Let’s be clear, obesity is not a disease. By some medical definitions it is a simple ratio of weight and height that includes Tom Cruise, The Rock, and me. By other medical definitions it is a body that is 30 pounds over “ideal” weight. By it’s more colloquial definition it is just another word for what someone considers a very fat body. Making obesity into a disease is simply pathologizing a body size. While it’s been highly profitable for everyone from diet companies to pharmaceutical companies to bariatric surgeons, it’s a dubious idea at best. Obesity is not a set of distinguishing signs or symptoms. Obese people have as much diversity of experience, behaviors, habits, and health as any group of people with only one common physical characteristic but for the exception of our shared size discrimination, bullying, and oppression. I have suffered because I’m obese, but I’ve never suffered from obesity.
Still, even if obesity is a disease, let’s look at how it is being handled compared to other diseases:
Can you think of another disease with a treatment protocol that is prescribed to over 30% of the total population despite over 50 years of studies suggesting that the protocol is unsuccessful and often makes the disease worse?
Can you think of another disease intervention that fails almost all the time that is not only still prescribed to everyone with the disease, but whose failure is actually blamed on those who aren’t cured ? In spite of evidence that the intervention itself actually causes the disease? While those receiving the intervention are told that everyone who tries hard enough gets cured.
Can you think of another disease that is diagnosed by a single physical characteristic which has no distinguishing symptoms other than the physical characteristic itself, has widely varied health outcomes, almost none of which have been causally related to the single physical characteristic that comprises the entire diagnostic criteria?
Do you think it’s a good idea to shame, stigmatize, blame, bully and oppress people who have a disease and call it a public health intervention?
Can you think of a disease that often has zero major health consequences where people are nevertheless pushed to choose highly dangerous and very expensive interventions that can kill them?
Can you think of a diseases where doctors practice experimental medicine on millions of people while leading them to believe that the interventions are proven to be successful?
Even if obesity was a disease, there is absolutely no justification for the way it is being handled by medical science. Of course it’s not a disease. The pathologization of fat bodies is just more size bigotry masquerading as “medicine” and those practicing it should, and perhaps do, know better than to call a body size a disease, and they should, and perhaps do, know better than to make all the mistakes that are happening after the first one. Sometimes it’s just lazy medicine, sometimes it on purpose for profit. Regardless of why it happens, until it stops the rest of us have the option to refuse to buy in, and to speak up and stand up against it.
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Beautifully put!
Directly to the point as always. Thank you for addressing the poor judgement of the Medical field for promoting tired and dangerous, or simply ineffective “treatments” for overweight individuals.
Again with the logic, Ragen. Hear, hear.
Wow! I’ve only read a few of your posts so far, but I’m QUITE impressed. I look forward to reading more of your work, which should take me quite a while. You really do light a spark in me, so forgive me if I kind of hope I won’t agree with everything you have to say – it would suck to think there aren’t parts of my mind that a person like you could change for the better. If not, I’m certain (and grateful) to find a vast wealth of evidence and perspective to confirm my own insufferable status of “Always Right About Everything, By God.” Either way, I’m very glad to have met you!
Hi Jenna,
Welcome! If history is any guide you needn’t fear that we’ll find something to disagree about eventually and I’ll look forward to an opportunity to have my mind changed for the better as well 🙂 Awesome to meet you as well.
~Ragen
I have no problem thinking of diseases and conditions which were in the past seen as failures of will and combated with dangerous devices and operations. For example, consider the way masturbation was treated at the turn of the last century.
When one examines the way snake oils and patent medicines have been presented, their failure is always blamed on the poor patient. Really, Ragen, there is nothing new about the game of blame-the-sufferer.
And obesity is not at all unique in being treated this way.
Wow, Ragen, I’d really never considered it in those terms. But you are so right. If obesity was actually a disease like cancer or lupus or anything else, patients would be treated with compassion, not contempt. The fact that shame is a necessary component in convincing people they should lose weight proves that being anti-obesity is a moralist stance, and has nothing to do with health at all.
“If obesity was actually a disease like cancer or lupus or anything else, patients would be treated with compassion, not contempt.”
….Except some people are treated with contempt because of their disease. It’s often assumed someone hasn’t taken proper care of themselves. For example, if someone has HIV, it’s assumed that they’ve been “sexually irresponsible” or have used needles. If someone has lung cancer, they must have given it to themselves by smoking (which is why people don’t donate towards research for lung cancer as much as they donate towards breast cancer or pediatric cancer). If someone has a gastrointestinal or autoimmune disease, there are always people out there who will say it’s because they haven’t eaten properly, or gotten enough rest or exercise. And let’s not forget mental illness, which is probably the most stigmatized of all (though maybe it ties with HIV/AIDS). While lifestyle choices affect a large number of diseases, no one is guaranteed to be disease-free just by living a “healthy lifestyle.” But no one wants to admit that because it’s scary, and also because for some reason blaming and holding people in contempt is satisfying.
Excellent points, all. I’d considered the mental health stigma, but not the other diseases. What pops to mind is the Just World Fallacy– that good people will be rewarded and bad people punished. Likewise, since we fear disease we blame people for their conditions which, in turn, grants us the false belief that if we follow a special set of rules, we’ll escape disease. Humans really just seem unable to come to terms with helplessness or random chaos. But we’ve all heard the stories of triathletes dropping dead at 25 and chain-smoking old ladies who live to be 102. You can improve your odds, but there are no guarantees. That’s my theory, anyway.
Right on!
I’ve been catching up on reading your blog, because it helps me with my body image issues. And it’s a great blog!
I understand the point you are making and I agree with it. If obesity was a disease, it should be treated respectfully and with evidence based medicine.
However, I could answer “yes” to several of your questions. ME/”CFS” is treated the way you describe. People with ME are often severely disabled and housebound or bedbound. One of the defining symptoms is called PEM or Post-Exertional Malaise. This means that people with ME get ill from exercise.
And yet, what is (or has been) often prescribed as cure: Graded Exercise Therapy, where you increase your exercise daily, ignoring any symptoms. This has led to people getting more ill (for years if not forever) and even dying from this cure.
Another supposed cure is CBT (Cognitive Behavioral Therapy), where patients are “taught” to not think of themselves as ill. It has sometimes been suggested that CBT cures up to 70 % of people with ME. In fact it cures almost no one (and the cured people were perhaps misdiagnosed).
And when people fail to get better, they get blamed for being lazy, for not really wanting to get better, for having secondary illness gains etcetera.
Also, in the last ten years people (for example the CDC) have been redefining the diagnostic criteria for ME, including many, many people who don’t have ME. The defining symptom, for them, is six months of “fatigue”. I think that by this criterion even more people have ME, than there are “overweight” people…
So. Sorry for the long post, but I thought it interesting to see how the treatment of “obesity” and ME overlap.