Should obesity be called a disease? For many people, the answer is simple. We are constantly reminded that we are in the midst of “an obesity epidemic,” after all, and Medicare proclaimed obesity a disease in 2004. Now, Arizona is considering charging overweight Medicaid recipients a fee on the grounds that they cost the health care system more than people whose weight is normal.
But there are compelling ethical, cultural, and even medical reasons not to jump to the conclusion that obesity is a disease. We all know thin people who live on sodas and chips and who are unhealthy, and we know large people who eat well and are active and healthy. Given that one’s body size doesn’t always correlate with one’s eating and exercise habits, and, therefore, one’s health, focusing primarily or only on weight may mean serious risk factors can be overlooked in thin people and too often assumed to be present in large people. Thus, too much focus on obesity fails to yield the best health care for both fat and thin people.
Some would argue that focusing on obesity may help provide better preventative care, especially to those at risk for conditions such as cardiovascular disease. This certainly seemed to be one of Medicare’s motivations for declaring obesity a disease. It meant that Medicare could cover weight loss interventions, such as visits to dieticians, for obese people. Yet it’s not only obese people who are at risk for cardiovascular disease, since diet and exercise – apart from weight -- may also affect the risk. Policies that require a diagnosis of obesity may mean thin people cannot receive proper preventative care.
Further, the focus on obesity may also make some large people, who may eat well and exercise regularly, feel unfairly stigmatized and avoid medical care, or worse yet, have difficulty finding health care providers and have additional difficulty finding providers who are willing to consider anything other than weight as their primary health issue.
Given that the aim of good health care and health care policy is to reduce morbidity and mortality across our population, the focus on a specific number on the scale may not get fat or thin people closer to that goal. What does seem likely to get us there is encouraging good eating and exercise habits for everyone -- regardless of size -- and not assuming that people’s body size is always an indicator of those habits.
April Michelle Herndon is an associate professor of English at Winona State University in Minnesota.