If Obesity Is a Disease, Why Are So Many

Obese People Healthy?

By Abigail C. SaguyJune 24, 2013144 Comments
The decision of the American Medical Association (AMA) to classify obesity as a disease
is great news for the pharmaceutical industry, as it is likely to increase pressure on
the Food and Drug Administration to approve more weight-loss drugs and increase the odds
that insurance companies will reimburse their cost. But it is deeply misleading
Treating obesity as a disease implies that moving into the category of obesity, which for
adults means moving from a body-mass index (BMI) of !" to a BM# of $%, is euivalent to
contracting a disease! But that is simply not the case!
&es, there are certain health risks associated with having an elevated BM#, such as type
! diabetes and heart disease More broadly, a higher BM# is associated with a greater risk
of cardiometabolic abnormalities, as measured by blood pressure, triglycerides,
cholesterol, glucose, insulin resistance and inflammation 'onetheless, almost one
(uarter of )normal weight* people also have metabolic abnormalities, and more than
half of )overweight* and almost one third of )obese* people have normal profiles,
according to a 2008 study That+s ,- million normal-weight Americans who have
metabolic abnormalities and !% million obese (or .- million overweight and obese)
Americans who have no such abnormalities
"ne explanation for this discrepancy is that physical fitness and/or nutrition 0 rather
than weight per se 0 may be what really matters 1everal studies have shown that
physically fit )obese* individuals have lower incidence of heart disease and mortality
from all causes than do sedentary people of )normal* weight A recent clinical
trialpublished in the 'ew 2ngland 3ournal of Medicine showed that adopting
a Mediterranean diet reduced cardiovascular risk independent of weight loss
#ome assume that the problem lies with BM# as a measure, which does not distinguish
between fat, muscle and bone! $hile BMI is indeed a flawed measure, it is not clear that
there are better ones! % 2009 study, using the &ational 'ealth and &utrition (xamination
#urvey, estimated excess deaths for people of standard BMI levels as well as for those with
comparable levels of percentage body fat, waist circumference, hip and arm
circumferences, waist-to-hip ratio, the sum of four s)infold thic)nesses and waist-to-
stature ratio! They found no systematic differences between BMI and other variables! In
other words, it is not *ust that BMI is a poor measure of obesity but that obesity is a poor
predictor of health!
#ome hope that designating obesity as a disease will remove the stigma associated with it,
and obese people will no longer be blamed for their condition! +et already it is being called
the !or" to mouth# disease, and the disease categori,ation may reinforce blame by raising
in
the sta)es! If obesity is a disease, parents of fat children may not merely be silently *udged
as bad parents but also accused of negle$t and $hild endangerment!
If the %M%-s goal is to address the serious diseases of type . diabetes and heart disease, it
would be more productive and accurate for the association to urge doctors to focus on
cardiometabolic ris), recogni,ing that there are both metabolically healthy and
metabolically unhealthy individuals in all categories of weight! /ather than promote
weight loss per se, doctors should instead encourage their patients of all si4es to
incorporate physical activity and a balanced diet into their lives