The great debate: Is obesity really a disease?

London, 2018. A group of experts attend a council meeting of the Royal College of Physicians (RCP) to discuss whether or not obesity should be recognised as a disease. Dr. Andrew Goddard is listening carefully. He should be. Only a few months before he was elected the 121^st president of the RCP – the youngest for 400 years.

For him, this meeting is not a word game. It’s a serious matter that will change how people see and treat obesity. In the end, their votes are united – obesity is a disease. A chronic yet manageable disease that’s affected not only by our genes, but also by the modern environment we live in.

“It is important to the health of the nation that we remove the stigma associated with obesity. It is not a lifestyle choice caused by individual greed, but a disease caused by health inequalities, genetic influences and social factors,” says Dr Andrew Goddard³.

Dr. Andrew Goddard’s team is not the first to sit down and discuss obesity. Around the world, similar expert working groups have arrived at the same conclusion that often provokes heated debates in the media. Obesity is still widely thought of as a simple matter of lifestyle – of how much you eat and how little you move. Of energy in and energy out. Simple, right? But not correct according to the science.

In order to understand why, let’s start with a short thought experiment.

Imagine a disease that:

• Puts people at a high risk of developing or worsening other serious health conditions such as cardiovascular disease, type 2 diabetes, increased blood pressure, high cholesterol, obstructive sleep apnoea, certain types of cancer, anxiety and depression.
• Changes the way the body responds to treatments. What worked before doesn’t work anymore.
• Is constantly made stronger by our everyday environment.
• Affects people for life.

But people living with the disease rarely seek professional medical help because they believe that they need to deal with it all on their own.

Now, wouldn’t you consider the disease to be a serious medical problem?

This disease is neither imaginary nor invisible. It exists and it’s called obesity. People living with obesity are reminded of it every day – in public transportation, clothing stores, parks, or even while eating dinner with the ones they love. But size is the least important aspect of obesity. The important aspects are the ones you can’t see.

The good news is that obesity is a manageable disease and people who live with it can still improve their health and wellbeing. In fact, a weight loss of only five percent is enough to lower the risk of some weight-related health complications, like high blood pressure.

But weight management has no quick fixes. To lose weight and keep it off, people with obesity need proper ongoing treatment and care. This is why it is important to recognise obesity as a disease and to treat it using the latest scientific advancements.

Although many people have obesity in common, they need individual treatment plans. We all have different genes, health, life histories, personalities, and environments. And we aren’t all motivated by the same goals. A personalised treatment plan will probably require a combination of different treatment options to meet an individual’s needs.

More and more healthcare providers recognise the complexity of obesity and are learning how to help. Their toolbox of treatment options is also growing and is constantly being updated. Today it includes behavioural therapy, meal replacements and low energy diets, anti-obesity medications and bariatric surgery. They also look beyond just what you eat and how much you move. Modern obesity management involves understanding individual eating patterns (how, when and why you eat) as well as patterns of mood, sleep, stress and physical activity.