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March 27, 2015

Did calling obesity a 'disease' make the problem worse?

Daily Briefing

    Nearly two years ago, the American Medical Association (AMA) officially recognized obesity as a disease—and researchers suggest the well-meaning decision has backfired by causing some obese people to be less motivated to lose weight.

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    A history of obesity

    The AMA's decision to recognize obesity as a disease follows decades of Americans' focus on weight-loss, Harriet Brown writes in the Atlantic. In the 1920s, physicians prescribed thyroid medications to healthy individuals to make them lose weight; in the 1930s, the weight-loss chemical 2,4-dinitrophenol (DNP) was introduced. And in 1942, Metropolitan Life Insurance Company in 1942 created "desirable" height and weight charts for its beneficiaries. Brown writes that was the first time individuals (and their physicians) had a marker for what they "should" weigh and could compare themselves to one another.

    The new metrics helped shape opinion that only doctors should diagnose and treat weight problems. Physicians even created a new terminology—including words like adipose, overweight, and obese—to describe individuals with such issues. "Medical professionals intentionally made a case that fatness was a medical problem, and therefore the people best equipped to intervene and express opinions about it were people with M.D.s," says Abigail Saguy, a sociologist at the University of California-Los Angeles.

    Obesity increasingly became a societal stigma during this era. For example, physician Paul Craig wrote in 1955 that "No one loves a fat girl except possibly a fat boy, and together they waddle through life with a roly-poly family," commenting on a 1907 obesity study.

    Obesity named a disease

    Nearly 60 years later, the AMA's internal vote on Resolution 420—which officially recognized obesity as a disease—was contentious.

    The committee noted that obesity did not fit the definition of a medical disease because it does not have symptoms, is not always harmful, and does not always involve the body's normal processes malfunctioning.

    On the other hand, physicians wanted to recognize the growing burden of obesity in health care; the disease is linked with a slew of illnesses, from diabetes to heart attacks. James Hill, the director of the Anschutz Health and Wellness Center at the University of Colorado, also says the decision was made in order to standardize coding and reimbursement protocols for physicians delivering weight-loss treatments to patients.

    However, some physicians feared that making obesity a "disease" would deflect blame from personal responsibility and could harm efforts to curb the problem. And a new study in Psychological Science suggests that those concerns may be right, Peter Ubel writes in Forbes.

    The researchers tested how different messages about obesity changed individual behavior. "The term disease suggests that bodies, physiology, and genes are malfunctioning," the researchers wrote. "By invoking physiological explanations for obesity, the disease label encourages the perception that weight is unchangeable."

    Ubel notes that when obese people in the study were exposed to the message that obesity was a "disease," they became less concerned about their weight and even made worse health decisions, like choosing less nutritious meals when presented with a range of options.

    "We are walking a psychological tight rope here," Ubel writes. The "better we succeed in convincing people that obesity is a disease, the less motivated obese people will be to fight back against [the] social and physiologic forces" that contribute to weight gain (Brown, The Atlantic, 3/24; Ubel, Forbes, 3/27).

    The takeaway: It has been almost two years since the American Medical Association named obesity as a disease, which has changed the way we treat it—and possibly harmed the way that obese people approach weight loss.

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