Obesity – It’s not a disease, but it’s still a huge problem

Dr. Charles Burant, director of the University of Michigan Metabolomics and Obesity Center, on American Medical Association’s decision to designate obesity as a disease:

“I don’t think that the American Medical Association should call ‘obesity’ a disease, because humans are programmed to accumulate nutrients. Our environment is allowing us to fulfill our biological potential. Therefore, you’d have to say that normal biology, which I believe obesity is, is a disease. And I don’t believe that normal biology is a disease.

“We’re higher-order animals. We’re supposed to be able to control our behaviors better than lower animals – that probably is true on one level, and some people are able to do it – but labeling obesity a disease is saying that two-thirds of the adult population in America (and perhaps the world) has a disease, because two-thirds of us are overweight or obese.

“It’s clear that obesity leads to other diseases, such as type 2 diabetes, hypertension, cardiovascular disease, arthritis, dyslipidemia, and increased risk of breast cancer, pancreatic cancer, and infertility. But in and of itself, I don’t believe that obesity is an abnormal condition. It’s just a condition that’s developed in our environment.

“There was no selection against being obese during prior eons of evolution, because nobody got obese; we were never before in an environment with a surplus of highly palatable things to eat. In our environment today, not only is food more plentiful than for our ancestors, but there are all types of foods that have been engineered to get us to crave more. So right now, we’re fighting against our environment.

“If calling obesity a disease brings more research funding, to understand the ways we might intervene to decrease the consumptive behavior in our environment or to change our environment, then it may not be bad, but I don’t think it’s accurate to call obesity a disease in and of itself.

“And if it helps to get insurance companies to cover more interventions that we know work, such as bariatric surgery, and to fund more research into why bariatric surgery works long-term to maintain people’s weight loss that would be a good thing. Perhaps we could tap into that biology to get more effective obesity interventions, either dietary or medicinal, so that people don’t have to have surgery to achieve the same results.

“For instance, we’re studying a combination of caloric restriction, exercise, and medications in our Investigational Weight Management Program. We haven’t been in operation long enough to say we’ve proven anything. But we can get people to lose a lot of weight and it looks like they can maintain weight loss better than people have in the past, but we only have data from a two-year follow-up. It looks pretty good, but I’m waiting for the five-year follow-up. Two years is usually the gold standard, but in my mind, five years is better. Anybody can get their weight down for a while, but it’s tough to maintain it.”