Is Obesity a Disease? Unpacking the Debate

Music.

And welcome to Change Your Relationship with Food, the podcast hosted by me, Kyla Holley. With many years experience as an eating disorder and bariatric therapist, I know exactly what it takes to help you break free from your diet history and develop a more healthy relationship with food. Please follow this podcast to make sure you don't miss a thing. Just a quick word before we start. I'm very excited to tell you that we are a nominee in the Women in Podcasting Awards.

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Thanks so much. Let's get on with the show today.

Last week, I attended a conference down in Melbourne, a very big conference. It was an international affair with people coming from, I think they said 73 different countries to attend. There were about 2,000 people there, huge conference, and one of the really interesting sessions that I attended, ran for about an hour and a half, and there were a whole group of academics debating a particular question. And that question was, is obesity a disease?

Now, even me saying the word obesity is going to get some people out there clutching their pearls, because in a lot of communities, the word obesity is very, very frowned upon. Some people actually won't even write the word down. Sometimes when you see it written, there's the letter O and then a series of asterisks afterwards, so that you have to work out what the word was. And of course, we all know what the word was. I fall into the camp, I suppose, of thinking it's just a word.

You know, what other word do we use that people love? I don't know. I know the word fat actually has been kind of reclaimed, if you like, by fat activists, just like the word queer has been reclaimed by the gay community.

This idea that you can say the word fat and it's not considered to be derogatory is kind of interesting because a lot of people that I do speak to when I use the word fat you can see that sharp intake of breath where they go oh dear should she be saying that so you know it's very divisive the word we use at the end of the day it's just semantics I'm really not fussed about the word.

Whether we use obese, whether we use fat, whether we say excess adiposity, which is another thing people use, at the end of the day, we all know what we're talking about. My belief is... That basically any of these words are okay. It really just depends what judgment we attach to it. If it's just a word and we just use it to explain how someone's body might look and we don't attach any judgment to that, any stigma, any relevance, then it's my belief that it's just a word.

But hey, you might feel differently and that's absolutely okay because we're adults. We can disagree and and not have to fall out over it.

Anyhow, let me get back to the subject. This debate, an hour and a half long, was on, is obesity a disease? And it was kind of interesting because a few interesting points came up. But as I walked out of the room, I turned to a colleague that was with me, and I said, so basically, we don't know, do we? They spent an hour and a half debating this subject and never actually really came to any decisions.

The interesting points that came up though and I'm trying to divide today's podcast into sort of for and against but it is confusing so I might jump around a little bit. So the general consensus I think because it was basically medical professionals there and mostly surgeons and mostly bariatric surgeons so obviously there There was a bit of bias as to maybe how the medical profession would view this. But the general bias was that obesity is a disease. That was generally what people were saying.

There is an argument against it that sort of says not everybody that is in a larger body has health issues. So in other words, you can be in that larger body and be healthy. And one of the counter arguments that one of the doctors gave was. You know, how we define obesity and how we define healthy, I suppose, because his argument was that if you are in a larger body and you are stating that you are healthy, you have no health issues relating to that.

His argument was that you still, if you're carrying extra weight, then the extra weight takes the form of internal fat, which will increase pressure in the abdomen. He also argued that that additional pressure could cause obstruction of airways. It could also increase intracranial pressure. And also that extra pressure in the abdomen can lead to things like reflux and perhaps sleep apnea as well.

So even though people are saying that they're healthy, they don't have things like the chronic diseases that you might link to that higher weight, which might be something like diabetes or high cholesterol or hypertension. Because someone doesn't have any of those things. His argument was that they're not necessarily healthy because the simple act of carrying that extra weight increases these pressures and leads to problems.

He also mentions, obviously, the pressure on weight-bearing joints and joint mobility, which can lead to neuropathy and reduced lung function and insomnia. So these are all things that people might not really realize are going on and might perceive themselves to be healthy, despite the fact that this is all happening in their body. He also argued that ectopic fat is more dangerous than visceral fat. So visceral fat is the fat that sits around our organs.

If you ever look at a video of surgery, you'll see all this sort of yellow mass, and that's the visceral fat. that. Ectopic fat, though, is fat which appears somewhere where it shouldn't really appear. So generally, from this perspective, it's places like the organs. So in your heart, in your liver, in your pancreas. This fat is more dangerous than visceral fat, he argues. And this is something you might not actually know that you've got.

He concluded his argument by saying, if you are fat and healthy, unhealthy should treatment still be offered to you to preserve that health so in other words to stop you declining into a place where you become unhealthy should we intervene at that point with people that are fat and healthy to make sure that they don't become otherwise which is kind of an interesting point as well the other side of the argument of course would point out that there are

people out there that have long-standing health conditions that are completely unrelated, to weight because they're not carrying what would be perceived as extra weight. So for instance, there are people out there who are very lean who have high cholesterol. There are people out there who are very lean who have hypertension, for instance. So we can't see our health necessarily.

And to connect obesity to being a disease in itself when there are actually no symptoms of a disease that run alongside it, is that fair just to classify someone purely on their weight? And also, how do we define somebody's weight and say that puts them into the obese category? Well, of course, that is done from via the medical model. That is done on the BMI scale. But the BMI scale does not take into account how much fat is involved in that equation.

So someone can have a high BMI and it all be due to muscle, not due to fat at all.

So again would we classify somebody who was very large very muscular someone like a rugby player who would officially be in a high BMI category and classified as obese does that person have a disease if they're running around a rugby field a few times a week and they're full of muscle would we say hey you have a disease you are obese well of course we wouldn't and likewise do we let somebody sort of escape from that diagnosis of disease because of the fact that they're in a lean body.

Well, again, is that fair as well?

One interesting thing that I've actually written down and I wrote it in capitals while I was watching this presentation, so obviously it really resonated with me at the time, is diet and exercise is prevention, not treatment. And that's something thing I really loved because anybody who's listened to any episodes of this will know I'm very anti-diet. I'm not anti-weight loss, but I am anti-diet. And I thought that was a lovely sentence. Diet and exercise is prevention.

It's not treatment. So in other words, if you've got to the stage where you are in a larger body, you are carrying lots of extra adipose tissue, you, then diet and exercise is not treatment. So you can't diet and exercise yourself out of that condition on a permanent basis. So most health organizations have actually officially declared obesity to be a disease, but experts still disagree because weight isn't always an accurate indication of health.

So let's look at sort of the arguments to and fro, shall we? So some people argue that larger bodies can actually be normal. They point out that disease actually means the body is functioning abnormally, but a larger body size may actually be normal for someone, and that fat accumulation can be a normal change in response to the environment, and that given these changes are natural and sometimes even protective then they argue that obesity is not a disease.

But most experts still acknowledge that excess body fat can actually prove to be a health risk. But they think that obesity may be more accurately defined as a risk factor rather than a disease, similar to the way that age is actually a risk factor. So no one considers that getting older is a disease, but it is actually a risk factor for certain medical conditions. And it's actually a natural process that all of us go through and we don't classify that as a disease.

So regardless of whether we do actually define obesity as a disease or not, let's look at some of the pros and cons if we did. So let's say it's a given, we've defined obesity as a disease. What would be the good aspects? What good could come with that? Well, a lot of people say if we did that, it would actually legitimize the increase for funding and research into that area, which could help us advance an understanding of it a little more.

I mean, I suppose you've got to backtrack and say, well, OK, but where would that money come from? Because money just doesn't arrive from nowhere as soon as we classify something as a disease, obviously.

Also, people say that one of the pros would be public awareness, that there'd be more attention to the potential health risks associated with weight, and also a decline in public perception that obesity is a result of lifestyle choice, that somehow an individual chooses to gain weight or it's an individual's responsibility. If it was recognized as a disease, would that remove that personal responsibility?

And also, would the amount of research going into it, if it was a disease, actually provide us with better answers that would be more widely understood? And people would stop this sort of eat less and exercise more argument that's often leveled at people who are carrying extra weight or who are in a larger body.

So also access to care. So imagine if obesity is defined as a disease, does that mean there'll be more treatment options that people will receive more care for the condition that their body is in rather than just being sent off to fix it by going on a diet? Because at the moment, that's the approach. If I go to my doctor and I say, hey, I'm carrying all this extra weight, The doctor almost says, well, it's your fault, go away and fix it.

Whereas if it was recognised as a disease, would the doctor take it more seriously and offer us more treatment options and actually be more empathetic and understanding in that situation? And also insurance cover. So this probably matters more in the US than it does here. But if something was a disease, would it be covered under insurance, medical insurance?

But I would imagine the medical insurer was very reluctant for it to be called a disease because again, imagine the costs and those costs would be shared with everybody indirectly, of course. So let's look at the cons. So, a lot of people say that this would actually increase weight stigma. If we said that obesity was a disease, would it actually make people act or react negatively towards people in larger bodies? Would that stigma increase? And I suppose there's arguments for and against,

isn't there? I mean, would you like to be told you have a disease if you're in a larger body? For some people, a diagnosis like that might actually be quite freeing. And for other people, it would feel very pathologizing and they don't want their bodies talked about in that way. There's also an argument that weight bias discourages people from seeking medical evaluation. If you're told you're going to have a disease, do you actually want to present

for medical assessment to be told that? A lot of people wouldn't be.

A lot of people are also scared about overtreatment. treatment so people who believe that yes they're in a larger body but they're actually feeling pretty healthy and they believe that actually health isn't an issue for them they don't want to be given medications they don't want to be given surgeries and they feel perhaps that that would be forced upon them if they were categorized as having a disease that they would be forced to have a treatment.

And also, a lot of people say that by defining obesity as a disease, there would be increased costs associated with unnecessary testing and treatment, which would, of course, be passed on to all of us. It would increase everybody's insurance premiums, everybody's tax bill, perhaps, because we are trying to sort out this issue, which has then been defined as a disease.

Disease. So regardless of the truth behind this, regardless of whether it is a disease or it isn't a disease or what would happen if it was classified this way, at the moment it's up to you to advocate for yourself. If you are in a larger body, it's up to you. So here are some tips that can make your next healthcare visit a more positive, supportive experience for you. And the first thing to do is to find the right provider for you.

So you deserve to have a provider that listens to you and develops an individual approach to your health, not just a blanket response. Don't be afraid to switch providers if you don't feel safe and supported with somebody. You do not need to be weighed. If being weighed feels stressful or traumatic to you, you can tell the staff that you would prefer not to be weighed.

And if they argue that it's absolutely necessary to weigh you, you can ask to provide a weight that you took at home, or you can ask to turn around on the scale and not be told that number. You can also lead the discussion. Tell the provider that you prefer your weight not to be addressed as a medical problem during your appointment. Or if you do have concerns about your weight, don't be afraid to be honest and lead the conversation.

It's It's especially important if you feel that your weight is affecting your mental health. And also provide feedback. If you experience a weight bias or stigma at any point during your healthcare visit, don't be afraid to speak up to your provider. More and more providers are making an effort to address this problem in their clinics. And this will help you get the care that you deserve. And it also might help others in a similar position.

So as I said earlier, probably the best answer is, I don't know. I left that debate after an hour and a half, not being any the wiser, but having picked up a few things to think about.

And that's all I wanted to really communicate in this podcast. I don't have the answers to this. I don't know if obesity is a disease. I don't know what effect it would actually have in our day-to-day lives if it was classified in that way. But what I do know is we should ask ourselves questions rather than make assumptions about this. And there's so many assumptions made about weight. There's assumptions about how somebody got to a particular weight.

There's assumptions about what somebody should do if they are at a particular weight, both fat and thin. And I think, you know, when judgment comes on board and we're dealing with other people's opinions, as well as trying to deal with our own sort of thoughts of self and how our bodies connect to our minds, it can all get super confusing for everybody. body.

It would be lovely to live in a world where we just respected that bodies come in all shapes and sizes and abilities and colors, and we didn't really see those differences. We just looked beyond that and saw the person that was living in that body. Wouldn't that be amazing? But unfortunately, it's not the world we live in, so we just have to do the very best we can.

So hopefully today has given you a little bit to think about as far as how we classify our health and how we classify our body and whether they are actually two separate things or whether they're one and the same. Thank you so much for your company today. I would also love it if you could follow this podcast. It really does mean a lot to me. Also, we have a six-week online Change Your Relationship with Food course that you can take.

Just visit www.acfeb.com and click on the ACFEB and me courses link. There's also a journal and a workbook available on Amazon and you'll find that link in our bio. I really hope you can join me again next week. Goodbye. Music.