Yesterday, the American Medical Association officially designated obesity as a disease — one requiring prevention and medical treatment. Although the AMA has no policy-making authority, it is hugely influential in shaping attitudes within the medical community, and the public at large — which means that its decision will change the conversation on fat for us all, not just the one-third of American adults who are defined as obese.
Spokespeople for the AMA say its decision will help physicians counsel obese patients, and encourage insurance companies to reimburse for obesity drugs and surgery. The decision goes against the AMA's own Council on Science and Public Health, which last year issued a study stating that obesity should not be considered a disease — mainly because the measure used to define obesity, the body mass index, is overly simplistic and flawed. And this is where the issue starts to get sticky for us.
Here's the thing: The BMI, a simple height-to-weight ratio, is not a reliable indicator of body composition. If you're large-framed, or especially muscular, your BMI will likely place you in the "overweight" range, even if you do not have excess fat. More importantly: Who says there's anything wrong with excess fat?
If you've ever stood at the finish line of a marathon, then you know that fitness comes in all sizes. Fat people can be both physically fit and metabolically healthy, with good blood pressure, cholesterol, resting heart rates, etc. — you know, all those markers that truly indicate health. That model-skinny girl on the cigarettes-and-Organic Avenue diet? Yeah, probably not so much.
When you look at a fat person or a skinny person, you can't truly know anything about their health — only their size. And that's why there's a major problem with classifying obesity as an illness. At best, it's incredibly lazy medicine to use a common co-factor of disease (obesity) as an indicator of disease itself. At worst, this decision stigmatizes a group of people who already suffer discrimination from society at large — and, yep, their doctors, too.
Despite years of conditioning that make us equate obesity with sloth, lack of will power, or ill health, we need to get a few things straight: Obesity is, simply, the condition of having lots of adipose tissue. Why that fat is there, and how it affects a person's health, is the result of an incredibly complex web of factors that includes fitness, genetics, amount and type of food intake. In fact, new research indicates that obesity may be far more affected by the types of foods we eat (i.e., insulin-producing refined carbs), than by the amount we eat or exercise. With so many factors in play, it makes no sense to stick obese people with a blanket diagnosis that does nothing to address their personal medical issues, or lack thereof.
The bottom line is, it doesn't help anyone to further medicalize and demonize fat. We need to work to erase medical and societal discrimination against the obese, and emphasize healthy lifestyle habits for everyone, instead of the quick fix of surgery and pills. We think this decision is a pretty major step back on both fronts.