Obesity should be classified as a DISEASE because it is ‘not always patients’ fault’, scientists say

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Obesity should be classified as a disease because it isn’t always a patient’s fault they are fat, scientists have argued. 

Labelling it as a chronic condition, similar to asthma or epilepsy, could encourage people to come forward to get treatment rather than relying on fad diets.

Experts said it could be the key to tackling the obesity crisis, which has almost a third of British adults dangerously overweight.

They added the view that obesity is entirely self-inflicted reinforces negative views of overweight people and makes it more difficult for them to get help.

Research shows that people’s weight is influenced by both genetics and their environment, such as how accessible junk food is where they live. 

Obesity should be classified as a disease because it isn't always patient's fault they are fat, scientists have argued in the British Medical Journal (stock image)

Obesity should be classified as a disease because it isn’t always patient’s fault they are fat, scientists have argued in the British Medical Journal (stock image)

Writing in the British Medical Journal, Professor John Wilding, from the University of Liverpool, and Vicki Mooney, a former plus size model and executive director of the European Coalition for People living with Obesity, spelled out the definition of ‘disease’.

They said: ‘The Oxford Dictionary defines disease as “a disorder of structure or function… especially one that produces specific symptoms… and is not simply a direct result of physical injury.”‘

The World Health Organisation has considered obesity a disease since 1936.

Studies in twins show that 40 to 70 per cent of the variability in weight is inherited, the doctors said.

More than 200 gene variations influence weight, most of which are involved in appetite regulation, and those that increase weight are unlikely to be found in slim people.  

Fat distribution, which contributes to risk of metabolic complications, is also influenced by genes, Professor Wilding and Ms Mooney said.

OBESITY IS PARTLY CAUSED BY GENETICS – BUT IS MOSTLY A CHOICE, SCIENTISTS ARGUE

Obesity rates have soared by three-fold since 1975. 

But the trends are the same in people both with and without what are known as ‘fat genes’, according to a study published in the BMJ in June.

This suggests poor diet and lack of exercise – poor lifestyle choices – are mainly to blame, researchers said. 

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Scientists based in Norway looked at findings, including BMI measurements, from a previous study of 118,959 adults who had repeated height and weight measurements recorded between 1963 and 2008. 

Participants were divided into five groups depending on their genetic risk to obesity, a fifth being the most susceptible and a fifth being the least.

People in the top ‘genetic-susceptibility’ group were more likely to have a higher BMI than those identified as having a lower risk, it found. 

But the findings also showed BMI has increased for both genetically predisposed and non-predisposed people since the 1960s.

Lead author Maria Brandkvist, a PhD student, said: ‘Genetically predisposed people are at greater risk for higher BMI and that genetic predisposition interacts with the obesogenic environment resulting in higher BMI.

‘An altered dietary pattern is the most plausible environmental factor influencing excess energy balance.

‘However, a more sedentary lifestyle and possibly changes in the biological environment, such as toxins and microbiota, could also contribute.’ 

‘Thus body weight, fat distribution, and risk of complications are strongly influenced by biology – it is not an individual’s fault if they develop obesity.’ 

Recognising obesity as a disease would ‘help reduce the stigma and discrimination experienced by many people with obesity’, thus encouraging them to get medical help, they said.

‘Instead of discouraging them from seeking treatment it should give them permission to do so.

‘The stigmatisation of obesity leaves patients fearful of discussing their weight, and they turn to fad diets or non-prescription medication because they assume that their obesity is solely their responsibility.’   

Most people with obesity will eventually develop complications, such as type 2 diabetes, cancer or heart disease.

But those who do not could be considered as not having a disease, the doctors argued.

‘But unless we accept that obesity is a disease, we are not going to be able to curb the epidemic,’ the experts conclude. 

But the argument has been criticised by some doctors. 

Dr Richard Pile, a GP from St Albans, said the Oxford Dictionary definition of disease ‘is so vague that we can classify almost anything as a disease’.

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Also writing in the BMJ, he argued that recommending a change implies that current strategies in the NHS are doomed to fail. 

He said: ‘It presents a vision of obese people hearing the announcement that obesity is a disease on the radio, getting up off the couch, and heading out of the door for a brisk walk.

‘It suggests health professionals will slap themselves on the forehead in a eureka moment, shouting: “This changes everything.”

‘Labelling obesity as a disease risks reducing autonomy, disempowering and robbing people of the intrinsic motivation that is such an important enabler of change.

‘It encourages fatalism, promoting the fallacy that genetics are destiny.’ 

Dr Pile said suggested classifying obesity a disease would make people complacent about losing weight.

He said: ‘Self determination is vital when it comes to individuals taking control of their lives and making the best decisions for themselves.’

In response to the article in the BMJ, Timothy Frayling, Professor of Human Genetics at University of Exeter, said genetics play a large role in obesity.

He told MailOnline: ‘Whilst some doctors might worry that labelling obesity as a disease will demotivate people to change their lifestyle, the same argument could be made for many chronic diseases including disease risk factors, for example high cholesterol, and yet we do not blame people for their high cholesterol in the same way that we blame them for their obesity. 

‘The best evidence that obesity is not a lifestyle choice is to ask why many well educated well motivated people are overweight? The only people I know of who choose to become obese are sumo-wrestlers.’ 

The debate in the BMJ follows calls from the Royal College of Physicians (RCP) for the Government and the NHS to urgently recognise obesity as a disease. 

In January, the RCP said it wanted to see obesity recognised as an ongoing chronic disease to allow the creation of formal healthcare policies to improve care both in doctors’ surgeries and hospitals.

They said this would improve care, for example by widening access to bariatric surgery, which NHS bosses have been reluctant to fund.

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It argued that obesity is not a lifestyle choice caused by individual greed ‘but a disease caused by health inequalities, genetic influences and social factors’.

WHAT IS OBESITY? AND WHAT ARE ITS HEALTH RISKS?

Obesity is defined as an adult having a BMI of 30 or over.

A healthy person’s BMI – calculated by dividing weight in kg by height in metres, and the answer by the height again – is between 18.5 and 24.9. 

Among children, obesity is defined as being in the 95th percentile.

Percentiles compare youngsters to others their same age. 

For example, if a three-month-old is in the 40th percentile for weight, that means that 40 per cent of three-month-olds weigh the same or less than that baby.

Around 58 per cent of women and 68 per cent of men in the UK are overweight or obese. 

The condition costs the NHS around £6.1billion, out of its approximate £124.7 billion budget, every year.

This is due to obesity increasing a person’s risk of a number of life-threatening conditions.

Such conditions include type 2 diabetes, which can cause kidney disease, blindness and even limb amputations.

Research suggests that at least one in six hospital beds in the UK are taken up by a diabetes patient.

Obesity also raises the risk of heart disease, which kills 315,000 people every year in the UK – making it the number one cause of death.

Carrying dangerous amounts of weight has also been linked to 12 different cancers. 

This includes breast, which affects one in eight women at some point in their lives.

Among children, research suggests that 70 per cent of obese youngsters have high blood pressure or raised cholesterol, which puts them at risk of heart disease.

Obese children are also significantly more likely to become obese adults. 

And if children are overweight, their obesity in adulthood is often more severe.  

As many as one in five children start school in the UK being overweight or obese, which rises to one in three by the time they turn 10.  



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