Reader Question – What Do They Mean That Obesity is Only a Disease if it Impacts Your Health?
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I got this question from reader Jenn:
I was hate watching a workshop about “ob*sity” treatment and one of the people on the panel said that “ob*sity” isn’t a disease unless it impacts someone’s health. I don’t understand how that works?
Thanks for the question Jenn. You don’t understand how it works because it doesn’t work. This is fully ludicrous and I’ve seen them make the claim in real time as well.
I was part of a panel that, I found out at the last minute, was being moderated by someone from the Ob*sity Action Coalition which gets most of their funding from the pharmaceutical industry, including and especially Novo Nordisk. She used her position as the moderator to throw in this line at the very end of the event, when there was no chance for any of the experts on the panel to refute it.
As always, before I get into this I want to be very clear that there is no shame in having a disease. The problem is that ob*sity simply does not quality, including and especially based on the idea that it’s not a disease until it impacts your health. In truth “ob*sity” is just a body size (and lacks even a consistent, coherent definition among major healthcare organizations.) Calling simply existing in a higher-weight body a disease means that people are exposed to so-called “treatments” and the risks of those treatments which can include everything from reducing quality of life to death. The conceptualization of being higher-weight as a disease has been, and continues to be, primarily architected by the weight loss industry (including through the liberal use of their astroturf “patient advocacy” organizations) and they’ve turned it into hundred of billions in profits.
The claim that ob*sity somehow becomes disease when it impacts health is simply not defensible through science or even logic. In order to buy into this idea, we would have to believe that a higher-weight person doesn’t have the so-called disease of “ob*sity” until they are diagnosed with another health issue, at which point they suddenly have two health issues, based on the assumption that the other health issue is caused by their size, even though thin people get the same health issues. Meanwhile, thin people with the exact same presentation and symptomatology simply get diagnosed with the actual health issue they have.
Let’s look at an example:
A higher-weight person has no health issues. So, by this claim they do not have the (so-called) disease of “ob*sity”
That person gets diagnosed with Type 2 Diabetes.
Now, suddenly, they have two diseases: Type 2 Diabetes and “Ob*sity”
Meanwhile a thin person with the exact same presentation gets diagnosed with Type 2 Diabetes. They only have one diagnosis, even though they have the same symptomatology.
It makes no scientific sense to suggest that you can only diagnose one disease if someone has another disease. This definition means that the diagnostic criteria for the disease of “ob*sity” is having health issues that people of all sizes get. Said another way, two people can have the exact same BMI, weight, accumulation/percentage of body fat, waist circumference etc., but only the person who happens to have another health condition (one which has its own diagnostic criteria and which people of all sizes get) has the disease of “ob*sity”. Thus, the disease of “ob*sity” becomes simply “having health conditions while existing in a larger body.” It would be like saying that someone is just tall, but if they develop a health condition then they are now “medically over tall” and, instead of the ethical, evidence-based treatments that shorter people with the same health condition get, they now need care the focuses on reducing their height.
This only makes sense if we jump off the logic train way before it reaches the station. So why would anyone try to define it this way?
Well, it’s an easy way to give lip service to the truth that diagnosing a body size (whether we’re talking about BMI, waist circumference, weight, adiposity, etc.) as a disease doesn’t actually make any sense, without losing any of your current market. In fact, if you do it right you can expand your market this way.
For example, Novo Nordisk and Eli Lilly with their new weight loss drugs (Wegovy and Zepbound) along with much of the rest of the weight loss industry are working very hard to expand their market to as many people as possible. It’s the next step in a long game they’ve been playing for decades including getting “ob*sity” declared a disease, expanding the definition and “diagnostic” criteria, and doing an end-run around science to get a massive number of health conditions labeled as “weight-related” using shoddy correlational research that fails to control for confounding variables like weight stigma, weight cycling, and healthcare inequalities.
Now, this sketchy definition brings this altogether, allowing for the greatest possible market by pushing for insurance coverage. The arguments go:
Those who are higher-weight but don’t have a health condition need “preventative treatment” to avoid developing them
Those who have health conditions while existing in a higher-weight body need “treatment” for their disease (not the real ones, but their supposed disease of existing while fat.)
Those who are lower-weight but have so-called “weight-related conditions” quality for “treatment”
This is pure nonsense. It’s also highly profitable nonsense that rests on the weight stigma that is already rife within a healthcare system , much of which is obsessed with making higher-weight people thin and blaming anything and everything on their weight in the meantime. Unfortunately, nonsense like this gets repeated (often by people/organizations who are profiting from it) and reiterated (and put into weight loss industry funded and conducted medical education) and soon it reaches “everybody knows” status – no logic or research required (or, for the weight loss industry, desired.)
But unscientific definitions of “ob*sity” that are created to support weight loss industry profit aren’t the answer. The answer is dismantling the weight-centric paradigm altogether. Once we stop trying to make everyone thin (or, perhaps more accurately, trying to make everyone a client of the weight loss industry) we can focus on actually supporting the physical and mental health of higher-weight people based on individual definitions and priorities. Until then, whether accidentally or on purpose, whether well meaning or not, way too many people are working for the weight loss industry.
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More research and resources:
https://haeshealthsheets.com/resources/
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.