Obesity
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Is Obesity a Disease?
obesity
The United States is the second most obese industrialized country in the world. [52] A 2013 report stated that 31.8% of Americans were obese, compared to 14% in the mid-1970s. [54] [52] Obesity accounts for 10% of deaths and healthcare spending in the United States. [2]

Proponents contend that obesity is a disease because it meets the definition of disease; it decreases life expectancy and impairs the normal functioning of the body; and it can be caused by genetic factors.

Opponents contend that obesity is not a disease because it is a preventable risk factor for other diseases; is the result of eating too much; and is caused by exercising too little. Read more...

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Obesity ProCon.org is a nonpartisan, nonprofit website that presents research, studies, and pro and con statements on questions related to whether or not obesity is a disease.
Did You Know?
  1. In 2013 the United States was the second most obese industrialized nation with 31.8% of Americans falling into the obese category. Mexico was first at 32.8%. [52]

  2. In Nov. 2013, the US Surgeon General reported an estimated 300,000 deaths per year may be attributed to obesity. [36] Obesity was the third leading cause of death in 2009, after high blood pressure and smoking. [2]

  3. Men burned 142 fewer calories daily and weighed 32.8 pounds more in 2003-2006 than in 1960-1962, while women burned 124 fewer calories daily and weighed 25.13 pounds more in 2003-2006 than in 1960-1962. [18]

  4. Obesity and obesity-related health conditions cost an estimated 10% of annual medical spending in the United States, totaling $147 billion in 2008. [22]

  5. In 1994 all US states had obesity rates at 19% or lower. By 2010, no state reported an obesity rate under 19%. By 2013, 11 states had obesity rates over 30%. [32]
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Pro & Con Arguments: "Is obesity a disease?"
PRO Obesity Is a Disease


  1. Obesity meets the definition of disease. The American Medical Association's 2013 "Council on Science and Public Health Report" identified three criteria to define disease: 1. "an impairment of the normal functioning of some aspect of the body;" 2. "characteristic signs and symptoms;" and 3. "harm or morbidity." [19] Obesity causes impairment, has characteristic signs and symptoms, and increases harm and morbidity. Scott Kahan, MD, MPH, Director of the National Center for Weight and Wellsness and Preventative Medicine Physician at Johns Hopkins University, stated obesity "satisfies all the definitions and criteria of what a disease and medical condition is... The one difference is that people who have obesity have to wear their disease on the outside." [26]


  2. Obesity, like other diseases, impairs the normal functioning of the body. People who are obese have excess adipose (or fat) tissue that causes the overproduction of leptin (a molecule that regulates food intake and energy expenditure) and other food intake and energy mediators in the body, which leads to abnormal regulation of food intake and energy expenditure. [35] Obesity can impair normal mobility and range of motion in knees and hips, and obese patients make up 33% of all joint replacement operations. [48] Obesity is also linked to reproductive impairment, contributing to sexual dysfunction in both sexes, infertility and risk of miscarriage in women, and lower sperm counts in men. [48]


  3. Obesity decreases a person's life expectancy and can cause death, like other diseases. Obesity in adults can lead to three years' loss of life. Extreme obesity can shorten a person's life span by 10 years. [4] The Surgeon General reports an estimated 300,000 deaths per year may be attributed to obesity. [36] People who are obese have a 50-100% increased risk of death from all causes. [36]


  4. Obesity can be a genetic disorder such as sickle-cell anemia and Tay-Sachs, which are classified as diseases. Studies have shown that obesity can be inherited like height. [5] [6] Genetic disposition plays a large role in determining if a person will be obese. [5] [6] A May 2014 study published in the Journal of Molecular Psychology linked higher rates of obesity to the "fat mass and obesity association" (FTO) gene. [56] The FTO gene reportedly lowers activity in the part of the brain that "controls impulses and the response to the taste and texture of food," so people with the gene are more likely to eat more fatty foods and eat more impulsively as they age. [56] A 1990 study published in the New England Journal of Medicine on body mass in twins not raised in the same home concluded, "genetic influences on body-mass index are substantial, whereas the childhood environment has little or no influence." [38] In addition to genetic predisposition, almost 10% of morbidly obese people have defects in the genes that regulate food intake, metabolism, and weight. [37]


  5. Government entities and major medical groups recognize obesity as a disease. The Food and Drug Administration (FDA), the American Heart Association, the American College of Cardiology, and the Obesity Society, the National Heart, Lung, and Blood Institute (NHLBI), and the American College of Gastroenterology (ACG) have identified obesity as a disease. [50] [46] [47] Even the Internal Revenue Service (IRS) recognizes obesity as a disease so weight loss expenses may be counted as a medical deduction from taxes. [49] On June 18, 2013, the American Medical Association recognized obesity as "a disease requiring a range of medical interventions to advance obesity treatment and prevention." [39]


  6. Physicians from as early as the 17th century have referenced obesity as a disease. English physician Thomas Sydenham (1624-1689) wrote, "Corpulency [obesity] may be ranked amongst the diseases arising from original imperfections in the functions of some of the organs." [9] William Wadd, a 19th century British surgeon and medical author, wrote, "when in excess--amounting to what may be termed OBESITY--[fat] is not only in itself a disease, but may be the cause of many fatal effects, particularly in acute disorders." [9] In the Feb. 12, 1825 issue of The Medical Advisor and Guide to Health and Long Life, Robert Thomas, a 19th century doctor, wrote "Corpulence, when it arrives at a certain height, becomes an absolute disease." [34]
CON Obesity Is a Disease


  1. Obesity is a preventable risk factor for other diseases and conditions, and is not a disease itself. Like smoking is a preventable risk factor for lung cancer and drinking is a preventable risk factor for alcoholism, obesity is a preventable risk factor for coronary heart disease, stroke, high blood pressure, type 2 diabetes, cancers (like endometrial, breast, and colon), high cholesterol, high levels of triglycerides, liver and gallbladder disease, incontinence, increased surgical risk, sleep apnea, respiratory problems (like asthma), osteoarthritis, infertility and other reproductive complications, complications during pregnancy and birth defects, and mental health conditions. [42] [36] Women who gain 20 pounds or more between age 20 and midlife double their risk of postmenopausal breast cancer. [36] For every 2 pound weight increase, the risk of developing arthritis rises 9-13%. [36]



  2. Obesity is a side effect, not a disease. Obesity can be caused by hypothyroidism, Cushing's syndrome, Prader-Willi syndrome, polycystic ovary syndrome, arthritis, increased insulin levels (from carbohydrate-heavy diets or diabetes treatments) and depression. [17] [55] Certain drugs like antidepressants, anti-seizure medications, diabetes medications, anti-psychotic medications, antihistamines, anticonvulsants, steroids, beta blockers, and contraceptives can cause obesity. [17] [16] Obesity can also be caused by lack of sleep (or sleep debt), ingesting endocrine disrupters (such as BPA, DDT, and phthalates), consuming high-fructose corn syrup, a lack of temperature variation (due to air conditioners and heaters), and quitting smoking. [16] [15]


  3. Many obese people live long, healthy lives. A 2013 Lancet article noted that as many as one third of obese people are "healthy obese," meaning that despite being significantly overweight they have normal cholesterol and blood pressure levels, and no sign of diabetes. [41] Obese people tend to go to the doctor more and have regular checks for other risk factors and diseases. [40] Many people with a BMI (Body Mass Index; a measure of body fat based on height and weight) in the obesity range are not physically impaired and live normal lives. BMI does not take into account the overall health of the individual and can identify fit, muscular people as obese because muscle weighs more than fat. [40] [41]


  4. Obesity is the result of eating too much. The suggested daily caloric intake for 31-50-year-olds is 1,800 calories for women and 2,200 calories for men. [7] In 2009-2010, 30-39-year-old women consumed an average 1,831 calories (which is 1.7% over the recommendation) while men of the same age consumed an average 2,736 calories per day (which is 22% over the recommendation). [3] The average American restaurant meal portion size is four times as large as portions in the 1950s and 96% of entrees at chain restaurants exceed dietary guidelines for fat, sodium, and saturated fat, with some almost exceeding daily intakes in one meal. [44] [45] The body is doing what it has evolved to do by converting excess calories into fat cells. The CDC recommends reducing consumption of sugar drinks (like sodas) and high-energy-dense foods to prevent and reduce obesity. [42] The Mayo Clinic states, "Having a diet that's high in calories, eating fast food, skipping breakfast, eating most of your calories at night, drinking high-calorie beverages and eating oversized portions all contribute to weight gain." [43]


  5. Obesity is the result of sedentary lifestyles. Compared to 40 years ago, people today spend more time commuting, sitting in front of a computer, watching television, playing video games, and generally exercising less. [10] In 1960 50% of jobs required moderate physical activity compared to just 20% of jobs in 2011; the other 80% in 2011 required little or no physical activity. [18] This shift represents 120-140 fewer calories burned per day, which closely aligns with the nation's overall weight gain trends. [18] Men expended 142 fewer calories daily and weighed 32.8 pounds more in 2003-2006 than in 1960-1962, while women expended 124 fewer calories daily and weighed 25.13 pounds more in 2003-2006 than in 1960-1962. [18]

Comment Comment
Background: "Is obesity a disease?"

Maps of obesity in America
(Click to enlarge image)

Maps showing the prevalence of obesity across all 50 US states in 1998 and 2008.
Source: "Battle of the Bulge," www.economist.com, July 13, 2009
The United States is the second most obese industrialized country in the world. [52] A 2013 report stated that 31.8% of Americans were obese, compared to 14% in the mid-1970s. [54] [52] Obesity accounts for 10% of deaths and healthcare spending in the United States. [2]

Proponents contend that obesity is a disease because it meets the definition of disease; it decreases life expectancy and impairs the normal functioning of the body; and it can be caused by genetic factors.

Opponents contend that obesity is not a disease because it is a preventable risk factor for other diseases; is the result of eating too much; and is caused by exercising too little.

How Obesity Is Measured

People are usually identified as obese, which is defined as "having an excessive amount of body fat,” based on their Body Mass Index (BMI). [14] BMI is calculated by taking a person's weight divided by the square of his or her height (kg/m2). The "normal" BMI range is between 18.5 and 24.9, while "overweight” is 25-29.9 and "obese” is 30 and above. For example, a person who is 5'5" tall and 180 lbs. (BMI of 30) and a person who is 6'0" tall and 221 lbs. (BMI of 30) are considered obese by the BMI measurement. Some people, such as muscle-heavy athletes, may have "overweight” or "obese” BMIs but may not have excess body fat. [1]


Obesity as an "Epidemic”

The Centers for Disease Control and Prevention (CDC) reported an "epidemic" of 72 million obese people in the United States in 2005-2006 [21] According to a 2011-2012 study published in JAMA, 34.9% of American adults and 17% of youth are obese. [13] The study indicated there were no significant changes in obesity rates from 2003-2004 to 2011-2012. [13] According to the CDC, "Non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic whites (32.6%), and non-Hispanic Asians (10.8%).”[12] Obesity is highest in adults who are 40-59 years old (39.5%). [12]

In the mid-1970s the obesity rate for the United States was about 14%. [54] 1994 is the first year with CDC data for all states and shows all states at obesity rates of 19% or lower. [12] By 1997, three states were in the 20-24% range: Indiana, Kentucky, and Missouri.[12] In 2001, Missouri became the first state to have an obesity rate between 25-29%. [12] By 2005, 14 states were in the 25-29% range while three states breached the 30% and higher rate (Louisiana, Missouri, and West Virginia). [12] By 2010, no state reported an obesity rate under 19%. [12]

highest and lowest 2013 state obesity rates
(Click to enlarge image)

Infographic with the lowest and highest 2013 US state obesity rates.

Obesity rates continued to increase in the United States each year since 2008, growing from 25.5% in 2008 to 27.1% in 2013. [32] 11 states had obesity rates over 30% in 2013: Alaska (30.1%), Arkansas (32.3%), Delaware (34.3%), Kentucky (30.6%), Louisiana (32.7%), Mississippi (35.4%), Ohio (30.9%), Oklahoma (30.5%), South Carolina (31.4%), Tennessee (31.3%), and West Virginia (34.4%). [32] Montana had the lowest obesity rate at 19.6%. [32] The poll data show that the 10 most obese states had the highest rates of high blood pressure (35.8%), high cholesterol (28.2%), depression (20.7%), diabetes (14.3%), cancer (7.8%), and heart attacks (5.0%). [32] The data also show that the 10 least obese states reported higher rates of healthy eating, eating five or more servings of fruits and vegetables at least four days a week, and exercising for 30 minutes or more on at least three days a week. [32]

A 2009 study published in PLOS Medicine found obesity was the cause of 1 in 10 deaths in the United States. [2] Obesity was the third-leading cause of death in men and women, after high blood pressure and smoking. [2] Obesity and obesity-related health conditions cost an estimated 10% of annual medical spending in the United States, totaling $147 billion in 2008. [22]

The United Nations’ "The State of Food and Agriculture 2013” report found that Mexico was the most obese populous country with 32.8% of Mexicans falling into the obese category compared to 31.8% of Americans in the second-place United States. [51] [52] The Republic of Nauru had the highest obesity percentage (71.1%) but, with a population of 9,488 in July 2014, was not considered a "populous country” by the study. [52] [53]

According to the World Health Organization (WHO) 2013 Fact Sheet "Obesity and Overweight,” obesity rates worldwide have almost doubled since 1980, accounting for over 200 million men and almost 300 million women. [11] Combined, overweight and obesity cause at least 2.8 million deaths annually and are the fifth leading risk for death globally. [11] 65% of the global population lives in countries where being overweight or obese causes more deaths than being underweight, making 2012 the first time overweight and obesity caused more deaths than malnutrition. [11]

Obesity and obesity-related health conditions cost almost ten percent of annual medical spending in the United States, totaling $147 billion in 2008. [22] In Apr. 2014 Duke Global Health Institute and Duke-NUS Graduate Medical School researchers found the lifetime medical costs for obese 10-year-olds alone will be $14 billion. [51]

Health risks associated with obesity
(Click to enlarge image)

Illustration of the health risks associated
with obesity.

Source: "Obesity and Health,"
www.nlm.nih.gov, July 25, 2007

Public Opinion and Medical Perspectives on Obesity

The FDA, the American Medical Association (AMA), the National Institutes of Health (NIH), American Heart Association, American College of Cardiology, and the Obesity Society have stated that obesity is a disease. [27] [10] [47] The WHO called obesity a "chronic disease" in 2000. [29] The IRS announced a policy in 2002 stating that "obesity is medically accepted to be a disease in its own right" and allows Americans who are medically diagnosed as obese to claim tax deductions for doctor prescribed treatments.[20] In Sep. 1998 the National Institutes of Health's National Heart, Lung, and Blood Institute wrote, "Obesity is a complex multifactorial chronic disease." [28] The American College of Gastroenterology, in 2008, stated that obesity is a "chronic, debilitating and potentially fatal disease." [30] In 2013 the American Academy of Family Physicians (AAFP) stated, "Overweight and obesity are chronic diseases with behavioral origins that can be traced back to childhood.” [8]

In the health care bill H.R. 3962, "Affordable Health Care for America Act” approved by the House of Representatives on Oct. 29, 2009 (but later abandoned in favor of the Patient Protection and Affordable Care Act; also called the PPACA or Obamacare), being overweight or obese was not classified as a disease but as a "behavioral risk factor" along with alcohol and drug use, tobacco, poor nutrition, physical inactivity, untreated mental health problems, and risky sexual behavior. [25]

The American Academy of Pediatrics (AAP), American College of Physicians (ACP), Centers for Medicare and Medicaid Services (CMS), and American Nurses Association (ANA) do not have policy statements stating whether or not obesity is a disease, as of Apr. 18, 2014.

Video Gallery

not clearly pro or conDiscovery News explores the pros and cons of calling obesity a disease.
Source: DNews, "Should Obesity Be a Disease?," www.youtube.com, June 21, 2013
not clearly pro or conKaren Chang discusses the pros and cons of the AMA decision to call obesity a disease.
Source: NTDTV, "AMA: Obesity Is a Disease--Officially," www.youtube.com, June 19, 2013


proDr. Nissin Nahmias explains the pros of calling obesity a disease.
Source: Nissin Nahmias, "Obesity Considered a Disease Dr. Nahmias at NBC," www.youtube.com, June 30, 2013
conLarry Mendte explains the cons of the AMA decision to call obesity a disease.
Source: Larry Mendte, "What Fathead Made Obesity a Disease?--Larry Mendte," www.youtube.com, July 28, 2013
 
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