Is obesity a disease?

Two years ago, doctors declared obesity a disease, but critics say, “Don’t pathologize my size!”

Two years after the American Medical Association—the country’s largest doctor’s group—declared obesity a disease, disagreement continues.

“Some people felt that this is going to lead doctors to take it more seriously and to address obesity with more compassion and respect,” said health researcher Rebecca Puhl, Deputy Director of The Rudd Center for Food Policy and Obesity at the University of Connecticut.

Others supporters said they hoped that classifying obesity as a disease would lessen stigma.

“I don’t see the logic in that at all. They say it will lessen the ridicule and blame fat people endure. But I say the way to lessen size-ism is to stop being size-ist,” said activist photographer Kimberly Massengill. Online and for her photographic work she uses the name Substania Jones.

When the Rudd Center surveyed Americans about their views, researchers found that most people, around 70 percent, were unaware of the new designation. Puhl, who lead the research, says AMA had its say back in 2013, but she also wanted to hear from the public.

“It’s important to know how people are thinking about the issue, because that effects how we deal with issues in our own lives,” she said.

There haven’t been many studies yet, but health researchers wonder if the new “disease” label would lead to discrimination at work, or perhaps make people feel pessimistic or fatalistic about getting healthy.

In the national survey, the majority of respondents, supported classifying obesity as a disease. About 40 percent agreed with statements in opposition.

When The Pulse conducted its own informal sidewalk poll, tourists and office workers in Philadelphia had more questions than opinions. They asked if obesity has a cure, and wondered what kinds of doctors typically care for people with obesity.

Rebecca Puhl says ever since the big pronouncement from the American Medical Association, the obesity conversation has shifted. Americans are talking more about genetics, food availability and the other complex factors that can lead to weight gain, she said. Puhl says she hears more counter-arguments to the messages from the diet industry, food makers and the fashion world.

“These are message that really say: ‘You can have whatever body you want, you just have to work hard, you just have to try the latest diet, or the latest conventional new fad,” Puhl said. “Those kinds of messages are not only not accurately scientifically, but they really perpetuate this kind of bias and blame of people.”

Excess fat can hurt health. In many people it messes with appetite and makes it hard for the body to regulate blood sugar, and that can lead to diabetes and heart trouble.

But, sometimes it doesn’t. It’s possible to be healthy at any size. Doctors say there are fit people who won’t ever experience health problems because they carry more weight.

“There are some rare individuals who do have a high BMI (body mass index) because of a lot of fat, but their body reacts in a way that isn’t problematic,” said Drexel University psychologist and obesity researcher Meghan Butryn.

She says medicine doesn’t yet have an accurate predictor tool.

“To understand who are the folks who are in that category and are going to stay, versus who are the folks for whom the weight is just kind of a ticking clock that’s going to eventually produce other problems for them,” Butryn said.

Body mass index is how most people define obesity. It’s a calculation of weight and height, and if yours is above 30, you fall in the government’s obese category.

But the measurement is imperfect, says Ted Kyle a board member and volunteer for the advocacy group, the Obesity Action Coalition.

For instance, BMI doesn’t account for the amount of muscle a person carries, and that can push them into the obese range. BMI should be used only as a rough screening tool for obesity, Kyle said.

“Just like a fever is not a diagnosis of a particular infection, it’s a sign that you might have an infection,” Kyle said.

A disease blocks the way the body works, and Kyle says that definition fits obesity. Still he’s careful about his language.

“You won’t find me using the word ‘obese,'” he said. “Calling someone obese is no better than calling someone handicapped, or diabetic or autistic—you are defining someone by their health condition,” Kyle said.

Photoactivist Substantia Jones hates the label “obese,” but feel free to call her fat.

“I say fat because the word fat is a morally neutral descriptor, the word overweight however is a term of judgment suggesting that there is an agreed upon line over which we mustn’t exist,” Jones said.

She says BMI has become a sloppy shorthand for real medical diagnosis.

“I’m fat, but I no more have obesity, than I have shortness, or I’m stricken with blue eyes, or trying to recover from end-stage curly hair.”

Jones’ curly hair is red. She wears bright lipstick. In any room she stands out.

Her picture series The Adipositivity Project gives big people a stage.

“I do it by demystifying the fat body and giving it the respect and visiblity too often denied by the media and popular culture,” Jones said.

The gallery is a “a parade of happy, naked, fat people mostly women, some men, some transgender folks.”

Research shows that physicians have some of the same biases against fat people as the general public. Jones worries that calling obesity a disease complicates the already tricky relationship between doctors and patients.

“A doctor’s first inclination is to say, ‘You’re having a symptom, it’s because you need to lose weight,'” she said.

Jones says she has several friends who were misdiagnosed—or their care was delayed—because the doctor couldn’t see beyond their size.

Drexel University researcher and psychologist Meghan Butryn says she’s thought through some of the potential downfalls of designating obesity as a disease, but she’s convinced that the benefits outweigh the risks.

Two-thirds of Americans are overweight or obese. One in three of us are obese.

“It’s actually the minority of adults now in the United States who are in the BMI range we would consider healthy,” Butryn said.

Lots of us successfully shed pounds on our own, but nearly everyone creeps back to his or her original weight—or gains more—within five years. At Drexel, Butryn and her team study ways to keep weight off.

“We don’t expect when people have other disease, that they can just choose to cure themselves,” she said.

Supporters of the “obesity as disease” designation hope it will open more doors to obesity treatment.

In recent years, the government approved four prescription weight loss drugs, but Medicare doesn’t cover any of them. Right now, Medicare does pay for intensive behavior-change counseling, and more insurance plans are covering weight-loss surgery.

Ted Kyle from the Obesity Action Coalition says between counseling and surgery—there are many anti-obesity interventions, and he says weight loss is only a small part of treatment.

Weight loss typically only happens for 6 to 12 months, treating obesity should be about staying healthy the rest of your life, he said.