Is Obesity a Disease?

It is January 1, 2023, and 60 Minutes runs a story called “Obesity”. I can’t recall any other time when a 60 Minutes story was so self-contradictory and counter to my personal experience.

It opens with Leslie Stahl saying “Almost half of American adults have obesity, a condition that was a fraction of that just forty years ago.” (1)

A major thrust is that there is a new medicine that causes weight loss, but it is very expensive, and often not covered by insurance.

“In 2013, the American Medical Association, some would say finally, recognized obesity as a disease.” (2)

Dr. Fatima Cody Stanford, an obesity doctor at Massachusetts General Hospital and associate professor at Harvard Medical School, says “It’s a brain disease.” (3) 96% of participants on The Biggest Loser regain the weight they lost through severe calorie restriction and torturous exercise regimes. Chronic stress can lead to higher “set points” which the brain seeks to maintain. There is no mention of lowering one’s set point.

The biggest contributor to obesity, according to Dr. FCS, is genetics. Diet is a small slice of the pie chart of contributing factors. She claims that if you have obesity genes, you are 50-85% likely to “have obesity” even with optimal diet, exercise, sleep management, and stress management. (4)

Doctors do not understand obesity, and are mostly biased against the obese. Making obesity a disease clarifies that it is not the patient’s fault. Ozempic and Wegovy are the same drug, semaglutide. They can bring about an average weight loss of 15-22% of the starting body weight. The vast majority of “people with obesity” can’t afford this drug, and most insurance companies refuse to cover it. Dr. Caroline Apovia dismisses concerns about side-effects with the claim that correct dosing alleviates them. She rages that an insurance denial because the doctor did not counsel the patient about behavior change is a manifestation of stigma. She doesn’t say what she thinks an optimal diet would be, or why not to suggest it prior to giving a new, expensive drug. She must be talking about herself when she says she would never suggest lifestyle changes to a patient with high blood pressure, heart disease, or type 2 diabetes. Why not? is not asked and not answered. (5)

Wegovy is marketed for obesity. Ozempic is the same drug, marketed for diabetes. It treats diabetes by causing weight loss, of course. If an obese patient has diabetes, their insurance may cover Ozempic, but if they don’t have diabetes, it often won’t cover Wegovy. Outrage over this inconsistency is the main point of the report. 110 million Americans are “eligible for an anti-obesity medication.” If it were covered, it would lower overall health care costs. (6)

An example is given of a 5 ft tall woman who weighed 194 pounds at her highest and has lost more than 50 pounds. Even with the medicine, she has to continue dieting and exercising. She will need to take the drug indefinitely, to maintain her weight. (7)

The State of Rhode Island will cover this drug starting now. (8)

Here are my comments:

Point (1) directly contradicts point (4), unless you believe that human genetics have changed significantly in the last 40 years.

I don’t much care to argue for or against obesity being a disease. Some people can’t work on a problem that isn’t their fault. Others may react in just the opposite way. Of course we should not stigmatize obesity. But we should also not give people excuses to avoid improving themselves. Calling obesity a “brain disease” (point 3) strikes me as silly and counterproductive. Dr. FCS also says it is the brain working correctly. So which is it?

In my opinion, obesity is most often a lifestyle disease, as are high blood pressure, heart disease, and type 2 diabetes. The preconception that diseases can only be treated with medication is misguided. It should be considered good news that lifestyle diseases are under the direct control of the patient. All they have to do is improve their lifestyle.

Point (4) just cannot be right, in my personal experience. I have been obese and I reached my healthy weight through eating whole food, plant-based. I have maintained it without excessive exercise or severe calorie restriction for over 12 years.

Point (5) is an indictment of doctors and medical education, not a reason to abandon proper nutrition for a silver bullet injection. My answer to Point 6 is that eating WFPB would save much more in health care costs, with lots of positive side effects and no negative ones. I lost about the same percentage of my starting body weight as the woman in Point (7), but I don’t have to take an expensive injection for the rest of my life. According to my BMI calculator, a healthy weight for a 5 ft tall woman would be no more than 128 pounds, so I suggest she look into Dr. McDougall’s work for further ways to improve and get off the drug.

I congratulate Rhode Island on making a modest improvement in their state health care. I would like to see them promoting healthier eating and lifestyle as well.