Person stepping on bathroom scale and wondering if obesity is a disease

Is obesity a disease?

Written on April 14, 2023 by Theresa Vuskovich, DMD. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

The American Medical Association (AMA) House of Delegates answered the question, "Is obesity a disease?" in 2013.[1] According to the AMA House of Delegates, obesity is a disease. By designating obesity as a disease, the AMA aimed to increase funding for obesity-related public health initiatives and health insurance coverage for obesity-related treatment. Nevertheless, many medical authorities see obesity not as a disease but as a consequence of lifestyle choices.[1]

According to the Centers for Disease Control and Prevention (CDC), approximately 41% of Americans have obesity.[2] Obesity is an epidemic affecting people of all racial backgrounds and socioeconomic statuses. Obesity increases your risk for various chronic diseases, including Type 2 diabetes mellitus (T2DM), heart disease, stroke, and cancers [2,5]

What is the definition of a disease, though? Currently, there is no universal definition of disease.[3] According to one definition, a disease is a set of signs and symptoms or a condition with an underlying cause.[3] Based on this definition, obesity is a disease since it has distinct symptoms and may have underlying causes. This article aims to explain the debate around defining obesity as a disease.

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What is obesity?

Obesity is characterized by an excessive accumulation of body fat, which can adversely impact health and is diagnosed based on your body mass index (BMI). Your BMI is calculated based on your height and weight. Here is how each BMI is categorized for adults [4]:

  • Underweight: Less than 18.5
  • Healthy: 18.5 to 24.9
  • Overweight: 25 to 29.9
  • Obesity: 30 or above

Diagnosis

Getting diagnosed with obesity requires a healthcare provider's expertise. Aside from BMI, other factors are considered when a healthcare provider is diagnosing obesity, including age, race, waist circumference, and family history. Body composition and muscle mass make it possible for people to have higher BMIs while still being healthy.

How you carry excess weight can also impact the health effects of obesity. Abdominal fat is more likely to cause health problems. [4] Even if you have a normal BMI, a waist size greater than 40 inches for men and 35 inches for women increases the risk of obesity-related diseases.[4]

A healthcare provider needs to consider all of these factors when diagnosing obesity. Providers aim to reduce obesity-related health risks and help people live healthy lives.

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Symptoms

While there is no specific set of signs and symptoms associated with obesity, people with obesity commonly experience the following [4,6]:

  • Breathing problems
  • Sweating more than usual
  • Sleeping problems
  • Inability to engage in physical activity
  • Feeling tired all the time
  • Pain in the joints and back
  • Feelings of insecurity and low self-esteem
  • Anxiety

Causes

Obesity often has an underlying cause. Taking certain medicines or having other medical conditions may increase your risk of obesity. The following are some common causes of obesity[4,7]:

  • Cushing's syndrome occurs when your body produces too much cortisol, the stress hormone.
  • Hypothyroidism occurs when you have an underactive thyroid causing your body not to produce enough thyroid hormone. Your metabolism slows down as a result.
  • Polycystic ovary syndrome (PCOS) occurs when there is a hormonal imbalance. Currently, there is no known cause of PCOS.

Is obesity genetic?

Obesity is a genetic condition, and obesity is associated with more than 100 genetic syndromes. [8] Additionally, people with a family history of obesity are more likely to become obese.[8] Genes can play different roles in the development of obesity. Genetic factors causing obesity can be categorized as follows [8]:

  • Monogenic: Monogenic obesity is caused by a single gene mutation. People with monogenic obesity typically develop obesity in childhood. Monogenic obesity can occur when the gene for leptin, a hormone responsible for fullness, is mutated. Other mutations in the leptin-melanocortin pathway can lead to monogenic obesity.
  • Syndromic: Syndromic obesity is characterized by a single genetic mutation or a combination of mutations but is always associated with a genetic syndrome. Prader-Willi Syndrome (PWS) is the most common cause of syndromic obesity.
  • Polygenic: Polygenic obesity is caused by multiple genes and their interactions with the environment. Polygenic obesity is the most common cause of obesity.

Is obesity a metabolic disease?

Obesity can result from changes in your metabolic hormones. Thyroid hormones contribute to your metabolism, and a deficiency in these hormones can contribute to obesity. Obesity is also linked to metabolic syndrome.[9]

Metabolic syndrome occurs when an individual has multiple factors that lead to heart disease. [9] Individuals with metabolic syndrome typically have insulin resistance and T2DM. Sedentary lifestyles and obesity are risk factors for metabolic syndrome. Although some people with metabolic syndrome have obesity, not everyone with metabolic syndrome is obese.

Metabolic syndrome is characterized by the following symptoms [9]:

  • Body fat around the waist: Obesity with an increased waist circumference is associated with metabolic syndrome.
  • High blood pressure: A blood pressure greater than 130/80 mm Hg (millimeters of mercury) or higher.
  • Insulin resistance: Fasting blood glucose greater than 100 mg/dL.
  • High triglyceride levels: Triglycerides are a type of fat in the blood, with a level of over 150 mg/dL considered unhealthy.
  • Low HDL cholesterol levels: HDL is a good form of cholesterol. Low levels are considered to be less than 40 mg/dL for men and 50 mg/dL for women.

Why is obesity not considered a disease?

Obesity is a complex condition, and some experts disagree about whether it is a disease.[1,10-12] The AMA's Council on Science and Public Health disagreed with the AMA House of Delegates' decision to define obesity as a disease. Other organizations, such as the Obesity Society and the American Association of Clinical Endocrinologists (AACE), released position statements also defining obesity as a disease.[11,12]

Some experts believe obesity is a risk factor rather than a disease.[11] They believe obesity is the consequence of modern living. Additionally, some people, who are diagnosed with obesity based solely on their BMI, are healthy and do not have any medical conditions.[11] As an additional problem, defining obesity as a disease fosters irresponsibility and forgiveness for unhealthy living.

Yet, other experts believe defining obesity as a disease will raise awareness of the problem. The Obesity Society seeks to improve the obesity epidemic by recognizing obesity as a disease. The organization believes this designation will bring greater awareness to the epidemic and shift the perception that obesity is solely based on lifestyle.[12] Additionally, they believe it will reduce some of the stigma people with obesity face. The designation may make getting insurance coverage for weight-management treatment and prevention easier.

Will insurance cover weight-loss treatments for people diagnosed with obesity?

Insurance will cover some weight-loss treatments, but coverage varies widely based on your health insurance plan. [13,14] The Centers for Medicare and Medicaid Services (CMS) does not recognize obesity as a disease.[11,15] However, they removed a sentence stating "obesity is not an illness" in their manual.[11,15]

Obesity treatment is covered under the Patient Protection and Affordable Care Act (ACA). [16] However, coverage varies considerably from state to state. As a result, it is important to confirm coverage with your health insurance provider when seeking obesity-related treatment.

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The Everlywell Weight Care+ program is a weight management program providing treatment for weight-related conditions. The program offers support throughout the weight loss process with virtual care visits with a healthcare provider. Your healthcare provider will create an individualized plan for you which may include medication. However, medications are prescribed based on clinical judgment and are not guaranteed. Weight Care+ helps you get your weight down to a science.

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What is obesity?

Obesity-related comorbidities: what comorbidities are related to obesity?

Managing obesity in patients with comorbidities: what to know

References

  1. Rosen H. Is Obesity A Disease or A Behavior Abnormality? Did the AMA Get It Right? Mo Med. 2014;111(2):104-108. URL
  2. Adult obesity facts. Centers for Disease Control and Prevention. URL. Published July 20, 2022. Accessed April 18, 2023.
  3. Tikkinen KAO, Leinonen JS, Guyatt GH, Ebrahim S, Järvinen TLN. What is a disease? Perspectives of the public, health professionals, and legislators. BMJ Open. 2012;2(6):e001632. doi:10.1136/bmjopen-2012-001632. URL
  4. Symptoms and diagnosis. NHLBI, NIH. URL. Accessed April 18, 2023.
  5. Health effects of overweight and obesity. Centers for Disease Control and Prevention. Published October 20, 2022. Accessed April 18, 2023. URL
  6. Obesity. NHS.uk. URL. Accessed April 18, 2023.
  7. What causes PCOS? NICHD, NIH. URL. Accessed April 18, 2023.
  8. Thaker VV. Genetic and Epigenetic Causes of Obesity. Adolesc Med State Art Rev. 2017;28(2):379-405. URL
  9. Metabolic syndrome. Hopkinsmedicine.org. URL. Published August 8, 2021. Accessed April 18, 2023.
  10. Garvey WT, Garber AJ, Mechanick JI, et al. American Association of clinical endocrinologists and American college of Endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract. 2014;20(9):977-989. doi:10.4158/EP14280.PS. URL
  11. Stoner L, Cornwall J. Did the American Medical Association make the correct decision classifying obesity as a disease? Australas Med J. 2014;7(11):462-464. Published 2014 Nov 30. doi:10.4066/AMJ.2014.2281. URL
  12. The Obesity Society. Obesity as a Disease: The Obesity Society 2018 Position Statement.; 2019. URL
  13. Stephenson J. Report finds large variation in states’ coverage for obesity treatments. JAMA Health Forum. 2022;3(3):e220608. doi:10.1001/jamahealthforum.2022.0608. URL
  14. Roser P, Bajaj SS, Stanford FC. International lack of equity in modern obesity therapy: the critical need for change in health policy. International Journal of Obesity. 2022;46(9):1571-1572. doi:10.1038/s41366-022-01176-2. URL
  15. Kyle TK, Dhurandhar EJ, Allison DB. Regarding Obesity as a Disease: Evolving Policies and Their Implications. Endocrinol Metab Clin North Am. 2016;45(3):511-520. doi:10.1016/j.ecl.2016.04.004. URL
  16. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Roundtable on Obesity Solutions. The Challenge of Treating Obesity and Overweight: Proceedings of a Workshop. Washington (DC): National Academies Press (US); 2017 Dec 21. 8. URL
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