Feature Articles: Food, Fitness and
Is Obesity a Disease?
Stephen D. Ball, Ph.D., Nutritional Sciences, College of Human Environmental Sciences, University of Missouri-Columbia
There is little question that Americans are getting
fatter despite one third of all adults trying to lose weight
at any given time. A staggering 30 billion dollars are being
spent annually on weight loss products and promotions, yet
as a nation we are gaining weight at an unprecedented rate.
Some statistics report that approximately half of all adults
in this country can be considered overweight and nearly one
third can be classified as obese. Childhood obesity has also
doubled in the last 20 years. These epidemic proportions
have forced the medical community, fitness and health
professionals, dieticians, and government agencies to "wage
a war on obesity." Former President Clinton was even
encouraged to declare obesity a national health crisis and
in 1998 the World Health Organization officially declared
obesity a disease.
Currently there is a heated debate within the fitness and
health care professions over the classification of obesity
as a disease. There is little question that obesity is
associated with a variety of negative health risks such as
high blood pressure, hyperinsulinemia, increased cholesterol
levels, diabetes, and even certain cancers. However, it is
still unclear if obesity is the cause of these risk factors.
I believe it is too premature to declare obesity a disease,
and that by doing so, it will only make the situation worse.
Why? First, is obesity itself generating the associated
health risks? Perhaps obesity is only a marker for poor
health but is not the direct cause. Research has not been
able to definitively conclude obesity to be the causal
factor of its associated negative health outcomes. Research
has shown that diet and activity levels, contributors to
obesity, are also related to cardiovascular disease, cancer,
and strokes despite body weight. In addition, there is
strong evidence that overweight, but active individuals, are
at a lower risk for cardiovascular disease than thinner
counterparts that are not active. In a series of landmark
studies at the Cooper Institute, renowned epidemiologist
Steven Blair (1996) found that the best predictor of
mortality was cardiovascular fitness independent of body
weight, Body Mass Index (BMI), or % body fat. In other
words, an obese person by BMI or % body fat standards that
has good cardiovascular fitness is at a significantly
reduced risk of all causes of mortality compared to a normal
weighted individual that has low cardiovascular fitness. In
other words, you can be overweight, or even obese, as long
as you have good cardiovascular fitness. It seems that being
overweight or obese becomes less of a factor when activity
and diet are controlled for, something that most obesity
researchers have not considered. More research must be done
in order to distinguish the contribution of each before we
can clearly say that obesity itself is the culprit.
By declaring obesity a disease many unhealthy strategies
for weight loss (stomach stapling, liposuction, diet pills,
body wraps, herbal remedies, etc.) for weight loss might
become warranted. Doctors could justifiably use these
treatments and feel confident that they are improving the
client's health simply by decreasing his or her weight.
Pharmaceutical companies would be able to market their quick
fix pills and quacks could promote radical diets that
promote fast weight loss. It must be emphasized that the
effect of these treatments would only be temporary since
they don't address long term behavior change such as
lifetime physical activity and improved dietary habits. In
addition, even if weight loss is achieved and maintained
there is no guarantee that it will be accompanied with
Finally, calling obesity a disease will likely promote
our nation's preoccupation with weight loss. This would take
away from focusing more on the processes of healthy living
and would undermine the entire purpose of health promotion.
The newly warranted unhealthy weight loss practices would
ultimately decrease the public's overall health and would
actually drive health care costs up. We must focus not on
the product (weight) but on the process (healthy behaviors).
We shouldn't be waging a war against obesity but rather a
war against inactivity and poor lifestyle choices. Perhaps
it would be better to declare inactivity a disease. Maybe
this would finally divert attention away from the bathroom
scale and help us to start focusing more of our efforts on
increasing activity and fitness levels.
Key Reference: Lee, C.D., Blair, S.N., Jackson, A.S. (1999). Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. American Journal of Clinical Nutrition, 69:3, 373-380.
Last update: Tuesday, May 05, 2009