OnMedica – News – Should we recognize obesity as a disease?

Would medicalization encourage people to come forward for effective treatment or reduce their motivation?

If we do not accept the fact that obesity is a disease, ineffective approaches will persist, based on the "mistake that obese people have to make more effort" – and recognize it as such would encourage people to seek treatment, according to two experts from around the world BMJ. But another writer in the same head-to-head* indicates that medicalization would not only reduce power, but also reduce motivation.

Professors John PH Wilding (University of Liverpool) and Vicki Mooney (European Coalition for People with Obesity, European Association for the Study of Obesity), Obesity and Endocrinology Researcher, support that obesity develops due to abnormal biological regulation of energy balance and multiple complications, so this should be considered a disease. They point out that genetic and environmental factors contribute to its etiology and the underlying biology of weight regulation, fat storage sites and the risk of complications. They add that metabolic and other complications of obesity include type 2 diabetes, fatty liver and hormone-dependent cancers; mechanical complications of joint pain, arthritis, increased obstetric risk and sleep apnea are common, and obesity can affect mental health, partly to because of the stigma.

The pair notes that a modified environment, rather than genetics, is at the root of the recent rapid increase in the prevalence of obesity and that it is also strongly related to social deprivation, some environments being "more obese" than others. They argue that "despite these facts, the prevailing view is that obesity is self-inflicted and that it is entirely up to the individual to do something."

They also cite research on attitudes towards obesity in 11 countries, which found that although 71% of the 2,800 health professionals thought that patients did not want to talk about their obesity, only 7% of the 14,500 obese people were of this opinion. Recognizing obesity as a chronic disease with serious complications rather than as a way of life should help reduce the stigma and discrimination experienced by many people suffering from obesity. Instead of discouraging them from seeking treatment, he should give them permission to do so.

They do not believe that recognizing obesity as a chronic disease with serious complications, rather than as a way of life, would eliminate personal responsibility, no more than in other chronic diseases – and, did he said, eliminating stigma "should help reduce the stigma and discrimination suffered by many obese people" and give them permission to seek treatment.

Dr. Richard Pile, general practitioner of St Albans who is particularly interested in cardiology, says that although the Royal College of Physicians believes that obesity must be recognized as a chronic disease to be fought with success, this could actually worsen the results of individuals. and society.

He argues that medicalizing obesity is not just harmless, but reduces autonomy, "thus depriving individuals of the intrinsic motivation that constitutes such an important driver for change," and encouraging fatalism , promoting that genetics is a destiny. He adds, "I do not need to cite here randomized controlled trials and systematic reviews because I've found the patients' state of mind every day for nearly two years." decades in general medicine. There is a significant psychological difference between having a risk factor for which you have a responsibility and the control of it and having an illness that someone else is responsible for treatment. "He thinks that the" campaign "to medicalize obesity is motivated by health care providers and the pharmaceutical industry, who will benefit" when health insurance and clinical guidelines encourage drug treatment and surgery"

Wilding JPH, Mooney V, Pile R. Face to face: Should obesity be recognized as a disease? BMJ 2019; 365: 14258 doi: 10.1136 / bmj.l4258