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.

167 comments
Lotus
Lotus

Abigail Saguy, I had the displeasure of reading your whole book, "What's Wrong with Fat", as mandatory for my Anthropology class. I wanted to shoot myself in the face while reading your comparisons of homosexuality and obesity. The title of this article is vomit inducing, if obesity is a disease then why are obese people healthy? PANTING AND GASPING FOR BREATH AFTER 2 OR THREE FLIGHTS OF STAIRS, IS NOTTTTT CONSIDERED HEALTHY. Maybe in your operational definition of healthy, but NOT in actuality. Stop writing books solely based on sociocultural and socioeconomic and political theories, it is not that black and white. Your findings are flawed, just as you mentioned many obesity studies have their limitations... so did yours. Anyone could get technical with words and linguistics like you do in your God forsaken book. This trash killed my winter vacation. 

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.   

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").

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.

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!


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.

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.

FlorNatalyVargas
FlorNatalyVargas

Hey fat haters! The purpose of this article was not to encourage obesity! It's to show that people who are obese are not necessarily unhealthy! We cannot assume that every fat person is unhealthy because that right there, my friends, is DISCRIMINATION! I'm considered obese by BMI standards, but I'm not what you consider a morbidly fat person, who is physically impaired. My doctor says I'm perfectly healthy, and I'm normally active! I knew a lady in my college swimming class who could out-swim everyone despite being a fairly big lady. Yes, you should maintain a normal weight, but fat does not always equate unhealthy! Is that so hard to conceive? Quit your fat hating, it makes you look like a terrible person! 

JohnNYC
JohnNYC

This is journalistic malpractice.  Let's unpack the most important paragraph in the article.  First, we have to quote it:

"Yes, there are certain health risks associated with having an elevated BMI, such as Type II 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."

When you analyze it more closely, that paragraph actually states that 2/3 of "obese" people and around half of "overweight" people have "metabolic abnormalities," whereas just 25% of "normal weight" people have metabolic abnormalities.  That means that the obese are 2.67 times (2/3 or 66.7% vs. 25%) more likely than those of normal weight to have such abnormalities and the overweight are 2.0 times (half or 50% vs. 25%) more likely to have them in comparison to people of normal weight.  

That is, by any reasonable measure, a material difference.  

Yet, if you read the headline, you'd think that it is alarmist to suggest that it is dangerous to be overweight or obese.  Not only is that an irresponsible pursuit of a cheap headline but, more importantly, it is dangerous to those who might read the article, not understand what the data actually say and figure it's just fine to be obese or significantly overweight.  

What these misused data actually suggest is that you might, most likely as a result of genetic good fortune, get away with being obese or overweight, but you are much better off maintaining a weight that is in the normal/healthy range.  Not stating that is irresponsible on the part of the author.

scotta777
scotta777

Being very fat isn't healthy.  Football players aren't normal people - they are juggernauts who need weight to stand up to incredible force and they are in general exceptionally strong.  When they stop football, they either become lardballs or loose weight as their lifestyle changes.  Everyone one who is protecting "fat is fit" is either fat or a socialist shrink.  Overweight is about personal responsibility.  Once you are morbidly obese, you've got a real problem and likely need help.  But as long as you can exercise at some level, a little education and lifestyle change can make all the difference.  But let's face it, most people LOVE cheeseburgers, pizza  and sweets.  And we live in the electronic age where we are enticed into sitting on our fannies and getting plugged in.  Look at Twitter and Netflix advertising to be on the go everywhere including around a camp fire for goodness sakes.  We are getting sucked into a lifestyle that is not healthy.  That's the facts and anyone who argues against it just isn't paying attention to reality.  It's really not complicated.  Eat right (not better, right), live an active lifestyle or you are likely to be unhealthy, have serious medical issues and die early.  Or you can stick your head in the sand until your hiney is so fat that it acts like a pendulum and pulls your head out as your hiney hits the ground leaving you wondering what happened.  Someone's got to make a cartoon out of that one!

MrSims
MrSims

All anyone needs to read in this entire section is THE TITLE, followed by a faint but clear 'thank you' in the background.

bobneedsmoney
bobneedsmoney

Obese aren't healthy since you can't count muscularity in with being obese, quit making excuses for being fat, obamacare would have been better if it subsidized gym memberships and forced everyone to go 3 days a week. Most health problems could be erased by having people get off their butts and get a little exercise.

tuffoldjock
tuffoldjock

Having the medical establishment declare obesity a disease will in no way lessen the social stigma attached to it. You can't help but suspect underneath it all is a familiar profit motive. An AMA official was quoted in a CNN article that doctors look forward to getting paid to counsel patients on nutrition and exercise. Not mentioned is that few docs have training in either. Worse, the average primary care doc makes close to $200k a year and there's a growing shortage of primary care docs. Already busy and under trained, why get them derailed in unproductive exam room chats? The more obesity gets tangled in the medical system, the more expensive it will become. There are numerous community resources to help with this that are cheaper and more effective. Read The Wellness Club: A Journey To Health Beyond Healthcare.

fatasfatass
fatasfatass

Newsflash, people: BMI doesn't account for muscle mass. All of your silly case studies are practically and legitimately meaningless. 

YoureObeseBecauseYoureUnhealthy
YoureObeseBecauseYoureUnhealthy

I'd also like to say for those of who you want others to appreciate your increased body size - they won't unless it's what they already like. Shoving body acceptance down people's throats won't make them want to date or accept a morbidly obese person.