Weight and Physical Health - Is Obesity A Disease?

Researchers now recognize that obesity does not simply result from willful overeating and laziness, but from a complex combination of genetic, metabolic, behavioral, and environmental factors. Rather than viewing it as a lifestyle choice or personal failing, many groups favor declaring obesity a disease. Proponents assert that many public health benefits would result from designating obesity as a disease including:

• Reducing the social stigma and prejudice associated with obesity, and promoting attitudinal changes to reduce weight-based discrimination.
• Enabling more people to seek treatment for obesity by providing health insurance coverage for treatment.
• Increasing public awareness of the severity of obesity as a threat to health and longevity.
• Stimulating scientific and medical research about prevention and treatment of the condition and speeding approval of new antiobesity drugs.

Advocates of classifying obesity as a disease, including the World Health Organization, National Institutes of Health, and the American Obesity Association, observe that not long ago in American history alcoholism was viewed as a personal choice or moral weakness, whereas today it is considered a disease. They also observe that such eating disorders as anorexia and bulimia are termed diseases. In view of the size and scope of the obesity epidemic, proponents argue that the social and financial costs of allowing it to go unchecked will far exceed the costs associated with extending health-care coverage for weight-reduction programs.

TABLE 2.1
Infant, neonatal, and postnatal mortality rates, according to detailed race and Hispanic origin of mother, selected years 1983–2001
[Data are based on linked birth and death certificates for infants]

Race and Hispanic origin of mother	1983–851,6	1988–881,6	1989–911,6	1996–982,6	1999–20012,6
	Postnatal3 deaths per 1,000 live births
All mothers	3.7	3.5	3.3	2.5	2.3
White	3.1	3.0	2.7	2.1	1.9
Black or African American	6.4	6.2	6.0	4.6	4.4
American Indian or Alaska Native	7.2	7.3	6.7	4.6	4.5
Asian or Pacific Islander	3.1	2.8	2.6	1.8	1.6
Chinese	3.1	2.5	2.4	1.2	1.1
Japanese	2.6	2.5	2.2	*1.7	*1.4
Filipino	2.9	2.4	2.3	1.9	1.7
Hawaiian	3.9	4.0	4.1	*2.6	2.9
Other Asian or Pacific Islander	3.1	2.9	2.8	1.8	1.6
Hispanic or Latino4,5	3.2	3.0	2.7	2.0	1.8
Mexican	3.2	2.9	2.7	2.0	1.8
Puerto Rican	4.0	3.9	3.4	2.7	2.5
Cuban	2.2	2.0	1.6	*1.3	1.4
Central and South American	2.5	2.6	2.2	1.6	1.5
Other and unknown Hispanic or Latino	3.7	3.2	3.0	2.3	2.3
Not Hispanic or Latino:
White5	3.1	3.0	2.7	2.1	1.9
Black or African American5	6.7	6.5	6.1	4.6	4.5
*Estimates are considered unreliable. Rates preceded by an asterisk are based on fewer than 50 events. Rates not shown are based on fewer than 20 events.
1Rates based on unweighted birth cohort data.
2Rates based on a period file using weighted data.
3Infant (under 1 year of age), neonatal (under 28 days), and postnatal (28 days–11 months).
4Persons of Hispanic origin may be of any race.
5Prior to 1995, data shown only for states with a Hispanic-origin item on their birth certificates.
6Average annual mortality rate.
Notes: The race groups white, black, American Indian or Alaska Native, and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. National linked files do not exist for 1992–94.
SOURCE: "Table 19. Infant, neonatal, and postneonatal mortality rates, according to detailed race and Hispanic origin of mother: United States, selected years 1983–2001," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, 2003 [Online] http://www.cdc.gov/nchs/hus.htm [accessed January 2, 2004]

Opponents contend that while obesity increases the risk of developing many diseases, it is not an ailment in itself but an unhealthy consequence of poor lifestyle choices. They liken it to cigarette smoking, a risk factor that predisposes people to disease, and they dispute the notion that labeling obesity as a disease will have a beneficial effect on the ability of public health organizations to alter the course of the obesity epidemic. They maintain that the public tends to view diseases as conditions that are contracted or contagious, and that with disease comes a victim mentality, rather than assumption of personal responsibility. Since many health professionals consider assumption of personal responsibility as crucial for the long-term success of obesity treatment, any action that releases people from assuming personal responsibility is counterproductive.

Another concern is that dollars spent to pay for weight-loss therapies would be diverted from other serious ailments, and some observers fear that the nation's health-care system could collapse under the weight of a far-reaching official policy that declares obesity a disease. Opponents to granting disease status to obesity predict that the financial ramifications would be devastating for taxpayers and the health insurance industry. Healthcare costs, already escalating every year, would skyrocket. Antiobesity programs would drive insurance premiums even higher and place unreasonable burdens on the already overburdened Medicare and Medicaid programs. Employers, especially small businesses, might be forced by high health-care costs to drop employee coverage altogether.

A related concern is the lack of universally accepted, effective treatment for obesity. If obesity is classified as a disease, which treatment or therapies should be covered? For example, if exercise is deemed beneficial, then health insurers might be asked to pay for gym memberships. Further, some opponents believe that it is not necessary to designate obesity as a disease in order to encourage Americans to seek treatment. They cite the more than $50 billion spent annually on weight-loss programs and services as evidence that Americans are not reluctant to seek treatment.

Although the debate has not been fully resolved, obesity is rapidly acquiring recognition as a disease. In 2002 the Internal Revenue Service ruled that for tax purposes, obesity is a disease, allowing Americans for the first time TABLE 2.2
Life expectancy at birth, at 65 years of age, and at 75 years of age, according to race and sex, selected years 1900–2001
[Data are based on death certificates]

	All races			White			Black or African American1
Specified age and year	Both sexes	Male	Female	Both sexes	Male	Female	Both sexes	Male	Female
At birth	Remaining life expectancy in years
19002,3	47.3	46.3	48.3	47.6	46.6	48.7	33.0	32.5	33.5
19503	68.2	65.6	71.1	69.1	66.5	72.2	60.8	59.1	62.9
19603	69.7	66.6	73.1	70.6	67.4	74.1	63.6	61.1	66.3
1970	70.8	67.1	74.7	71.7	68.0	75.6	64.1	60.0	68.3
1980	73.7	70.0	77.4	74.4	70.7	78.1	68.1	63.8	72.5
1985	74.7	71.1	78.2	75.3	71.8	78.7	69.3	65.0	73.4
1990	75.4	71.8	78.8	76.1	72.7	79.4	69.1	64.5	73.6
1991	75.5	72.0	78.9	76.3	72.9	79.6	69.3	64.6	73.8
1992	75.8	72.3	79.1	76.5	73.2	79.8	69.6	65.0	73.9
1993	75.5	72.2	78.8	76.3	73.1	79.5	69.2	64.6	73.7
1994	75.7	72.4	79.0	76.5	73.3	79.6	69.5	64.9	73.9
1995	75.8	72.5	78.9	76.5	73.4	79.6	69.6	65.2	73.9
1996	76.1	73.1	79.1	76.8	73.9	79.7	70.2	66.1	74.2
1997	76.5	73.6	79.4	77.1	74.3	79.9	71.1	67.2	74.7
1998	76.7	73.8	79.5	77.3	74.5	80.0	71.3	67.6	74.8
1999	76.7	73.9	79.4	77.3	74.6	79.9	71.4	67.8	74.7
20004	77.0	74.3	79.7	77.6	74.9	80.1	71.9	68.3	75.2
20015	77.2	74.4	79.8	77.7	75.0	80.2	72.2	68.6	75.5
At 65 years
19503	13.9	12.8	15.0	—	12.8	15.1	13.9	12.9	14.9
19603	14.3	12.8	15.8	14.4	12.9	15.9	13.9	12.7	15.1
1970	15.2	13.1	17.0	15.2	13.1	17.1	14.2	12.5	15.7
1980	16.4	14.1	18.3	16.5	14.2	18.4	15.1	13.0	16.8
1985	16.7	14.5	18.5	16.8	14.5	18.7	15.2	13.0	16.9
1990	17.2	15.1	18.9	17.3	15.2	19.1	15.4	13.2	17.2
1991	17.4	15.3	19.1	17.5	15.4	19.2	15.5	13.4	17.2
1992	17.5	15.4	19.2	17.6	15.5	19.3	15.7	13.5	17.4
1993	17.3	15.3	18.9	17.4	15.4	19.0	15.5	13.4	17.1
1994	17.4	15.5	19.0	17.5	15.6	19.1	15.7	13.6	17.2
1995	17.4	15.6	18.9	17.6	15.7	19.1	15.6	13.6	17.1
1996	17.5	15.7	19.0	17.6	15.8	19.1	15.8	13.9	17.2
1997	17.7	15.9	19.2	17.8	16.0	19.3	16.1	14.2	17.6
1998	17.8	16.0	19.2	17.8	16.1	19.3	16.1	14.3	17.4
1999	17.7	16.1	19.1	17.8	16.1	19.2	16.0	14.3	17.3
20004	18.0	16.2	19.3	18.0	16.3	19.4	16.2	14.2	17.7
20015	18.1	16.4	19.4	18.2	16.5	19.5	16.4	14.4	17.9

to claim a deduction for some health-care expenses related to obesity, just as they can for expenditures related to heart disease, cancer, diabetes, and other illnesses.