Episode Details

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Reader Eliah sent me the following email:

I’ve seen you write about how the idea of “ob*sity”* as a disease is problematic which is I think why I started noticing that in all the articles about these new diet drugs it seems like it says at least once that “ob*sity is a disease like asthma or type 2 diabetes” I thought you might have some insight into the concept in general and why this specific phrasing is being used.

This is a great question. This specific phrase “ob*sity is a chronic disease like asthma or type 2 diabetes” is indeed making the rounds. I’ll start by talking about the veracity of the claim, and then answer the question as to why people are saying it.

Before I dig in, I want to be clear that there is absolutely no shame in having a disease or diagnosis of any kind, this is about the intentional misapplication of the concept and the damage it does.

First let’s answer the basic question: Is “ob*sity” a chronic disease like asthma or type 2 diabetes? In order to get to the bottom of this, let’s examine each diagnosis in turn.

In order to be diagnosed with asthma, there has to be documentation of signs or symptoms of airflow obstruction, reversibility of obstruction (that the signs or symptoms decrease with asthma therapy,) and no clinical suspicion of an alternative diagnosis.

In order to be diagnosed with type 2 diabetes one of the following thresholds must be met (typically with at least one repetition): an A1C of greater than or equal to 6.5%, fasting blood glucose of greater than or equal to 126 mg/dl, a two-hour blood glucose of greater than or equal to 200 mg/dl on an Oral Glucose Tolerance Test, or blood glucose of greater than or equal to 200 mg/dl on a Random Plasma Glucose Test.

In order to be “diagnosed” as “ob*se” one’s weight in pounds times 703 divided by their height in inches squared has to be 30.0 or higher.  There is no shared symptomology among this group of people, it includes people with various health diagnoses, people without any health diagnoses, and with widely varying cardiometabolic health, body composition, etc. Literally, the only thing this group has in common is a similar ratio of weight and height (and being “diagnosed” using a deeply problematic math equation.)

When you take into account the “class” system (ie: class 1, class 2, and class 3 ob*sity) the folly of this becomes even more apparent. Consider that, for class 1 ob*sity, 1 pound, or 1 inch in height canbe the only difference between someone who is “diagnosed” with “ob*sity” and someone who is not, again with no shared symptomology or cardiometabolic profile. Even more ridiculous, while class 1 and 2 each encompass a 4.9 point BMI spread, class 3 is defined as a BMI of 40 to…infinity. That does not have the ring of sound science.

Then there is the issue of treatment. For both asthma and type 2 diabetes, treatments focus on managing the common symptomology. With “ob*sity” the “treatment” is focused on making the patient look different by changing their size. Setting aside that the “treatment” almost never works and has considerable risks, no matter what size someone ends up at, there will be people of that size who have the same (and different) actual health issues.

So the answer to the question of whether ob*sity is a disease like asthma and type 2