Birds' Argument

Enduring Arguments About “Medicalizing” Obesity

It’s been eight years since the American Medical Association resolved that obesity is a complex, chronic disease. But still, the argument endures. For different reasons, some people continue to resist what they see as medicalizing obesity. So with the closing session of the YWM2021 convention, it was quite interesting to hear a discussion from two thoughtful people about this resistance – Joe Nadglowski and Arya Sharma. Nadglowski is a patient advocate and CEO of the Obesity Action Coalition. Sharma is a physician, researcher, and founder of Obesity Canada.

Here are five of the arguments we hear frequently and perspectives from the discussion between Nadglowski and Sharma.

BMI Is Bogus

BMI is flawed. But that has nothing to do with whether or not obesity is a disease. That just means if you’re going to call obesity a disease, you need a better definition than body mass index.

This is why the Canadian guidelines have moved away from using BMI. They say you actually have to do a physical exam. You have to run a few blood tests and see if someone’s health is actually being affected.

Adding to Stigma

The opposite is true. Taking obesity seriously can relieve stigma. Often, says Sharma, people break down in clinic and cry with relief upon hearing from him that obesity really is a disease. It’s because they’ve finally found someone who recognizes that they have a real health problem. someone who is taking their problem seriously.

The truth is that the other approach – saying obesity is purely a lifestyle thing – is what is far more stigmatizing. Poo-pooing the whole problem is another approach, saying obesity is not really a problem, you can be healthy at whatever size. That’s basically saying get over it. Those approaches are much more stigmatizing than offering help.

People Will Give Up

The most ridiculous and ignorant argument ever, said Sharma. Cancer is a disease, and that does not lead to people being unconcerned about it. People who have a history of colon cancer get their colonoscopies because they don’t want it coming back. People with a history of heart disease in their family do their best to be as healthy as they can. Because they don’t want to have that disease too.

So again, the exact opposite is true. Understanding obesity as a disease provides a reason to deal with it.

People Can Be Healthy at Every Size

Many ideas of the Health at Every Size movement can be found in Canadian obesity guidelines. The guidelines no longer use BMI as a definition of obesity. Persons can be healthy at many different sizes. Weight should not be sole focus of obesity care.

But if you have a condition caused or complicated by obesity, body weight can be important. Untreated sleep apnea, for example, can kill a person. Weight loss can be quite helpful for some patients. It is not the answer to every problem. But for some problems it is essential for health.

“Medicalizing” Obesity Will Detract from Preventing It

This argument simply makes no sense to Sharma. Cancer is a disease. We put tremendous efforts into preventing it. The same is true for heart disease. Treating heart disease or cancer doesn’t take away from the importance of preventing it. In fact, it adds to the reasons for preventing those diseases. Because people don’t want to go through the ordeal of living with chronic diseases.

A Reflection of Pervasive Bias

When you get right down to it, persistent feelings that “medicalizing” obesity is a problem reflect bias. Those feelings reflect a desire to keep up a pretense that obesity is not a real medical problem. Some people want to fault the people who have the problem. Others want to deny that it’s any kind of problem at all.

But at the end of the day, reality keeps intruding. Obesity harms health and for some the harm is quite profound. This is why the world is moving toward better prevention and care for obesity.

For further perspective on the fear of medicalizing obesity, click here.

Birds’ Argument, photograph © Mathijs van Lisdonk / flickr

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July 26, 2021

4 Responses to “Enduring Arguments About “Medicalizing” Obesity”

  1. July 26, 2021 at 7:30 am, Mary-Jo said:

    Great summary of the very thoughtful, informative presentation by the 2 speakers. It was also so great to hear Dr. Sharma affirm that recognizing obesity for the chronic disease it is, sends the extremely important message to healthcare providers, health policy makers, and health insurance companies that obesity needs long-term treatments and care, certainly not one-off visits, not even 12-week programs.

  2. July 26, 2021 at 2:07 pm, Angela Kae Golden said:

    This sounds like an amazing presentation and I agree with Dr. Sharma 100%. I certainly wish my schedule would have allowed me to attend this years conference – it sounds amazing! Thank you for covering parts of it and sharing an overview of this talk!

  3. July 30, 2021 at 4:02 am, Margaret Steele said:

    It’s a compete false dichotomy to say that we either call obesity a disease or else we blame and shame individuals. Everyone knew pretty much from the start that AIDS is a disease, but that didn’t exactly stop the blame or the stigma, did it?

    There is a third option: We recognise the fact that there is no necessary, universal, or causal link between fat mass and health, and we treat the actual issues, metabolic diseases, cardiovascular diseases, osteoarthritis etc and stop making it about body size. If the disease can’t be defined or diagnosed by BMI or body fat, then why insist on linking it to fatness at all?

    • July 30, 2021 at 4:33 am, Ted said:

      That’s an interesting argument, Margaret, but the dichotomy you are proposing (either call obesity a disease or blame and shame individuals) is not something that Sharma and Nadglowski suggested. A person can indeed live with some excess fat for some time before it causes other diseases and premature death. Likewise, a person can live with hypertension, cardiac arrhythmias, or a tumor mass before it harms or kills them. But that does not mean that those are not medical problems. The false dichotomy in this circumstance is the choice between either ignoring a medical problem or accepting stigma. Neither of those options are good.