Those who live with obesity often encounter stigma, including from health professionals, and difficulty gaining access to the treatment they need.
The World Obesity Federation has published a new position statement that finds the condition to be more chronic and complex than previously understood—and, making things worse, the “pathological agent” is not a microbe, but food, also needed for life.
Obesity, which is increasing worldwide and related to rising rates of diabetes, is causing problems for national health systems and bringing controversy as not everyone agrees that it is a “disease” in the same sense as cancer or other chronic conditions.
Indeed, health coverage policies in the United States frequently treat obesity differently than other conditions, with an underlying assumption of personal control or moral failure, even though the evidence shows that a complex mix of genetic, social, and environmental factors—as well as modern food manufacturing and distribution practices—all contribute to its rise.
“Accepting the concept that obesity is a chronic disease process is important for several reasons,” said George Bray, MD, of the Pennington Biomedical Research Center at Louisiana State University, the lead author of the position statement, which was published today in Obesity Reviews.
The American Medical Association declared obesity a disease in 2013, which many hoped would open the door to improved healthcare coverage for obesity treatments in the United States. Progress has been mixed, although the US Preventive Services Task Force requires health plans to provide screening and multidimensional interventions for those with a body mass index of 30 kg/m2 or higher, the point that the CDC defines as obese. Coverage for medications to treat obesity has been limited.
Authors of the statement write that declaring obesity a disease could help those who are living with obesity and need support and expert medical attention. Fatima Cody Stanford, MD, MPH, MPA, of Harvard Medical School, has told The American Journal of Managed Care® that those who are obese are more likely to be unemployed and uninsured, more likely to suffer stigma, and often cannot access a dietitian unless they already have diabetes.
The new paper focused on the difficult issue of relapse, a problem that has received increased attention in the literature recently as scientists study the body’s tendency to maintain a certain weight. As hard as it is to lose weight, it seems even harder to keep it off, as the body “remembers” what it once weighed and seems primed to reset to the prior weight. “One of the most challenging questions remaining to be solved is why long-term weight loss is so difficult to sustain and how these compensatory mechanisms can be disabled or overcome,” the authors state.
The position paper notes that while some people who are obese do not have any related risk factors for associated diseases, evidence shows that at least half will develop obesity-related diseases during their lifetime. Other evidence shows that those who are obese cause higher costs to the health system, so there is reason to provide care to help them lose weight.
The paper examines the pathological factors associated with obesity, including the behavior of fat cells, the effect on the joints, the higher risk of cancer, diabetes, hypertension, and stroke; and the fact that persons with obesity are victims of stigmatization—including by health professionals.
“For preventing damage to the host from obesity, medical personnel play an important role in the evaluation and treatment of the comorbidities in people with obesity,” the authors write. “Continuous effort is needed to control obesity because it is a relapsing disease process.”
Bray GA, Kim KK, Wilding JPH. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation [published May 10, 2017]. Obes Rev. DOI: 10.1111/obr.12551.