This week the American Medical Association recognized obesity as a disease. One good thing about the change is that it should simplify procuring insurance coverage of treatments, programs, and drugs to help people whose weight is negatively affecting their health. But other than that, the decision doesn't have much to recommend it. While many obese people have serious metabolic and hormonal issues, some don't. Conversely, some healthy weight people suffer from the same metabolic and hormonal issues that we associate with obesity. In other words, though obesity may be a decent proxy for elevated health risks, it's not a disease in itself. Will pretending otherwise really cause people to afford the problem more gravitas, as is being claimed, or will it simply debase the currency of the "disease" label in general? And does any of it really matter if doctors are terribly equipped to treat obesity either way?
Given what a complex and emotional issue obesity is -- few other health conditions are so closely tied to self-image, social standing, and shame -- it would have been more constructive if the AMA had chosen to emphasize to the public that this isn't a clear cut problem. Are obese people powerless to help themselves? Obviously not. The healthy-diet and exercise mantra may sound trite, but it's been proven beneficial in reducing the risks for the conditions associated with obesity. Are obese people the sole authors of their own problems -- lazy over-eaters who just don't try? Obviously not. At least, it should be obvious from a look at the booming weight-loss industry. If achieving and maintaining significant weight loss were as simple as eating less and moving more, Jenny Craig would have filed for bankruptcy long ago. Innumerable individual variables such as genetics, endocrine function, metabolic efficiency, and personal history matter too. Until we recognize and acknowledge this grey area that obesity inhabits -- somewhere in between the black of disease and the white of individual choice -- we shouldn't hold out much hope for improving the situation.