If Obesity Is a Disease, Why Are So Many Obese People Healthy?

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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 29 to a BMI of 30, is equivalent to contracting a disease. But that is simply not the case.

(MORE: Viewpoint: The New Food Police Are Out of Touch)

Yes, there are certain health risks associated with having an elevated BMI, such as type 2 diabetes and heart disease. More broadly, a higher BMI is associated with a greater risk of cardiometabolic abnormalities, as measured by blood pressure, triglycerides, cholesterol, glucose, insulin resistance and inflammation. Nonetheless, almost one quarter 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 16 million normal-weight Americans who have metabolic abnormalities and 20 million obese (or 56 million overweight and obese) Americans who have no such abnormalities.

One explanation for this discrepancy is that physical fitness and/or nutrition — rather than weight per se — may be what really matters. Several 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 trial published in the New England Journal of Medicine showed that adopting a Mediterranean diet reduced cardiovascular risk independent of weight loss.

(MORE: Can We Drink Soda Responsibly?)

Some assume that the problem lies with BMI as a measure, which does not distinguish between fat, muscle and bone. While BMI is indeed a flawed measure, it is not clear that there are better ones. A 2009 study, using the National Health and Nutrition Examination Survey, 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 skinfold thicknesses and waist-to-stature ratio. They found no systematic differences between BMI and other variables. In other words, it is not just that BMI is a poor measure of obesity but that obesity is a poor predictor of health.

Some 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. Yet already it is being called the “fork to mouth” disease, and the disease categorization may reinforce blame by raising the stakes. If obesity is a disease, parents of fat children may not merely be silently judged as bad parents but also accused of neglect and child endangerment.

If the AMA’s goal is to address the serious diseases of type 2 diabetes and heart disease, it would be more productive and accurate for the association to urge doctors to focus on cardiometabolic risk, recognizing that there are both metabolically healthy and metabolically unhealthy individuals in all categories of weight. Rather than promote weight loss per se, doctors should instead encourage their patients of all sizes to incorporate physical activity and a balanced diet into their lives.

149 comments
webgoddess7
webgoddess7

nah, it needs to be classified as a disease; it just should be put in the "mental illness" category of diseases.  and it's essentially a pro-drug for harder diseases, like diabetes. 

rusty_shackleford
rusty_shackleford

That's like saying smokers are healthy because they don't have black lung. The fat acceptance movement is just sticking their head in the sand when it comes to the consequences of being overweight and obese. I'm sure there are outliers, but when large and overwhelming majority of Doctors have done a lot of studies showing the negative consequences of obesity, then i'm more inclined to believed them then some victim complex fat activist (which is some first world tomfoolery if you ask me)

craigprimackMD
craigprimackMD

If not having "apparent" disease is the qualifier, what about the patient with high blood pressure who doesn't know they have it nor the diabetic who never gets his or her sugar checked... are those not diseases?


Obesity is a disease because it has a characteristic constellation of symptoms and if treatment is stopped (diet, exercise, counseling, Etc.) the disease persists and subsequent risks of being overweight continue.  There are physical manifestations and psychological manifestations of the disease of obesity. Not all of them can easily be measured with a blood test. 

prophetess.noella
prophetess.noella

I keep reading this defense of obesity  "Just because you're skinny doesn't mean you're healthy."  I don't think anyone has ever made this claim.  But just because a thin person can be unhealthy doesn't mean that being obese doesn't affect your health.   

2013yourwelcome
2013yourwelcome

The obesity problem in America is fueled by the average adult eating habits, like I stated earlier it is very illogical to explain to a child that they should sacrifice backyard bar-b-ques and candy filled holidays to be healthier.  Suprisingly this is natural because kids are expected to learn not make those kinds of decisions, but it's unnatural for so many adults to fuel the Y.O.L.O propaganda which is You. Only. Live. Once. It doesn't take a PHD to understand the benefits of eating healthy and shouldn't take an epidemic like obesity for adult Americans to start promoting healthy eating habits. This behavior is symmetrical to the attitude towards environmental protection, I believe Americans need to see 70 foot tsunamis to understand they should stop polluting. The fact of the matter is that the majority of parents have chosen not to support such eating healthy and that instance overwhelms the pleads from the opposition. These parents do not want to sacrifice their pleasures in unhealthy food even for their children. If more parents eat healthy then more children will follow them everything else is individuals denying responsibility.

The most stupidest thing is to categorize obesity as a disease, and this propaganda which is being fueled by doctors and individuals who see economic advantages from this dilemma. And their solution is assigning a regime of pills to your child which will chemically burn the fat off your children bones and then have you send a monthly check and perhaps some thank you letters to their mail box. This tend to be the road of Americans love to take so I'll sit back and watch. Your welcome.

KevinStock
KevinStock

Disease or not - it's hard to argue that obesity diminishes the quality of life. And (coming from someone who suffered from childhood obesity) it really sucks to be a fat kid - health issues aside!

n2egypt
n2egypt

We've been calling alcoholism a disease for years - how is this any different?

mbpowell83
mbpowell83

BMI (which is really meant to be used to describe relationships between populations and groups as opposed to individuals) is simply a ratio of body weight to height and is defined as mass(kg)/height(m^2).  This does not take into account fat mass, fat free mass, or bone and muscle atrophy due to aging.  Yes, a high BMI is correlated with a higher risk and incidence of cardiovascular disease and diabetes, but I think a better way to relate the data on an individual level is that a person with a high body fat % may be more susceptible to chronic disease.  I agree that many people with a high BMI are perfectly healthy.  But I would also make a pretty general assumption that, two people standing at 5'9" weighing 210 lbs each, but one with 30lbs of body fat (14%) and one with 60 lbs of body fat (28%), will show a marked difference in likelihood to develop a chronic disease.  

BodyPositivePhD
BodyPositivePhD

I suggest that people who have the sanity points to read the comments treat them as a little slideshow on "anxieties, fears, and dread that get projected onto higher-weight bodies." 

samsonite333
samsonite333

I think America needs to redefine what a normal eating lifestyle is.  First I think 2 meals a day would be the best option for people older than 30yrs old. 1 meal a day if your older than 45.  Everyone who has lived over 90 testifies to the benefit of eating less.  Breakfast should not include bacon and sausage and buscuits with gravy.  1apple or orange, 2 slices of toast and a glass of water.  For lunch or dinner you get to eat a normal sized meal.  The other should be a salad. 

chrissy1984
chrissy1984

I think fat people have no food discipline. It is disgusting looking and you are still very likly to develope type 2 diabetes when you get older. Set an example for the rest of FAT America.

enquiries
enquiries

Stupid question. Influenza is a disease, that doesn't mean everyone has it.

Obesity is not a disease.  The AMA is just playing politics when they say that it is a disease. Their pronouncement on this is about as accurate as their decision that homosexuality is not a disease.

2013yourwelcome
2013yourwelcome

We live in a world were the healthy choice is alien, no one wants to abandon the guilt of sugary pleasure? But, life goes on and in the times before twinkies, pizza, and all the others there was apple, carrots, berries, more healthy choices. If these times we have choice, now choose wisely.

swordarkeereon
swordarkeereon

An unhealthy lifestyle is unhealthy no matter what your size. I know A LOT of skinny people who sit on their butts, never exercise, and eat cheeseburgers and pizza all day. They have great metabolism, but it's still *just* as unhealthy to be skinny and sit on your butt and eat poorly as it is to be fat and do the same. It seems to me we need to stop only focusing on fat people and body type and focus on lifestyle instead. We need to start encouraging ALL PEOPLE (regardless body type) to live active, healthy lifestyles and have diets rich in veggies, lean meats, and less processed foods. The bottom line -- skinny does not equal healthy. I know because I used to be one of those skinny people. I smoked two packs a day, had a perfect BMI, never exercised, and ate crap. I had obese friends who were far healthier than I was. I've since changed my lifestyle and am far healthier now (and have a few more pounds), but I'm now in far better shape.

FrancisMulhare
FrancisMulhare

One of the main problems here is the use of BMI. Sure it is easy and simple but that is really all that can be said for it. It basically defines people as overweight , or even obese, who by other measures clearly are not. The gold standard in all of this are the MetLife tables which have calculated the weights at which you become more likely to die prematurely. Using myself as an example..under the bmi formula at 68 ins and 165 lbs i am classified as overweight but according to the Met tables I could add another 9 lbs before my risk of premature death increases. In the meantime my bodyfat is 13% and I am running 40 miles a week. Shaq , in his playing days, had a bmi of 31 (obese) but (despite what Kobe said) he was one of the fittest athletes on the planet. BMI needs to be scrapped. Why not use bodyfat % instead. Granted the methods used to calculate are a little inaccurate but everyone can immediately tell the difference between say John Candy and Sylvester Stallone.


Read more: http://ideas.time.com/2013/06/24/if-obesity-is-a-disease-why-are-so-many-obese-people-healthy/#ixzz2XCVSTjIC

Openminded1
Openminded1

I know a man who is obese he eats good no junk or fast food, he walks two miles a day does not drink, but he is still way over wait, 6 feet 282ibs much like James Galdofino was. I asked him why he is over weight when I know he eats well never over eats and keeps active. His answer Stress he has had so much stress in his job and with his family and money that he has gained 90 pounds in 3 years. No medical problems like tyroid according to doctors just stress. Not everyone who is over weight eats to much.  granted most obese people have a eating problem but lack of activity is a major componet.

sedwards79
sedwards79

I don't think the point of the article is to encourage people to be overweight or saying that being overweight is ok. I think the point is that there are PLENTY of people with "normal" BMI's who eat nothing but crap and sit around all day and have health issues, too. The funny thing is that everyone knows a super skinny person who can eat "anything" and never gain weight (I have a 110 lb friend who literally lives off potato chips dipped in ranch dressing and french fries - she has counted her calories and admitted she eats 3000+ a day and NEVER gains weight). Obviously these people are not the norm, but they are out there. However, people have a hard time believing that there are, on the other side, overweight people who try very hard to eat healthy foods and exercise. They fail at times, clearly, but not all overweight people are oblivious and/or uncaring about their health or appearance. Just as there are HUGE genetic ranges for everything else (height, skin color, intelligence, hair types, athleticism, vocal abilities, you name it..) there are also huge ranges of what people can and can't eat and still maintain a healthy weight. There are also huge ranges of how we respond chemically to food - there are people who can literally forget to eat and derive very little pleasure from it (but maybe they smoke or drink to excess), while some people experience almost a euphoric high from eating a cupcake. You can't possibly know what the food battle is like for someone else due to these ranges. Yes, it might take willpower to walk away from that brownie for you, but for someone else, they may crave it like a drug addict craves a high and they can go hours thinking about that brownie and nothing else. It sounds awful, but that is truly what it's like for some people. I get so tired of folks being so judgemental and awful about overweight people...we're all human..and I doubt any one of you here is perfect and you have your own demons.. Show support for people who want to change and just be decent to one another. Personally I'd rather be overweight than a judgemental jerk.

cori
cori

@rusty_shackleford 

yes I agree weight can be a large issue and factor in a lot of peoples health but there is more to weight then just eating and exercising habits. The only time I have ever been "normal" weight is when I was deathly sick and could barely walk from one end of my house to the other (I live in a small house). I, like a lot of females at least, have a disease called poly-cystic ovaries which means my hormones are out of control along with other issues that cause me to retain weight no matter how much I try to work out along with depression and some other horrible side affects. I just cant really get below 190 ever since I was 11 after puberty came along (and I was also born severely under weight). I eat healthy I love veggies and hiking all my blood tests say I'm healthy (my doctors even yell at me to stop coming in because I have nothing wrong with me). I bike to work every day and yet me being healthy on every other count is still thrown away because the number on the scale is wrong or the number on my pants. I probably eat severely less food then you do and know I eat way less then any of my skinny friends do (while still staying in a non starvation mode) and yet my weight stays the same.I also go to the gym between 2 and 4 times a week as well as hiking with friends ice skating and long boarding. its not just a lack of activity for a lot of people or the wrong foods sometimes it just is their body structure. on top of that they have done studies that show that being under weight or at a low weight for your body type can have the same detrimental affects as being severely over weight with heart problems and other things associated with being fat. The best place to be for "health" weight wise is actually the middle of the weights they tell you. skinner is not always better. I am still struggling to get my weight lower but after getting sick  being 190 when I was younger was healthier then the 190 I am now because now it is a lot more fat where as before I was mostly muscle. on top of all of this there is the mental problems we create by shaming people for there size instead of trying to help them I would love to be accepted and skinny but I'm not and that's just life. I don't think we should be pushing people to the point where they want to kill them selves or harm others and for the people who are depression eating it just makes it worse. 

Chantal_Mendes
Chantal_Mendes

@prophetess.noella - That is exactly what I wanted to post! The argument that there are unhealthy people of acceptable weight (BMI under 29) doesn't negate the fact that being obese is just unhealthy. I shadowed a family doctor a little while ago and one of the take-aways from that experience was the importance of exercising and maintaining a healthy weight. Seriously, it was THE biggest thing he stressed for almost every single patient he saw that day (including patients that I would not have considered to be truly "overweight").

jemyaya
jemyaya

'The most stupidest" Bahaha.

drkangelcat
drkangelcat

@KevinStock Diminishes quality of life? But I was a fat kid and now a fat adult and I love my life. In fact, I seem happier than most people I pass every day.

IsamarCMasso
IsamarCMasso

@n2egypt Because not every fat person has an eating disorder, and not every slim person is a healthy eater. That's why.

SwarnGill
SwarnGill

@thewholetruth I agree Tebob2.  In fact there was an experiment done several years ago where a guy when on a junk food diet.  He basically ate a bit less than his normal caloric intake and supplemented his diet with multivitamins, and actually lost weight.  Because in the end it is largely about the calories, although obviously over long periods of time your metabolism can suffer from poor nutrition particularly if you are not exercising.

Tebob2
Tebob2

@thewholetruth   Huh? Sorry but it's another cop-out to blame the 70% in America that are overweight on "chemicals", some spiked "Agent Orange" in your food... uh, it's more like consuming more calories than you burn, period. Staying away from sugar (High Fructose Corn Syrup included) and bad fats. Easy to blame fatness on some mysterious chemical. HARDER to move your ass and eat healthy.... I hit the gym 5X a week, eat no desserts, add sugar to nothing, 58 years old and slim. Try it, it works..... (chemicals? please......) -MS in Health 


Tebob2
Tebob2

@BodyPositivePhD And I suggest you maybe going to the gym, sweating, eating no desserts, doughnuts or fries and stop projecting your weight on our healthy-selves...... 

fatasfatass
fatasfatass

@BodyPositivePhD My wallet gets afraid when it has to pay for obesity treatment.


Why don't you all lose some weight through a healthy lifestyle of eating the right amount of the right foods and by exercising? It costs less to everyone. 

cori
cori

@samsonite333 

They have done studies that show eating small amounts steadily through out the day is healthier then any large meals at any point and also its better for your first meal to be your largest meal and full of protein to keep your energy up all day and have your last meal be the smallest because your generally going to bed not to long after and don't need the calories just sitting there since you burn less in your sleep.  yes there are studies done that show it can be way healthier to eat one meal a day that's at like 500 calories but again that's in small amount of people every body type is different and needs different food my friend who works on a chicken farm needs way more food then i do while i work in an office and even before that when we were kids he just has a higher metabolism then i do and while i would eat one in n out burger he would eat 10 and is psychotically skinny.

mbpowell83
mbpowell83

I hope this post was a joke.  A healthy style of eating is actually the opposite of what you described.  Eating large meals periodically will not only produce a major calorie deficit which can lead to nutrient deprivation, but it can also cause problems with your metabolism and how your body allocates food energy.

fatasfatass
fatasfatass

@swordarkeereon So what you're saying is that you want an excuse for being fat? Trust me, being obese and mostly body fat is not better than being a skinny guy who eats like crap. You're still going to be more prone to illness and will have more joint pain, difficulty receiving proper surgery, etc. than a skinny person will. 

GlennTurner
GlennTurner

@Openminded1 It's not the stress, it's the calories, and it's more than likely from drinking pop.

fatasfatass
fatasfatass

@Openminded1 If he's stressed out there's a chance he's going to eat for comfort instinctively. Other than that, how do you know he doesn't over eat? Do you watch him eat every meal? 

fatasfatass
fatasfatass

@sedwards79 If more than one third of Americans are obese, then that shows that there, most certainly, is a pattern of uneducated nutritional habits among those whom are obese. Not to say that there are the outliars who do have legitimate, diagnosed health issues causing uncontrollable weight gain, but the data suggests that the obese population is far too common in scope to be the result of anything but poor habits.  

PhilVarlese
PhilVarlese

@Tebob2 @BodyPositivePhD And I suggest that you stay in your gym and stop telling others how to live their lives or find their own personal path to health.

Oh that's right, you're going to complain about how your dollars are spent supporting fat people who become "ill", and that you're sick of these people draining you financially.  Here's a clue, if you're that upset, stop paying your taxes, or vote people into office who won't spend the money taking care of fat people.

By the way, fat people pay taxes too, and if you end up in the hospital because of a medical issue that may have been genetic, I hope they pull their support for you too.  Look around inside a hospital, and you'll see an even distribution of body sizes and shapes.  Too bad for you that your tax dollars could be distributed solely to the body styles and shapes you think are healthy.

It's such a cruel world...

samsonite333
samsonite333

@mbpowell83 Well I see the logic behind eating smaller meals which supposed to keep your metablism up but I also think your gastrointestinal system would benefit with more rest in between meals.  But this is my opinion.  As we all get older, including myself, don't we all find that its hard to keep off weight.  Everyone with a six pack can attest that you really dont need much to eat, especially when you get older.  And a simple google search of the oldest people alive will show you the benefits of eatin 2 or 1 meal a day

swordarkeereon
swordarkeereon

@Tebob2  -Another person with a reading comprehension problem! Notice the sentence "I used to be one of those skinny people."   I may be 30 pounds overweight now, but I no longer smoke, my diet is healthy, and I work out 5 times a week. Good try on the assumptions though. And no - MANY skinny people are NOT eating well and exercising like they should. Where do you think fat people come from? Dur!


swordarkeereon
swordarkeereon

@fatasfatass You clearly have a reading comprehension problem. What I'm saying is that we need to quit pretending that if you're skinny, you're assumed, automatically, to be healthy. It's a very dangerous assumption. I'm not saying being overweight doesn't present problems. What I'm saying is that NO - if you're skinny and you do not live a healthy lifestyle, you're just as much at risk for issues as those who are fat and don't exercise or eat right. What I'm saying is that we should promote a healthy lifestyle to EVERYONE regardless their body type. Do you think all overweight people started there? No. Most of them were probably relatively thin folks until they hit their thirties and their metabolisms started to go. By then, their poor eating and exercise habits were already set. If we could get to them while they're still skinny and teach them the value of exercise and good nutrition then, maybe they won't end up obese later. Eventually eating crap and not exercising. if you're skinny, will catch up to you. According to you - if I'd kept smoking two packs a day, never exercised, and ate whatever the hell I wanted, but remained thin, I would have been better off. I disagree, dear. Please pay attention. 

sedwards79
sedwards79

@fatasfatass @sedwards79  

I never even said that the people who are overweight have some kind of medical issue causing uncontrollable weight gain. I fully realize that those people are few and far between. MOST people are overweight because they eat poorly. That's an indisputable fact. What I did say, however, is that you cannot possibly know what it's like for someone else to fight the constant barrage of unhealthy foods in our faces, because our bodies are all wired differently and you don't know what it takes for someone else to make the right choice.

Here's an illustration of what I was trying to say. Don't eat anything at all, just drink water, for the next 7 days. Then have someone put an apple pie in front of you. See how long you can go without eating it. At some point your biological urges will overcome your willpower and you WILL eat that pie. Obviously, that's an extreme example, but the point is that many people have these very, very strong chemical responses to food and to make these healthy choices is to deny what their biological urges are telling them to do. Like I said, some people can say "no" to a brownie, and while they might have really wanted that brownie (I'm not saying it's exactly easy for anyone), they walk away from it and a few minutes later it's no big deal. For others, they say "no" to that brownie but it's on their mind for the next 24 hours...like a drug addict. Saying no to sugar and sweets for someone else may feel like what it might feel like to YOU to sit in front of an apple pie after you haven't eaten for a week. 

So my point is, yes, overweight people (for the most part) are eating too much of the wrong foods. No one is wrong about that. But it's more complex than just "making the wrong choice." I honestly believe that many people have such strong physical reactions (addictions if you will) to these foods that it's truly a battle, and belittling people does not help that.

PhilVarlese
PhilVarlese

I'd like to invite you to my pro wrestling training facility in NJ, where we burn more calories in 15 minutes than you do in a week.

Better yet, you're more than welcome to have mom drive you to one of our shows, and perhaps we can coerce you to step in the ring to see who's in better shape.

Perhaps you cant read, but I said in an earlier post that I'm not fat, comprende, little man?

Tebob2
Tebob2

@PhilVarlese @Tebob2 @BodyPositivePhD So so sorry about your hugeness and NO, there is nothing fair about those of us who eat healthy and sweat to pay what you people pay, absolutely not. Good luck, try burning a few calories sometime, live on the wild side...... 

mbpowell83
mbpowell83

*macronutrient, not micronutrient. Sorry abt that.

mbpowell83
mbpowell83

I agree that there may be benefits to a short term limited diet as you described but I believe it would be difficult for many people to maintain that type of diet. However, I do not doubt that there may be some benefits that I am unaware of. I am not a dietitian so I am certainly open to the idea. In my experience working with individuals whose goal is weight loss, I have found that eating more frequently is key to meeting their goal. I will concede that as long as a person has adequate micronutrient, vitamin, and mineral intake, then in theory they should be able to maintain normal health

BlogZilla
BlogZilla

@swordarkeereon @Tebob2 You are too funny.  OMG!  I laughed so hard at your comment. Have pity on them. We graduate people from college these days that can't even spell.

fatasfatass
fatasfatass

@sedwards79 I'd also like to add, I wouldn't care about eating the pie in that case because I wouldn't gain weight from eating one pie, especially since I probably just lost weight from not eating for 7 days. 

fatasfatass
fatasfatass

@sedwards79 @fatasfatass (I'm not sure if my first post went through, so I'm retyping a shorter one)

Your example is completely pointless. You're comparing addiction to giving a starving man food. People will eat what they can get when they're starving, no doubts about that. But you dare compare addiction to starvation? The two are completely different. 

And EVERYONE has to face those urges of unhealthy foods. Some people conquered them a long time ago, and some people gave in and never looked back. But saying "we're all wired differently" is such an illogical statement considering the condition of America. If 1/3 of adults are obese, then obviously they are all wired to eat like pigs and not care. If the other 2/3 are not, then obviously most of them care to stay thin.