Disorder or disease? Semantics of obesity

To the Editor: The article “Understand Obesity before Treating It” in the June 2021 ACP Internist concludes with the statement, “Obesity is a chronic disease, which requires lifelong treatment.” I wish to take issue with categorizing obesity as a disease, as opposed to a disorder or a condition, for I think the implications for us as a profession, as well as for all the patients we treat, are significant.

Nearly 72% of all American adults are overweight, and nearly 40% are obese. These numbers alone are staggering and almost unfathomable, given current projections that over the next decade they are only likely to grow.

I do not dispute the importance of dealing with obesity as a serious health issue, as a clear progenitor to many things that are properly categorized as diseases, such as type 2 diabetes (in 2018, 13% of the entire adult U.S. population was diabetic) and obstructive sleep apnea (estimated now at 7% of the U.S. adult population, and likely much higher). I am concerned that categorizing this disorder of physiology as a “disease” alters how our patients approach it, and hinders our ability to help them, by shifting their focus from prevention to treatment.

If we view obesity as a disorder of normal physiology, then perhaps what is really called for is a vigorous public health effort to prevent its development in the first place. This would push public policy measures to the fore to reduce reliance on energy-dense food and spur employers, schools, and governmental agencies to create robust policies that would encourage normal body weight and fitness.

One need only look at pictures of the 500,000 persons at Woodstock in 1969, barely any of them overweight, to know that no “disease” could have altered our evolutionary design so radically, so fast.

In this battle, semantics do matter—substantially.

Joseph G. Weigel, MD, MACP
Somerset, Ky.