OBESITY: SHOULD WE CALL IT A DISEASE?
Summary:
There is now a vast volume of evidence to support the definition of obesity as a disease. Epidemiological research has identified genetic factors, metabolic disturbances, alterations of intestinal hormones and of the gut microbiome, psychological factors and disorders in other body systems that are implicated in the onset and progression of obesity. Subsequently, the relevance of these factors has been confirmed in experimental and clinical trials. However, it must be acknowledged that recognition of obesity as a disease has far-reaching implications from many points of view, and many countries still have to take this step. There continues to be considerable resistance to this classification in some sectors.
What does it mean if we define obesity as a disease?
- It would remove the stigma attached to obesity, reducing the feelings of shame or guilt that some individuals feel…or are made to feel
- It could encourage sufferers to seek help earlier
- The healthcare sector would have to develop guidelines and apply a consensual approach
- Governmental bodies would have to prioritise and adequately fund measures for prevention and treatment
- Changes would need to be made to the education of healthcare professionals and of the public.
On the downside:
- We would label over a quarter of the UK population as having a disease
- We risk promoting fatalism and eliminating the intrinsic motivation to change
- Could the already overloaded primary care system find itself overwhelmed?
In my opinion, despite the downside, we should define obesity as a disease. I have now seen many obese patients in my clinics and have first-hand experience of the physical and psychological effects of obesity and of the huge benefits of treatment. One of the most common reasons patients tell me they have not sought help earlier is that they are ashamed of their situation and feel responsible for it. Most of them have tried many diets before they come to see me, usually diets they can do at home, out of sight, often based on mistaken ideas promulgated on the web by ill-informed and unqualified individuals, or fad diets.
Regarding NHS guidelines, they do exist and they are very helpful. It is their application that is difficult. A report on this subject showed that many NHS area administrations (CCGs) did not consider themselves responsible for treating obesity.
Government departments are subject to intense pressure from lobby groups. The soda drinks and junk food lobbies fought hard against the sugar tax, probably explaining the long delay in its introduction in the UK compared to many other countries. If obesity were labelled a disease in the UK (it is in Scotland, but not England, Wales or N. Ireland), the government would be more likely to dedicate more time and money to its prevention and treatment. Given that obesity costs the country around £28 billion annually, the potential economic benefit is undeniable and frankly it beggars belief that the administration still drags its feet.
And the arguments against. First, what about the stigma of chronic disease. Are we just going to change one stigma for another? Very many chronic diseases exist, and I have not seen patients who feel a stigma for that reason, except when they are made to feel culpable or a burden for having the disease. Second, with any chronic disease, patients usually wish to receive treatment and to participate actively in that treatment. Labelling obesity as a disease could encourage patients to seek help earlier.
The increased workload on the health system is obviously a risk. However, any epidemic needs an intervention, even if the workload is already excessive. We don’t just stop calling flu a disease in order to reduce the workload on doctors; but equally, we cannot keep expecting the same doctors, nurses and other health professionals to manage the ever-increasing workload without increasing their numbers and resources. No, the administration must allocate the resources necessary to cover health needs rationally and fairly. And, as I stated above, a correct solution to this situation will decrease costs in the long term, not increase them. Unfortunately, it will take considerable political courage not only to commit to the short-term increase in the health budget to achieve the long-term gain, but also to face up to the extremely powerful lobby groups from industry that makes vast sums of money from maintaining this obesogenic environment.
In conclusion, anyone seeking help for a weight problem must be given our support, and every effort must be made to provide the best and most suitable treatment in accordance with current guidelines, with a non-judgemental attitude.
