I was a guest on the Sun News Network in Canada this morning, talking about the American Medical Association’s decision to classify obesity as a disease – not as a marker of disease, but as a disease in and of itself.  (That will come as a shock to the many obese people who live into their 80s and 90s while suffering from the disease – and yes, that happens.)

Obesity is not a disease. Obesity correlates with disease because the main drivers of many diseases – chronically elevated glucose and insulin levels – can also make you fat. But lots of obese people are healthy in spite of being fat, and lots of lean people are unhealthy. I mentioned awhile back that a small, lean co-worker asked me to look at his latest lab tests. His HDL was abysmally low and his triglycerides were way too high. Meanwhile, back when I was still classified as “obese” with 31% bodyfat, my HDL was high and my triglycerides were low. My lean co-worker is at much greater risk of dropping dead than I was back in my “obese” days.

As for why the AMA decided to classify obesity as a disease, Dr. William Davis already spelled it nicely out on his Wheat Belly Blog, so I’ll just quote him:

Well, it’s hard to know how the internal discussions at the AMA went until we get a look at the transcripts. But let’s take a look at the Obesity Action Coalition (OAC). I believe it tells the whole story.

The OAC Board of Directors is filled with bariatric surgeons, such as Drs. Titus Duncan and Lloyd Stegemann, people who make a living from procedures and surgeries like gastric bypass and lap-band. The largest contributors to the OAC? Eisai Pharmaceuticals, maker of BELVIQ, the new drug for weight loss; Ethicon EndoSurgery, makers of laparoscopic operating room supplies; Vivus, Inc., another obesity drug maker; the American Society for Bariatric Surgeons; and Orexigen, developer of the combination drug naltrexone-buproprion for weight loss, now in FDA application stage. (Recall that naltrexone is the opiate blocking drug taken by heroin addicts but now being proposed to be gain approval for weight loss.)

In other words, while it is being cast as something being done for the public good, the motivation is more likely to be … money: Bariatric surgeons gain by expanding the market for their procedures to patients who previously did not have insurance coverage for this “non-disease”; operating room supply manufacturers will sell more equipment for the dramatically increased number of surgical procedures; obesity drug manufacturers will have the clout to pressure health insurers to cover the drugs for this new disease.

As always, follow the money.

Over the weekend, I dug out the original footage from my Fat Head interview with Dr. Eric Oliver, author of Fat Politics, and put together a sequence of clips addressing the topic of obesity and disease. He told me back in 2008 that insurance coverage for weight-loss drugs and procedures was behind the push to label obesity itself as a disease.  Looks like that push is working.

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54 Responses to “It’s Official: Obesity Is Now A Disease”
  1. Lepoth says:

    Well, I guess that means I’m diseased now.

    Don’t forget to take your pills.

  2. Lyndsey says:

    Holy crap! I’m, like, SUPER diseased! D:

  3. Beowulf says:

    Treating obesity like a disease is like trying to turn the “check engine” light in a car into the problem itself. It’s an indicator, not a problem in and of itself.

    Exactly.

  4. Hi Tom,

    Nice interview. Many barbaric surgeons, including those in my local community here in Colorado, stand to profit from the recognition of obesity as a disease. However, there have been other docs, including myself, who have spent many years treating patients with the fear of not getting reimbursed because medical insurance companies do not typically pay primary care docs who choose to help patients lose weight.

    Whether or not you consider obesity a disease or a symptom of disease, we are dealing with chronic metabolic disorders. I applaud the AMA and their statement. Perhaps more docs might actually be willing to learn a thing or two about nutrition and share it with their patients. – Dr Jeff

    It would be nice if that’s how it works out. My fear is that it will just lead to more drugs and procedures to treat the “disease” instead of more interest in nutrition.

    • Be says:

      So all we need to do is to add “healthy” food as a deductible prescription in our health care plans? And who gets to define “healthy” food, the USDA?

      They already have defined healthy food. That’s how we got into this mess.

    • Kathy K says:

      Tom’s fear is well justified. I had emailed Tom several months ago to see how to arrange having him come speak where I work in East TN having shared my heath success (~130 lb loss) and Tom’s blog with our corporate wellness program manager. I have shared the link to Tom’s Fat Head video with all my co-workers who have seen my transformation because it explains the science at a broad level & in an entertaining way. I had hoped our corporate wellness program manager would help get Tom here. Instead I offended her and have had all further emails and contact attempts ignored once I pointed out the speaker on Metabolic Syndrome is associated with a clinic that markets meal replacements for weight loss as well as performs bariatric surgery when the meal replacements fail. He passed out samples of bars and shakes. The bars had 9 sources of sugar making up the 22-25 grams of sugar to the 6 grams of soy protein. Their practice also offers Corporate Wellness services. My guess (and it is only that) is that his appearance was at no cost to my employer and the expense written off as marketing. Sorry, Tom, that I blew it for you.

      No worries, Kate. You were right to speak up.

  5. Lori says:

    My mother is overweight (probably obese) and 83. A LC diet has brought her diabetes under control, but sadly, she hasn’t lost weight.

    Some people do have a disease–I’m thinking of the woman in Why We Get Fat whose upper body was very thin and lower body was very fat, for instance. But my feeling is that most people would see some weight loss just with smarter choices, and even more results for good health with some fine tuning. As Dr. Oliver said, people shouldn’t be obsessed with losing that last 10 pounds.

    Sure, obesity can be the result of a disease.

    • Jeane says:

      Low carb alone is not enough. You also have to lower you protein intake and up your fat intake. I myself eat about 40 grams of protein en 200-250 grams of fat. Do not eat carbs, except the ones coming with the cream. No fruit, no greens, except for about 40 grams of carrots to knibble on. When starting you need 2 weeks about 100 grams protein, after two week you must lower it.
      My breakfast consist of 3-4 ounces of real butter, melted in 4 ounces of 35% fat cream. In a bowl I put 1 egg and 5-6 yellow of egg. Mix together. Drink like that or put in your coffee. At midday I take broth of bones with some butter. Later that day only 2,5 ounces fresh fatty ecologic pork minced meat with wrapped around 1,5 ounce fatty fresh bacon slice, fried in butter. Slice in the middle and add some butter juice on it. As desert again 100-125 grams of whipped cream with about 1-2 ounces of sauce made of strawberry and some lemon juice. Good fatty food is also cream paté, made of liver. I eat the same every day!
      After a few days you must lose about 7-8 ounces a day or more. It is like a ketogenic diet. Do not eat fiber. Bad for your intestines.

      • Michelle B. says:

        I’m trying LCHF, but that sounds really digusting.

      • Lori says:

        Agreed, some people do need to take stronger measures, but not everyone is so carb intolerant. A friend of mine dropped 20 pounds at age 57 just by cutting back on the carbs. Her 50-year-old fiance lost some weight just by cutting out sugary drinks.

      • Firebird says:

        Carrots are a bit on the starchy side.

      • Trekkiemaiden says:

        Hi Leanne, thanks for your interesting post, I’m doing a fat fast too , to lose those last stubborn 10 pounds as I have plateaued for a couple of months. i only do this 5 days a week and then go to a normal LCHF at weekends. I need fibre, so take psyliium husks in an omlette everyday, which works only every 2-3 days as this really doesn’t equate to eating very much. I average about 1400 cals a day on this. So I was very interested to read your ideas to improve my variety.
        Michelle, this is a fat fast, its not the same as the LCHF, this is an emergency diet for when things get metabolically stuck. Not to be done longterm or permanently, which you are to going to do on the LCHF. Actually it’s quite tasty, the portions are small, – little and often but the high fat means you are satisfied and don’t go hungry. Works like magic.

    • Justin B says:

      My grandmother is about that age, and also was hoping to lose a bit of weight. I gave her the advice that I know, and she was pretty much already following it before, just now with the removal of all bread and potatoes. She has always been mostly fish and veggies. However, even without losing weight, and getting a bit discouraged, I reminded her that she is constantly assumed to be 10 years younger than she really is, so there is that.

      • Firebird says:

        I’ll be 49 in September. Recently a 44 year old woman, being trained by my friend who is her personal trainer, mistook me for a 30 year old. She’s always complimenting me on my skin tone. And at 48 years, 9 months of age, I have no crows feet emerging from the corners of my eyes, though I wish my eyesight was what it was when I was 30.

        Low carb, moderate protein and fat, plus a fitness routine entrenched in resistance training has been my best medicine for maintaining good physical health, though I cannot speak to my mental health ;)

    • Willa Jean says:

      Take a look over at Blood Sugar 101. Jenny has lots to say about weight loss for diabetics, and, while I’m not technically diabetic, her info helped me bust a seemingly endless plateau. Maybe it will help your mom. In the meanwhile, a healthy low carb diet can’t do anything but help.

  6. TJ Huber says:

    I’m going to swim against the current here. DEO GRATIAS! I have a disease! I no longer have to watch what I do, I can drink to excess, I can smoke, I can eat myself into the ground, lie, steal, cheat on my wife and let all discipline go. I have a disease, and I am proud of it! Since I have a disease it is now somebody else’s job, no, holy obligation, to “cure” me, take care of me and be responsible for me. How much better can it get?

    There is that advantage.

    • David says:

      What are you talking about? When did anyone ever say that people with diseases have no responsibilities in improving their own health?? It’s the opposite: people with diabetes, cancer, or other diseases have to have more discipline in taking care of themselves.

      I’m not saying I agree with the AMA’s decision but this satire – if that’s what it’s supposed to be – is way off the mark.

      Satire?

      • mm says:

        Is something being a disease an excuse to do nothing, or to do less, to treat it?
        I suppose this is a matter of perception. That being said, some people already give up on weight loss by blaming it all on the technicality that they have bad genetics, so calling it a disease in addition to bad genes won’t have that much of an impact on the defeatists of the world.
        Disease = more drugs, I think we can all agree to that.

        That’s my fear.

  7. Cyborcat says:

    I just feel that we need to take all the mysticism out of weight loss–it’s really not that complicated once you learn about carbs and how they effect weight gain and loss. Declaring it a disease takes the personal responsibility out of it and makes people feel even more helpless about their weight and therefor less likely to try to do something about it without resorting to drugs and surgery.

    Since most people have been given lousy weight-loss advice that fails, they do feel helpless — which works out well for the drug-and-surgery crowd.

    • Walter Bushell says:

      Oh, yes. I remember being so much on a Weight Watcher’s diet, that I managed to convince myself that I was “entitled” to more WW treats. When I realized my mistake, I decided that being crazy was worse than being fat. Of course, I was hungry at the time and that may have swayed my decision.

      In starvation mode the brain don’t work so well, which explains a lot of history.

  8. Ghost says:

    I’ve always told people that obesity its self is not a disease, but a symptom of disease.

    I guess now that its officially a ‘disease’ they can push starvation diets (Bariatric surgery) rather than look into the reasons WHY someone may be obese.

    That pill though, I wonder if it’s got something to do with wheat, because isn’t wheat addictive in a way similar to opiates? A pill to reduce carb cravings?

    I reduced carb cravings by giving up carbs. Didn’t take long for the cravings to vanish.

  9. Suzanne Garrett says:

    I am pleased that this decision was made. I think the opportunity to receive medical treatment for managing obesity paid for by insurance will make such treatment more accessible. Ideally it will drive research and reduce then number of charlatans who practice because they have so little competition from medical practitioners. People are desperate to take/keep weight off.

    That would be nice, but my fear is that it will lead to more drugs and more surgeries, not more (good) dietary advice.

    • Brandi says:

      This decision just angers me. I lean more towards the opinion that people will use this as an excuse. And also I have been obese in my lifetime so I feel that entitles me to make the following statement. Every insurance that I have had for the past few years has covered gastric bypass which is what a $50,000 surgery right? Well I feel like that is a situation you put yourself in, you can lose weight without surgery. Meanwhile my insurance doesn’t cover squat towards infertility testing or treatment. Which is a real disease that is not brought about by life choices. I’m sorry but that just infuriates me.

  10. Vic says:

    Yeah, I too am now a disease. Since I have up to now lost 40 pounds low carbing I guess I am less of a disease. The point about the bad advise is correct, if I had continued to follow my Drs advise I would still be gaining. And to me there is the problem. An entire segment of the population has been labeled and diagnosed based on the BMI, and hospital after hospital is revving up to put these folks on their version of a diet, it may be shakes, coupons for Weight Watchers, or some expensive delivered meals program. When that fails the push will be on for the highly profitable WLS, and they have one for everybody–don’t want your stomach amputated? Fine we can strangulate it for you instead! Why we even have cute little “mini- bypass surgeries” and these darling little sleeves! You still won’t “Do what it takes?” Then obviously you are either crazy or non-compliant or both and it WILL go on your PERMANENT record! erg!! I think I’m going to go walk the dogs, they at least, I can understand.

  11. Marilyn says:

    It would be nice if this worked out so that doctors could become informed on nutrition and actually help people with a weight problem. Judging from the way things have gone with other diseases/conditions, however, I would expect the definition of overweight/obese to be continually adjusted downward over the years, and for doctors to be expected to use “approved” treatments/drugs — which, of course, would not include anything so dangerous as low carbohydrate.

  12. Linda says:

    Hi Tom,

    By coincidence today, before my daily check of your blog to see what’s new, I read the article about the AMA declaration of obesity being a disease on cnn.com. In that article there is a quote from psychologist Peggy Elam which says it all:

    “I can guarantee you that if there was no money to be had in this, the term ‘obesity epidemic’ would not exist,” said clinical psychologist Peggy Elam.

    As you said in both Fat Head documentaries: “follow the money.”

    She’s spot-on.

  13. Bo says:

    If Obesity officialy is a disease now it is even more easy to medicate patients by the pill-popping-allopathic-shooting-from-the-hip goons (MD doctors) My self I have an interest in naturopatic medicine that advocate micronutrients such as trace-elements and minerals, can have a huge inpact on our health, this even mainstream pundits admit.

    Thesis: A high level of vitamines and minerals per carbohydrate-calorie is perhaps a formula that is optimal for health, it maybe explains why people starting lowcarb often than not gain their health fast even without mineralsupplement. Normailzed levels of insulin is also a factor of cource, as is the fact that we avoid crappy carbs such as modern wheat. all of the above helps I belive.

  14. Kristin says:

    This explains a lot. My father died last Pearl Harbor day after being progressively more fragile for years. He was so proud of his statin-controlled cholesterol of 130 but he had sores that just kept getting bigger (no cholesterol to repair them.) He had been heavy his entire life. He lived a pretty standard 1960s kind of life and diet (meat, potatoes, cooked veg, sandwiches, eggs, lots of breakfast cereal) and had a quadruple bypass in 2000.

    Mother was very upset when the death certificate came back. Cause of death – obesity. She said Dad was always sick ad tired of people judging his health on his weight. Until the last 10 years he fished and hunted regularly and was active in his Masonic and church work. His size did not slow him down. It was a final insult to him to have his death blamed on his weight. His sudden death indicated that the true cause was probably an embolism. I’m posting this one on my FB feed. I would really like my friends to hear what Eric Oliver has to say on this subject. It was very articulate.

    I’d say someone has a vested interest in attributing his death to obesity.

    • SmoledMan says:

      Overeating all the time is a mental disorder.

      No, it’s the effect of a biochemical/hormonal disorder.

  15. mlantenac says:

    What’s closer to the truth is that being a politician and/or bureaucrat is a frickin’ disease. God help us we need a cure…..

    Or at least a good vaccine.

  16. AndreaLynnette says:

    I’m not exactly an expert in the field of healthcare and health insurance, but can’t insurance companies deny treatments in the case of a pre-existing condition? So, couldn’t an insurance company say “your heart problem/diabetes/stroke/coronary artery disease/etc. is because of your obesity and therefore not covered”?

    Or am I just paranoid?

    If you’re not paranoid, it means you’re not paying attention. We now have the federal government stepping in and telling insurance companies what they’ll cover, like it or not. You know, to make sure people don’t die of life-threatening conditions such as a lack of “free” birth control.

    • AndreaLynnette says:

      The government getting involved will make it worse, not better. Aren’t the government health care systems in places like Canada and Britain and others telling smokers and people above a certain BMI that they can’t have X treatment because they smoke or are overweight?

      They’re telling people they can’t have a treatment because they aren’t worth the cost. And in the case of overweight people, they’re making moral judgements on the worth of people based on their inability to lose weight on a program that fails 95% of the time.

      Never fear. Once the same government that has IRS employees using our tax dollars to buy online porn and diet pills takes over the health system completely, it’ll all be efficient and competent.

      • Nick says:

        Since the “Affordable Care Act” was upheld by citing the Commerce Clause, how long will it be before we are forced to take part in government approved “weight loss” programs under the same Commerce Clause?

        I’m not an extremist by any means, but doesn’t this give them the power to determine what we are allowed to eat, what medicine we can take, what health programs that we have to participate in, because our habits can affect health insurance coverage and costs, and poor health patterns can raise health care costs for everyone, thereby affecting commerce?

        And we see how spot on the people in charge are in regards to eating healthy.

        The Commerce Clause is the most-abused section of the Constitution. Congress has decided it gives them the power to pass pretty much any law they like, thanks to some truly crappy Supreme Court decisions back in FDR’s day.

        How’s this for legal reasoning: if you don’t participate in interstate commerce, we can still regulate you … because by NOT participating in interstate commerce, you’re AFFECTING interstate commerce.

      • Walter Bushell says:

        Perchance buying government employees porn would be a wise use of money, keeping them from causing trouble.

        Now that you mention it, I’d rather they watch porn than write more regulations.

    • Lori says:

      It’s bad enough that states stepped in and decided medical insurance had to cover this, that and the other thing whether customers wanted those things or not. When I was a student in the early 1990s, I bought major medical for $50 a month. Any medications and office visits were out of my own pocket, but a major illness would have been covered. Some five years later, when I was laid off from work, insurance through COBRA was $300 a month. Major medical had been regulated out of existence. On a $10 an hour job, I’d have had to shut off all the utilities or stop buying groceries to afford insurance.

      We’ve been carrying a policy that covers us for injuries and major ailments (my knee surgery was mostly covered), while routine medical care is out of pocket. I’m dreading seeing what happens to my premiums when ObamaCare kicks in and forces me to buy WAY more insurance than I want or need … to make health care more “affordable” of course.

  17. ShannonCC says:

    I agree the focus should be on health, not weight. As you pointed out, you can be fat and healthy and skinny and not.

    Sure, often extreme weight (in one direction or another) is a symptom of something, but even then the weight shouldn’t be the focus. If you “treat” the weight without figuring out why the person is so over or under weight, it will just revert back to where it was when the treatment stops. It’s like stuffing an overly thin person with extra food to get them to gain weight and never looking to find out that they have cancer that is causing the weight loss in the first place. They might gain weight but no, they aren’t healthy.

    And if we focus just on weight there are plenty of unhealthy ways to get thin. A friend of mine (not making this up) quit smoking and then, years (and many pregnancies and some weight gain) later was smoking again and told me it helped with reducing her food cravings (headdesk). And of course there are pills you can take, surgery, bulimia.

    I refuse to do crazy things to lose weight. My emotional health is also important to me, and as someone who has been fat since childhood and tried many times to lose weight, I know how easy it is to fall into obsession or starvation. When I eat paleo and exercise (not crazy exercise, but a minimal amount, regularly) I tend to be slimmer than when I don’t do these things. Since I’m unwilling to take drastic measures maybe I’ll never be “slim”, but eating this way my blood pressure is fantastic, my triglycerides went way down (they were up really high on the “healthy whole grain” diet we ate), I get to eat yummy food and not starve myself and I’m not crazy obsessed with my weight. That’s worth more than a dress size.

    Dr. Mary Vernon put it nicely in a lecture: I don’t care how much you weight. I care about what you’re burning for fuel.

  18. Marshall says:

    I want to buy bacon using my Health Savings Account now!

    Do it while you’re still allowed to have a Health Savings Account. People with those accounts tend to make their own medical decisions and choose to pay for routine care out of pocket, which isn’t popular in D.C. right now. They want all you health-conscious people who need little or no medical care paying into their system.

  19. Mike P says:

    This is definitely worrisome. As you may know by now, Mark Sisson also wrote about this today and he highlighted a very interesting viewpoint – the legal one. By calling it a disease, does that put all of my favorite blogs [and our rights] at a similar risk to what Steve Cooksey experienced? I hope not….

    Keep on keep’in on…

    Mike P

    If they come after people like Mark Sisson, Robb Wolf, Jimmy Moore, Richard Nikoley, yours truly, etc., they’re going to have a hell of a fight on their hands.

  20. Kate says:

    Just what we need: another disease which will eventually cause yet another “disability” to be created.

    And yes, that will probably happen.

  21. Roby says:

    Oh! Does this mean that I can certify my Dog as a service dog?! you know.. since my pup helps me stay active… lol

  22. Rick says:

    And just think how many people will be told they are obese, and therefore diseased, when BMI is used solely as the measuring tool. Imagine all those “diseased” pro athletes and bodybuilders with 10-15% bodyfat, and anyone who weighs more than 200 pounds. Basically the Obesity Apocalypse!

    Indeed.

  23. Ulfric Douglas says:

    Surely the health-insurance companies will have to rush to insert clauses barring them being liable for people catching this disease : or they’re going to be paying for all the gastric bands!
    It doesn’t make any sense. FATness is not a disease, duh.

  24. TBM says:

    Doctors are more far more likely to dismiss a person’s cardiac symptoms as less serious or mere anxiety if they’re lean. Especially if you’re lean and young! Conversely they’re more likely to just give the easy answer of blaming weight for symptoms which may have nothing to do with weight. Either way they’re not as thorough.

    Good point. I read a book awhile back titled “How Doctors Think.” The author (a doctor) described a case in which a lean, muscular park ranger went to the hospital because he was sweating, having difficulty breathing, etc. Someone gave him a pill and sent him home. Turns out he was having a heart attack, which no one bothered to check because he looked so healthy.

  25. Bill C. says:

    This is going to be great. Now they can force insurance companies to pay for the mistreatment of obese patients. The doctors will make more money, the drug companies will make more money, and yes, the insurance companies will also make more money because we will all get to pay higher health care premiums! Also, now millions more Americans have a pre-existing condition……

    That sounds about right.

  26. Ed says:

    Obesity as a disease?? Wow, great way to pay for the new Mercedes.

    Our perception of how prevalent obesity is depends on large part in where we make the observations. When I am in my local Whole Foods market I rarely see anyone who is slightly more than a little overweight. Go to our local Walmart and it would appear half of the world must be morbidly obese.

    It’s regional too. In our area, I really don’t see many obese people. But when we travel, that can change rather quickly.

  27. Bret says:

    Great interview with Dr. Oliver. He is a brilliant person, and articulate too. I found the full-length episode of the Stossel show featured in your Food Police video and watched Dr. O’s appearance and comments for the first time this morning. He did a splendid job debating and debunking Banzhaf and Roth without stooping to their level and being pedantic.

    I wish more university scholars were like him.

    I agree wholeheartedly.

  28. Cath says:

    Obesity is self inflicted. Unless it is children, don’t even get me started on honey boo boo!

  29. Obesity is both complex and controversial. And to put it mildly, there are differing opinions about whether or not classifying obesity as a disease would improve health outcomes.

  30. Amanda Reed says:

    When I first heard this news, I was ecstatic, because it meant that I may finally be able to get bariatric surgery. I had been trying for years, unsuccessfully, to lose weight and keep it off. I started looking very seriously at bariatric options but then decided to give changing my diet one more go. I decided to check out low carb recipes online, and discovering that there are about a million new recipes helped me make the decision to try again. I had tried LC back in 04, and failed miserably because I couldn’t live without foods like pizza and donuts. Well now there are tons of recipes for those things! So I joined an LC group on FB and found out that I’d been doing it wrong last time, low carb and high protein, when I needed high fat. That scared me a bit (eating high fat), until someone suggest I watch Fat Head and check out this site. Mind = blown.

    Now I realize that my fat isn’t the disease, I suppose what we’ve been brainwashed to believe is the disease! And I’ve also made the decision that surgery is not for me. Frankly, I think eating LCHF is easier. I’ve since changed my entire family over to LCHF. I’ve watched the documentary with my kids and with my husband, and continued to research, reading up on the Wheat Belly website. It’s mind boggling what the USDA, CSPI and the pharmaceutical companies along with B.G. have done to us in the name of a buck. Jerks.

    Thanks for outing them. I wish the entire world would watch this documentary with an open mind and an open heart.

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