Is obesity a disease? Experts try to agree on an answer

A obese person is she sick? The controversy, which mixes medical issues and issues around discrimination, is intense.

A group of global experts has just adopted a nuanced response, at the risk of satisfying neither camp.

“The idea that obesity is a disease is at the basis of one of the most controversial and divisive debates in modern medicine,” summarizes the work published by a large panel of experts on Wednesday in the Lancet Diabetes & Endocrinology.

The long article is signed by dozens of obesity specialists who agreed to redefine the way in which this condition is defined, as well as the problems it represents from a medical point of view.

The topic is very sensitive because it regularly provokes intense debates that go beyond the medical community itself.

Experts know that obesity is associated with a wide range of diseases such as diabetes or cardiovascular disease.

But for some specialists, an obese person can sometimes live in good health and their overweight should then be considered only as a risk factor.

For others, obesity is necessarily a health problem, which should be considered as a disease in itself.

That is the opinion of the World Health Organization (WHO).

Gordophobia

The debate partly covers issues related to the fight against discrimination.

Some activists against fatphobia believe that their body appearance should not be stigmatized by judging it as pathological.

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However, it would be a caricature to summarize the controversy as an opposition between patients and doctors.

Among the first, many consider it essential to see obesity as a disease, to be taken seriously and for sufficiently ambitious public health policies to be implemented.

On the contrary, for many doctors there is a risk of not responding adequately to the needs of patients if obesity is taken as a single disease, rather than a risk factor involved in diseases that vary greatly from one patient to another.

These issues become particularly acute with the arrival of very effective treatments for weight loss, such as the well-known Wegovy.

Since their side effects still raise questions, should they be widely prescribed or reserved for patients whose health is most affected?

BMI is not enough

In the end, “no one is completely right and no one is completely wrong,” Francesco Rubino, an obesity surgeon who chaired the work of the expert commission, said at a press conference.

The new recommendations try to address the issue: obesity is a disease… but not all the time.

The experts first insist on a point that is now agreed upon. The well-known body mass index (BMI), which reflects the relationship between weight and height, is absolutely insufficient.

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It should be complemented with other tests to decide if a patient is obese: measuring their abdominal perimeter, for example, or, through radiology techniques, estimating the amount of fat in the body.

But even if a patient is declared obese, experts do not necessarily judge that it should be considered a disease.

In his opinion, only if the organs show signs of dysfunction does obesity become “clinical.”

If these conditions are not met, obesity is “pre-clinical.”

In that case, it would not be a disease but a state that essentially requires preventive measures, and not necessarily medical or surgical treatments, to avoid “overmedicalization.”

These conclusions agreed upon in the article, however, run the risk of discontenting both camps. Some patient associations simply do not want to hear that obesity is not always a disease.

“It is counterproductive to the public health message,” says Anne-Sophie Joly in France, founder of the National Collective of Obese Associations (CNAO), very vehement against the experts who in her opinion are disconnected from the reality experienced by obese patients who They do not find adequate follow-up.

However, the commission’s work also does not satisfy skeptics of obesity as a disease, such as psychologist Sylvie Benkemoun, who chairs the Reflection Group on Obesity and Overweight (GROS).

“It is insufficient although it has the merit of starting a reflection,” comments this expert, estimating that the experts do not provide many answers in terms of attention.