There is a certain irony in the nearly immediate juxtaposition of the rare introduction of a new FDA-approved drug for weight loss (Belviq) to the marketplace and the recognition of obesity as a “disease” by the AMA. A line from the movie Jerry Maguire comes to mind: “You complete me!” Drugs need diseases; diseases need drugs.

And that’s part of what has me completely worried. The notion that obesity is a disease will inevitably invite a reliance on pharmacotherapy and surgery to fix what is best addressed through improvements in the use of our feet and forks, and in our Farm Bill.

Why is the medicalization of obesity concerning? Cost is an obvious factor. If obesity is a disease, some 80 percent of adults in the U.S. have it or its precursor: overweight. Legions of kids have it as well. Do we all need pharmacotherapy, and if so, for life? We might be inclined to say no, but wouldn’t we then be leaving a “disease” untreated? Is that even ethical?

On the other hand, if we are thinking lifelong pharmacotherapy for all, is that really the solution to such problems as food deserts? We know that poverty and limited access to high quality food are associated with increased obesity rates. So do we skip right past concerns about access to produce and just make sure everyone has access to a pharmacy? Instead of helping people on SNAP find and afford broccoli, do we just pay for their Belviq and bariatric surgery?

If so, this, presumably, requires that everyone also have access to someone qualified to write a prescription or wield a scalpel in the first place, and insurance coverage to pay for it. We can’t expect people who can’t afford broccoli to buy their own Belviq, clearly.

There is, of course, some potential upside to the recognition of obesity as a disease. Diseases get respect in our society, unlike syndromes, which are all too readily blamed on the quirks of any given patient and other conditions attributed to aspects of character. Historically, obesity has been in that latter character, inviting castigation of willpower and personal responsibility and invocation of gluttony, sloth, or the combination. Respecting obesity as a disease is much better.

And, as a disease, obesity will warrant more consistent attention by health professionals, including doctors. This, in turn, may motivate more doctors to learn how to address this challenge constructively and compassionately.

But overall, I see more liabilities than benefits in designating obesity a disease. For starters, there is the simple fact that obesity, per se, isn’t a disease. Some people are healthy at almost any given BMI. BMI correlates with disease, certainly, but far from perfectly.

The urge to label obesity a disease, and embrace the liabilities attached to doing so, seems to be a price the medical profession is willing to pay to legitimize the condition. It may also be an attempt to own it (and the profits that come along with treating it), whereas that right and responsibility should really redound to our entire culture. Is it necessary for obesity to be a disease for it to be medically legitimate? I think not.

Carbon monoxide poisoning is medically legitimate, but it is not a disease — and there’s a good reason for that. It is poisoning, so the fault lies not with our lungs, but with what is being drawn into them. Your lungs can be working just fine, and carbon monoxide can kill you just the same. Perfectly healthy, disease-free bodies can be poisoned.

None would contest the medical legitimacy of drowning. If you drown, assuming you are found in time, you will receive urgent medical care — no matter your ability to pay for it. If you have insurance, your insurance will certainly pay for that care.

But drowning is not a disease. Perfectly healthy bodies can drown. Drowning is a result of a human body spending a bit too much time in an environment — under water — to which it is poorly adapted.

And so is obesity. Our bodies, physiology, and genes are much the same as they ever were. Certainly these have not changed much in the decades over which obesity went from rare to pandemic. What has changed is the environment.

We are awash in highly-processed, hyper-palatable, glow-in-the-dark foods. We are afloat in constant currents of aggressive food marketing. We are deluged with ever more labor-saving technological advances, while opportunities for daily physical activity dry up.

We are drowning in calories. And that’s how, in my opinion, we should make obesity medically legitimate: as a form of drowning, not as a disease.

With drowning, we don’t rely on advances from pharmaceutical companies. No one is expecting a drug to “fix” our capacity to drown. Our capacity to drown is part of the normal physiology of terrestrial species.

Our capacity to get fat is also part of normal physiology. Obesity begins with the accumulation of body fat, and that in turn begins with the conversion of a surplus of daily calories into an energy reserve. That’s exactly what a healthy body is supposed to do with today’s surplus calories: store them against the advent of a rainy (i.e., hungry) day tomorrow. The problem that leads to obesity is that the surplus of calories extends to every day, and tomorrow never comes.

Thinking of obesity as a form of drowning offers valuable analogies for treatment. We don’t wait for people to drown and devote our focus to resuscitation; we do everything we can to prevent drowning in the first place. We put fences around pools, station lifeguards at the beaches, get our kids to swimming lessons at the first opportunity, and keep a close eye on one another. People still do drown, and so we need medical intervention as well. But that is a last resort, far less good than prevention, and applied far less commonly.

There is an exact, corresponding array of approaches to obesity prevention and control; I have spelled them out before.

Disease is when the body malfunctions. Bodies functioning normally asphyxiate when breathing carbon monoxide, drown when under water for too long, and convert surplus daily calories into body fat. Perfectly healthy bodies can get obese. They may not remain healthy when they do so, but that is a tale of effects, not causes.

The most important reasons for rampant obesity are dysfunction not within our individual bodies, but at the level of the body politic. We do need medicine to treat obesity, but more often than not, it is lifestyle medicine. Lifestyle is the best medicine we’ve got — but it is cultural medicine, not clinical.

That’s where our attention and corrective actions should be directed. If calling obesity a disease makes us treat the condition with more respect, and those who have it with more compassion, and if it directs more resources to the provision of skill-power to adults and kids alike, it’s all for the good. But if, as I predict, it causes us to think more about pharmacotherapy and less about opportunities to make better use of our feet and our forks, it will do net harm. If we look more to clinics and less to culture for definitive remedies, it will do net harm. If we fail to consider the power we each have over our own medical destiny, and wait for salvation at the cutting edge of biomedical advance, it will do net harm.

Long before labeling obesity a disease, the AMA lent the full measure of its support to the Hippocratic Oath and medicine’s prime directive: First, do no harm. Obesity is much more like drowning than a disease. Calling it a disease has potential in my opinion to do harm. And so it is that I vote: No.

David Katz, MD, MPH, FACPM, FACP, is the founding (1998) director of Yale University’s Prevention Research Center. This piece first appeared at The Huffington Post.

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40 Responses for “Is Obesity a Disease? I Vote No”

  1. Peter1 says:

    “We know that poverty and limited access to high quality food are associated with increased obesity rates. So do we skip right past concerns about access to produce and just make sure everyone has access to a pharmacy?”

    Yes, because that keeps the money flowing to corporations, and from corporations to politicians. This all about corporate control of our political system. Enjoy your freedom.

    • Jack Lohman says:

      I’d have to agree. I have a stomach, though at 75 I have a “right.” :-) And at 6′ and 225# I’ll have to live with it. But to you younger folk, eat right. Don’t ever let your body get bloated. It’s the FOOD, dummy!

  2. Samual Minor says:

    Although obesity is not a disease, my daughter who was diagnosed with schizophrenia because of obesity. Her insurance did not cover her medication because of obesity. I hope there be a law that supports of inclusion of obesity or any body-weight-related issue to medical insurance.

  3. ytisebo says:

    Everything is a disease. Look at ICD 10. Why not obesity.

    So volume food discounters create the sisease so that the drug makers can use their drug disease to cure the food disease. Just wonderin if Walmart has an investment in VIVUS?

    BTW, CPOE is a disease as well, requiring more intellectual power to solve than the patients’ diseases.

    That is rapidly becoming the number one cause of iatogenic illness.

    • Right on! Everything causes PTSD as well. Even now a hospital stay. We are a nation of ill and disabled individuals. Were it not for insurance requiring ICD and CPT’s for payment, all of this nonsense would disappear.

  4. Sheila, FNP says:

    Thank you for an outstanding piece, giving voice to what many of my colleagues and I have been thinking. Health Promotion is my number one priority, every patient, every day. My job just got a lot harder, after all, they have a disease, it isn’t their fault and there is nothing they can do, so efforts at lifestyle modification will probably be a waste of time, right? I have dedicated my life and career to promoting patient self efficacy and change behaviors. I’ve helped some people, but by and large I feel as though I’ve accomplished nothing and am even less likely to now. No one wants improvement, they want validation, myself included I suppose. Some days I wish I’d followed my 1st career path into physics. Unless I want to do diabetes care, I don’t see a future for myself in healthcare anymore. I’m truly depressed and saddened. I feel useless.

  5. Labeling obesity as a disease just perpetuates the false belief that drugs and surgery are the first choice in treatment of disease. Obesity is essentially a lifestyle disease and must be treated with lifestyle change. Great article.

  6. stop_eating says:

    I am a glutton for diagnostic accuracy. Why not just call the heavy weights prader willi syndrome?

  7. Dave says:

    Very thought provoking article. I’ve always thought that obesity is the cause of a lot of diseases, and the result of our modern way of living.

  8. Kyle Samani says:

    Dr Katz

    I 100% agree. Obesity is a lifestyle problem. Society has made it too easy to get and stay obese. I’m currently writing a blog post about the very issue, and my perceived solution to the problem.

    The answer: social pressure. If everyone you know holds you to keeping diet, you can probably lose weight.

  9. tom says:

    One out a of a thousand cases of obesity has a true disease cause. The rest, no. The other 999/1000 obesity cases are caused by eating too much food.

    Calling obesity a disease tells people that obesity is out of their control, a very destructive notion.

  10. CPR says:

    What is important to understand is that neither of the drugs being brought to market will melt fat off anyone’s body. They are to be used as adjuncts to behavior therapy. Belviq, in particular, works on satiety…helping people recognize the signal from their brain that says “you’ve had enough”. There are patients who will plow through that signal and keep eating (as many of us will do this upcoming 4th of July), but some won’t. Some will get just the boost they need for their behavior change efforts to work…and make no mistake…most users will have tried and failed to lose weight time and again.

    Finally, note that the labeling on both drugs requires that patients lose 5% or more of their weight within the first 12 weeks, or their prescription is not to be renewed. So, those who habitually eat through the “stop” sign for Belviq, will have the drug for only about 3 months.

    It would be great if we could engineer society to keep people from drowning…and I applaud efforts to improve nutrition, put PE back in schools, build neighborhoods with sidewalks…all of it. In the meantime, there are lots of people drowning under their own weight. If these pills can help, I say “Great.”

  11. Josie says:

    Obesity is a symptom– not a disease. It’s a slippery slope to identify it as a disease mostly because the assessment of the patient is then complete at the diagnosis of obesity without a need to look at the issues that have led to it. This can lead to a one size fits all approach for treatment mostly benefiting big pharma not the patient. If someone is undereducated about nutrition it would require a much different treatment than for someone who is anxious and eats to self-medicate. Consider the paranoid schizophrenic who eats compulsively because they think someone is after their food supply or the indigent family who stretches their food stamp dollars buying cheap eats and overly processed foodstuffs at the dollar store. It all leads to obesity, but a diet pill just isn’t going to cut it for a cure.

    • Cassie Stegeman says:

      I agree it’s not one size fits all! A pill isn’t a cure for obesity, it’s about a lifestyle change and the cause for being obese. Someone who is uneducated about proper diet and nutrients is very different than someone who is obese due to emotional or mental reasons for overeating.

  12. Vik Khanna says:

    I agree wholeheartedly with Dr. Katz that obesity is not itself a disease. Not only are many obese people not ill with a treatment-worthy comorbidity, many who work at it are quite fit even without weight loss. Their fitness level aligns their morbidity and mortality risk with that of their lighter weight (undiseased in the AMA’s view), unfit peers. Labeling as “disease” a phenomenon that is is the inevitable and normal consequence of maladaptive behavior is ludicrously illogical.

    I disagree, however, that this is particularly about big pharma. This is about a health care system, generally, in which trade groups — the AMA particular — keep telling us that physicians are the keepers of the flame of policy legitimacy. Unfortunately, the system suffers from both a dysfunctional sense of entitlement (go ahead and tell the CEO of your local hospital that is should be stripped of its tax-exempt status, taxed, and regulated like a utility) and a ravenous need to find new patients. The best way to do that (and to cause the dominoes of coverage, reimbursement, and revenue to fall their way) is to keep lowering the bar for what constitutes disease.

  13. Yolanda McCain, RN, BSN says:

    Outstanding perspective Dr. Katz! I do agree that obesity is in fact not a disease. However, obesity is medically legitimate. Research lends that many individuals have a strong genetic predisposition for obesity. However, obesity is usually the result of a disregulation of eating and poor lifestyle choices. More emphasis should be placed on patient education, improving access to quality foods, and streamlining resources which provide assistance with modifying lifestyle and behavioral choices. Additionally, medical treatment options such as Belviq are designed to be used temporarily in conjunction with dietary changes and exercise. Medical alternatives such as Belviq and bariatric surgical interventions are temporary solutions aimed at treating obesity. I agree with you Dr. Katz, the best medicine is lifestyle modification.

    Yolanda McCain, RN, BSN

  14. Jeff Kane MD says:

    Hats off to Dr. Katz!

    Calling obesity a disease is a tactic of MEBS, or Medicalize Everything Business Strategy. Wherever in healthcare there’s conceivably a buck to be made, MEBS agents will sniff it out.

    A report issued in 2011 by the National Heart, Lung and Blood Institute (NHLBI) advocated checking all American kids age nine and up for serum cholesterol, and then medicating high-fat kids. Taking into account that the condition might be a lifestyle effect rather than a disease, the report mentioned deploying “intense lifestyle management” along with drugs, but didn’t say what that management might consist of. (In fact, there’s been so little development of effective behavioral intervention in obesity that the response will essentially be drugs.) So kids at risk will be medicated—presumably along with the drugs they already take for their attention deficit disorder.

    Are we surprised that half the authors of that NHLBI report have had drug industry ties? And what sort of financial windfall might accrue to the MEBS-proficient when obesity is officially a disease?

    • Jack Lohman says:

      Yea, Jeff, but that’s our “free market” system. It’s too bad that we do not have an honest political system, where politicians regulated without pocketing a piece of the action. ALL of our problems in healthcare, even ObamaCare, are driven by campaign bribes.

  15. Lee says:

    Interesting points – I side with Dr. Katz. An earlier comment said something about obesity “causing” other diseases. I am not sure that is entirely true – that scenario overlooks the fact that the causes of the obesity may also be the causes of the disease. obesity is caused by, in the most simplistic of terms, consuming more calories than one uses during the course of a day. The root of the problem is the cause of that – what makes people consume way more than they need and do it chronically over time?

    In my experience it seems that people are too lazy to change their habits or simply do not understand their bodies well enough to regulate their weight. I have also heard it said that “obesity” is an entirely different and more complex issue than simply being “overweight.” Allegedly, in obese people there are many more behavioral health factors at play whcih perpetuate a cycle of overconsumption.

    I am not sure that education and information are necessarily the only answer. Education and information are available to those who need it or want it – in spades – the problem lies in motivating the people who could benefit from losing weight to actually not only care about being overweight but become actively involved in their health and actually modifying their behavior to accomplish a goal of becoming thinner.

    I wonder if a “herd immunity” type of effect is also applicable to obesity. If one looks at maps of the country morbid obesity is concentrated in some specific areas – one has to wonder if just living with and among heavy people all the time accelerates the incidence of obesity in those areas. One wonders what could happen if a critical mass of people in those concentrated areas of obesity suddenly started a movement towards eating more healthily.

  16. CAERMD says:

    Gosh, reading the comment section is like reading a CNN comments section. Did you pay all these people to post their positive comments? Facts: We are a fast food nation, we are video game/computer nation, we are a process food nation. Alcoholism is well accepted as a disease and I have no problems not feeling sorry for these people. So the people who can not control eating two servings get pushed aside by some Preventive Medicine MD. Well, try spending some time with me in my Emergency Room. Obesity is the root cause of pretty much the majority of what I see in the ER. The AMA got it right on this one and finally the government is realizing that it’s nation needs to turn the tide.

    • Yolanda McCain-Lee Rn, BSN says:

      Lifestyle modifications to control obesity are very important. The US FDA began requiring labeling for chain restaurants. I really don’t believe that this is the cure for the epidemic. In reality most individuals may not understand how calories or how the excessiveness leads to obesity. Maybe if the amount of time it takes to work off and menu item was placed along with the calories, individuals would be more alarmed. This is an extreme measure, however, just putting the calories are not solving the problem. Education is ultimately the key to winning this battle.

    • Judy says:

      The treatment for alcoholism is primarily non-pharmecuetical, while the recommendation for obesity is, as noted previously, using drugs lifelong.

  17. Dr. Rick Lippin says:

    To medicalize obesity is a huge mistake and a fraud born out of greed based on treatments. We need both individual (behavioral change) AND institutional (public health) prevention. One without the other can lead to too much victim blaming.

    To really understand a root cause of obesity check out http://www.unnaturalcauses.org

    Dr. Rick Lippin
    Southampton,Pa

  18. Blake H says:

    I think the reason the AMA decided to label obesity as a disease is because they want to see a call to action. It will empower public health agencies to take action. If we had any other condition that was causing the morbidity and mortality that obesity has and continues to cause, action would have already been taken. As with most things, education is the key to prevention, and we must do a better job educating the public at large.

  19. Karen A says:

    I say a hearty NO! Lazy humans who are given everything and have to spend no time at all on working, cleaning, volunteering, walking a dog, swimming….our society demands nothing of anyone who receives govt support…..we should demand a min of eight ours a week volunteering to save animals. Work at a shelter, build houses for Habitat, clean streams, pick up litter, cut grass for parks, anything to get moving. Less food stamps for packaged foods, desserts, pop, sugar……less fed support for the farm bill that sports poor eating…hell, less support for farms period. Education of the masses on eating yourself to death has done nothing. The creation of SUVs only allowed fat people to get into cars easier. My taxes should nOt subsidize your decisions to allow yourself to become fat. My taxes are paying for your medical bills, for your motorized carts, for your lack of ability to work, for your kids……calling being fat a disease is disgusting and a cop out. We do need to turn the tide but not by regulating being fat as a disease.

    • Sheila, FNP says:

      Some unfortunate commentary in this thread, and they sadden me because they serve (perhaps unintentionally) to shame the obese patient, which is inappropriate and counterproductive. It is grotesque to begrudge the poor their food assistance because they have legitimate health problems, and disease or not, obesity is “medically legitimate.” We needn’t victimize, feel sorry for. or iinfantilize the patient, but we must respect them. So many more of our tax dollars go to causes much less worthy than public health, (far too many)! Neither obesity nor it’s euphemisms should be in the same sentence with the word “disgusting.”

      Those of us spending our lives working for public health and that object to labeling obesity a disease as opposed not because we lack respect for the patient or want to punish them by withholding social service or medical benefits, but rather because we simply do not accept that pharmacological and/or surgical intervention ought to become the standard of practice for every obese patient.

      Excuse me colleagues, but I thought that needed to be said. Not everyone who is alarmed or demoralized by this decision is represented by some of the rather appetite reducing comments appearing on the subject.

    • Larry says:

      Karen A. If you’re a doctor I’m glad you’re not mine.

  20. Sumathi says:

    Past 10 years I was shunned by so many doctors who would not believe that I did regular exercise ( 1 hour on the treadmill & 2 days of weights ) & portion control too – I counted calories…still I could not lose the 40 lbs I needed to. They thought I was cheating and thats why could not lose the weight. My thyroid tests said normal..but i used to be tired all the time..showed symptoms of under active thyroid…I was so depressed and occasionally thought of ending life. My husband left me for another woman. I took most basic jobs to support myself – buying organic and healthy foods was such a burden on my pitiful salary.

    Finally I started to research extensively online at my local library & started being my own doctor and managed to lose 30lbs with alternative theraphy and medicines.

    For all of you needing medicines and supplements without prescriptions & for self treatment outside of the system check out this site –
    http://www.iherb.com?rcode=adi101
    You will get $10 off your first purchase. You can also get free shipping via UPS + Zero Tax for orders over $80.00. Free 1-3 Day shipping for orders over $40.00.

  21. Lipedema is a disease where abnormal fat cells do not respond to diet or exercise yet it is often mistaken for simple obesity. It is estimated that 11% of women have Lipedema (Lipoedema in Europe). While there are risks of considering Obesity overall as a disease given the tendency to develop a pill, it is important that research dollars be directed to the subject as it is so complex and the common assumption that is all about diet and exercise as well as the tendency to blame the obese for their own condition is getting in the way. At least one brave surgeon has put himself on the line to deal with that: http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+rokuNewest+%28Roku+|+Newest%29

  22. Brian says:

    I find it interesting that there is no mention of food addiction in the post of any of the comments. I imagine just about everyone knows people who have tried and failed to quit smoking many times. However, you don’t often hear much about food addictions as a contributing factor to obesity. WebMD has an interesting article on this topic and how “highly palatable foods” including those high in sugar, fat and salt triggers the release of dopamine. I’ll admit to having struggled with my weight my entire life and I think there is something to this considering the number of people who have tried to lose weight and failed or who have lost weight but gained it all (plus some) back…I’m in both of those camps! If you are interested in the addiction article on WebMD check it out: http://bit.ly/5kzWeC

  23. Larry says:

    What if everything you’ve said re: obesity not being a disease is true, including the fact that it’s a medical issue? Let’s look at some other facts. Obesity is extremely difficult to overcome. Many, if not almost all, obese people spend their entire adult lives trying to lose weight, exercise more, & eat in a healthy manner. They want to be thin. They want to be healthy. They’ve been scared half to death by physicians who tell them about the increased risks of being heavier than normal. Want to make a guess at how many of them actually succeed? How about almost none? Obesity remains a problem without a workable, viable, long term solution. It’s fine to sit in our offices and tell people they have to change their lifestyle. HAH! Take a look at your patients and let me know how that’s working for you. Asking people to put down the fork and get off their behind have simply not worked. Every obese person knows what causes their condition. They very rarely need to be educated on how or what to eat. They know how and they’re unable to follow a healthy plan on a long term basis. It’s a condition similar to alcoholism. It’s an addiction. I hear what you’re saying about drugs & they have been used OTC or prescribed for decades. That hasn’t worked. Surgery has been the most successful treatment found so far. I propose instead of all the hand wringing about what it is and what it isn’t, the medical community needs to get involved immediately to find a solution to the obesity dilemma, and to keep an open mind about what might work.

  24. Karen says:

    I wish doctors would demand of their obese patients and just overweight patients that they eat less, eat better, get out and walk, do something other than sit home and do nothing or go out and eat or drink. Overweight, by and large, is too many calories in and not enuf out.. So you all want a namby pamby dr who says, no, its ok to be overweight and to be grossly overweight. I can give you meds for your blood pressure, for you yeast infections, for your poor circulation, for your whatever…but no, don’t bother to eat better, or to get up and walk? Really? So the huge number of overweight Americans is ALL medical? Really? Ha! What an excuse. We are all paying for fat people to sit and eat crap food, watch TV, use motorized scooters and use medical as an excuse. I feel for all of you who think that way, sad our country has come to that point.

  25. Sarah Lyon says:

    One of the biggest problems that is leading to obesity is that healthy food is more expensive. Fruits and veggies and healthy options are just not as easy to obtain because when you are living with only a small amount for food – it’s better to buy pasta and rice instead of the vegetables you should be eating. Part of it is cultural – kids that don’t grow up eating veggies, won’t eat them as adults. Part of it is simply inertia – it’s hard to change. But quite a lot comes down to money. There are a lot of obese/overweight people who are also chronically malnourished.

  26. valentine says:

    Oh. My. God.
    “And so is obesity. Our bodies, physiology, and genes are much the same as they ever were.”
    SO not true. Please read this, which includes actual science instead of your antiquated “calories in, calories out” long-disproven premise:
    http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html?pagewanted=all&_r=0
    I’m overweight. I used to be obese. I’m also adhd with some ocd. And schedule iii and iv drugs work: they quiet my flighty reiterative mind so I can concentrate about other issues instead of “I want to eat, I wonder what’s in the fridge, I should eat, I want food” over and over and OVER endlessly.

    Yes, people have to be less stupid. Drugs aren’t a magic pill. My sister went on phen (after I lost 75 pounds in first year on it ) and two years later (she’s still getting them) she’s 50 lb heavier. She’s a doctor. She’s also an idiot.

    Whole foods, exercise, etc. is basic. No junk, avoid plastic and pesticides, nothing extreme (vegan people, I’m talking to you) but moderate portions of good food with lifestyle of more movement. My sister (my whole extended family, really) eats horrifically and has barco-furniture in almost every room. Why sit when you can lay?

    Throwing the baby out with the bathwater is bad science, judgmental, and you better be without sin when you come at my glass house. Because maybe someday my sister will want to right her ship. And she’ll need help. (READ THE FREAKING ARTICLE above for a good start, though there are more scholarly sources.)

    I am appalled that someone who writes so passionately about health care (I’ve been cruising your site and like most of what I’ve read) could be this ignorant about the permanent changes in physiology when a person weighs too much.

    I just expected more from you. More science, more actual proven facts.

    And shame on all the doctors in the comments with such asshole condemnation. Not ALL fatties want to stay that way. Not all fatties are just “weak.” (Assholes.)

    p.s. The obvious next step is to deny diabetics insulin (or whatever they need) because Type 2 is most usually caused by dietary past. And from what I’ve read, strict diet can manage a lot of that. So why are you willing to give meds above and beyond what a patient would need IF “strict diet” was being followed? Yet doctors do this all the time. Most of the time.

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  28. I get these type of comments all the time. #13 actually made me laugh aloud. This is funny but sad. I own several blogs, and on some of the older ones I’ve completely given up trying to moderate them.

  29. Thank you for the perspective. Note, though, that my argument does not really close the current debate- rather, it offers a different alternative altogether. The current debate presupposes that obesity must be a ‘disease’ to achieve medical legitimacy. If it is a debate, it is between: obesity is both a disease and medically legitimate, or it is neither. I am pointing out that drowning is medically ‘legitimate,’ without being a disease. There is a third option: obesity is medically legitimate, and needs to be treated seriously and systematically by every resource of clinic and culture alike. But the true problem is around us, not within us. And the emphasis must be on preventive measures. My hope is not to foreclose further debate, but to open up access to ignored options and implications beyond the current either/or. Best- DK

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If you've healthcare professional or consumer and have had a recent experience with the U.S. health care system, either for good or bad, that you want the world to know about, tell us about it. Have a good health care story you think we should know about? Send story ideas and tips to editor@thehealthcareblog.com.

REPRINTS Questions on reprints, permissions and syndication to ad_sales@thehealthcareblog.com.

WHAT WE COVER

HEALTHCARE, GENERAL

Affordable Care Act
Business of Health Care
National health policy
Life on the front lines
Practice management
Hospital managment
Health plans
Prevention
Specialty practice
Oncology
Cardiology
Geriatrics
ENT
Emergency Medicine
Radiology
Nursing
Quality, Costs
Residency
Research
Medical education
Med School
CMS
CDC
HHS
FDA
Public Health
Wellness

HIT TOPICS
Apple
Analytics
athenahealth
Electronic medical records
EPIC
Design
Accountable care organizations
Meaningful use
Interoperability
Online Communities
Open Source
Privacy
Usability
Samsung
Social media
Tips and Tricks
Wearables
Workflow
Exchanges

EVENTS

TedMed
HIMSS South x South West
Health 2.0
WHCC
AHIP
AHIMA
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