Does society want us healthy or just beautiful?

Is obesity a disease, or can big be beautiful and healthy?

photo credit: Dilona via photopin cc

In case you hadn’t heard, the American Medical Association classified obesity as a disease last week.

As CBS reported, “Medical therapies and procedures like the lap-band or gastric bypass surgeries are courses of treatment that may now be included in insurance coverage, based on the AMA’s decision.”

Does that sound like good news for the obese?  Maybe.  It sounds like even better news for the pharmaceutical companies who market weight loss drugs and the doctors who perform weight loss surgeries.

Will losing weight actually make people healthier, though?

Yes, there are certain health risks associated with having an elevated BMI, such as Type II diabetes and heart disease. More broadly, a higher BMI is associated with a greater risk of cardiometabolic abnormalities, as measured by blood pressure, triglycerides, cholesterol, glucose, insulin resistance and inflammation. Nonetheless, almost one quarter of “normal weight” people also have metabolic abnormalities, and more than half of “overweight” and almost one third of “obese” people have normal profiles, according to a 2008 study. That’s 16 million normal weight Americans who have metabolic abnormalities and 20 million obese (or 56 million overweight and obese) Americans who have no such abnormalities. (Abigail C. Saguy, read full article here)

I think medical procedures should be available to those who need them, but this decision from the AMA troubles me.  It seems like one more way that our society promotes appearance over substance.

We want people to be beautiful more than we want them to be healthy, and we equate thin with health.

Why can’t insurance companies cover treatments based on metabolic abnormalities, instead of BMI?  If the doctors believe gastric bypass would be an effective way to treat heart disease, cover it.  However, if it isn’t making one sick, why is obesity a disease?

Weight Loss is a $6.1 billion industry.Am I jaded that I think this decision was based on money?  There is so much money to be made in the weight loss industry.  $61.6 billion in 2012.  Most of that money is not spent in doctor’s offices or on pharmaceuticals.  Even less of it is spent on surgical solutions.  According to Marketdata Enterprises,

The number of bariatric surgeries is significantly less than reported by the ASMBS (bariatric surgeon’s national society). Surgeries peaked at 135,000 in 2008, according to government healthcare agency data (not 209,000 reported by the ASMBS). However, since then, insurers have gotten tougher on coverage and the number has fallen 15% to an estimated 114,000 last year. This reduced the size of the total weight loss market by $2.6 billion and translated into less business for bariatricians and VLCD programs.

Now that obesity is a disease, perhaps those numbers will change.

Does society want us healthy or just beautiful?It seems like we are still moving one step forward two steps back when it comes to body image.  We have campaigns to promote the idea that healthy beauty comes in all sizes.  Then we declare fat a disease.

Sorry, you’re not beautiful; you’re sick.  Poor pitiful you.  It’s not your fault; you have a disease.  Let me cure you, then you’ll be happy, healthy, and – most of all – thin.


9 thoughts on “Does society want us healthy or just beautiful?

  1. For some, obesity causes disease, but classifying it as a disease in itself seems fraught with misinterpretation. Now those who are comfortable with their larger bodies will be considered ill, which is just another issue for them to confront on a daily basis. On the other hand, I’m glad that those who are morbidly obese and need treatment will be able to get insurance coverage for that.

    • I have friends who have had lap band surgery. They needed to lose weight to control medical issues, and their insurance covered it. I also have healthy obese friends with no need for further stigma.

  2. This is a loaded piece, your title underscores the insidiousness of the seemingly endless media messages that shape our views regarding beauty/masculinity, to your point now those messages carry another layer; you are sick if you are obese. I think you hit the nail on the head that there is a great deal of profit for “Big Pharma” hanging in the balance of this decision. Really great post.

  3. I wonder why alcoholism, drug addition, and now obesity, are diseases? Particularly since it is something you created yourself. Why aren’t addicted smokers “diseased?” Too much revenue/taxes in the tobacco industry?
    BMI is a hot button for me. I don’t remember the last time the qualifiers were updated, so you could have a 220 pound athlete – rock solid – that would register as obese.
    I think we’ll probably see the bariatric/lap band surgery numbers increase. Cause ya know….if it’s a disease, there will be cure$. Great piece, thank you!

  4. I really don’t like the obesity IS a disease classification. Obesity can lead to disease. Some disease can be alleviated by losing weight. But BMI does not tell the whole picture. I have had gymnasts upset by health classes that calculate BMI and tell the girls that they are obese when they are muscular and have a body fat percentage in the teens. I have had clients who have severe scoliosis so their true height isn’t included and they are called “obese”, severely affecting their self-image. I have other clients who are obese according to BMI who work out more than I do and eat extremely healthy foods and probably make better food choices than I do! Our genes are different.
    Our society has a multitude of attitudes about beauty and weight and calling obesity an illness isn’t going to help those who are already struggling.

  5. When we were at the doctor with Tiny-Small the doctor said her BMI was high. Then he looked at my skinny kid and looked back at his chart. It turns out the medical assistant didn’t measure her height well and had shaved two inched off her height skewing the results. I think these kind of declarations are dangerous, especially when so much is determined by what is written on a piece of paper. The BMI formula doesn’t make any sense to me. My husband hikes all the time. He’s has leg muscles that rival soccer players. He was recently told he was over weight. If you just look at him you can he isn’t. He’s just fit. I am not sure how I feel about obesity being a disease, especially when it’s determined by a number and very little common sense. On the other hand, people who need help and treatment should have access to it.

    • Common sense is definitely needed. I know you can’t determine fitness level at a glance, but you can surely see the difference between firm and flab. Or tell that a kid is skinny.

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