call them is not what matters. So if calling obesity a “disease” gets medical systems to deal with it (rather than ignoring it) – so be it!
Monday, September 21, 2015
Dear Dr. Sharma
I am always interested in what you post. I have worked a few decades in healthcare often with people with severe wt. issues that impact their life. I find it interesting how we as a society view being labeled as obese. Pts. do not get too upset with hypertension, 40 pk yr smoker , OSA on their chart – but as soon as they see obese their defenses go up. I believe that most healthcare workers see obesity as a multifaceted issue but should it be labeled as a disease or is it (for most) just the result of lifestyle or other medical conditions? Are we removing the accountability of the pt. by labeling it a a disease?
Monday, September 21, 2015
What are the financial consequences of being labeled with a chronic disease? For instance, how does the cost of long-term health care insurance in the US change? This may be a case where the presence or absence of single-payer health care makes a big difference to the patient.
Monday, September 21, 2015
This is an important question and to my knowledge is not yet resolved. People with obesity are already being charged more by some plans (even without calling it a disease). My suspicion is that most insurance plans would rather not call obesity a disease to avoid having to pay for treatments.
Thursday, September 24, 2015
To clarify it rightly is of great significance for the public to know better about the condition.
Thursday, September 24, 2015
That’s ridiculous for the doctors who appose calling obesity a disease just because they are not willing to provide related treatment. Shouldn’t they judge that with their professionalism?