Obesity is a disease and not a lifestyle choice

The Royal College of Physicians has called for the recognition of obesity as a disease, and not a lifestyle choice. Falling behind the USA, the ‘fat capital’ of the world, where obesity was recognised as a disease in 2013.

The distinction is important. For too long, being overweight or obese has been deemed by doctors, politicians and the general public as an individual’s fault, the result of wanton gluttony, sloth and laziness. Not that we employ the same blame approach to other ‘lifestyle’ diseases. Smoking causes lung cancer, but who would think of denying a smoker specialist treatment? Alcohol causes liver damage, some cancers, heart disease and stroke, but help for those afflicted is readily available.

Obesity is not the individual’s fault. We live in an environment that encourages obesity – one that promotes lifestyles that lead to weight gain. It’s not that we fail to have no control over what we eat, and what activity we undertake, but there are powerful underlying reasons for why we do what we do, and why some of us make poor choices. There is also compelling evidence that obesity, in children and adults, is much more prominent among the less financially well off and those living in socially deprived communities. Poor access to healthy food, or exercise opportunities, oppressive environments, unsafe streets and the underlying stress of poverty all takes its toll.

Genetics also play a part. Between 40-70% of the variation in our BMI (body mass index) is due to genetic factors. There are a few rare genetic disorders that cause severe obesity, but the environment that we live in has a much larger impact. Over the last 30 years, our environment has changed how we live considerably. In the 1980s, 8% of women and 6% of men in England were obese; in 2016 levels were recorded at 26%.

Calories are cheap; we are inundated with adverts for high-fat, high-sugar, processed foods, aggressively marketed, and priced cheap to sell; hard to resist if you’re on a limited budget. It’s hard to be physically active if you have a job in which you’re sitting most of the time, you have your own car to drive from door to door, a much more appealing option if public transport is limited and streets feel unsafe.

Such a scenario leaves you with the heavy feeling that obesity can never be cured, only managed. An important thing that is often missed when it comes to tackling weight management is the role of psychological therapy. Unless underlying stress, anxiety, depression, lack of self-esteem or self-confidence is tackled head on, any progress made will be little and definitely short-lived. 

Regardless of how much weight loss and health goals are achieved, if you are “stuck” in old ways of life, eg an unfulfilling job or an unhappy relationship. Old demons will surface time and again, as will old habits return, and the likelihood of falling back, once again, into an unhealthy, overweight lifestyle.

Obesity kills. On average, if you’re obese, it could cut your life expectancy by 10 years. And that could be after years of debilitating living. You could also contract type two diabetes and heart disease, mobility problems, sleep disorders or some forms of cancer. You’ll be offered medical help for all of those disorders of course – and so you should – but it’s unlikely that you’ll be offered help to deal with the underlying problem, your weight.

And that’s why it’s important that we recognise obesity as a disease, as a product of our unhealthy environment and a cause of significant morbidity and premature mortality. Dealing with the health consequences of obesity is already causing profound strain on NHS resources, yet treatment for those with a weight problem is starkly limited and where it is available, results are often poor and short-lived. Reclassifying obesity as a disease will hopefully sharpen minds, improve patient care and force the government to finally step up and deal with the real causes.

Extracts taken from Dr. Ian Campbell from https://metro.co.uk