Intended for healthcare professionals

Head To Head

Should obesity be recognised as a disease?

BMJ 2019; 366 doi: (Published 17 July 2019) Cite this as: BMJ 2019;366:l4258
  1. John P H Wilding, professor of medicine1,
  2. Vicki Mooney, executive director2,
  3. Richard Pile, general practitioner with special interest in cardiology3
  1. 1Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
  2. 2European Coalition for People living with Obesity, European Association for the Study of Obesity, Teddington, UK
  3. 3St Albans, UK
  4. Correspondence to: J P H Wilding, R Pile

Categorising obesity as a disease will encourage people to seek treatment say John P H Wilding and Vicki Mooney,but Richard Pile thinks medicalisation would be disempowering and reduce motivation

Yes—John P H Wilding and Vicki Mooney

Excess accumulation of body fat (obesity) develops because of abnormal biological regulation of energy balance, has multiple complications, and should be considered a disease. The Oxford Dictionary defines disease as “a disorder of structure or function . . . especially one that produces specific symptoms . . . and is not simply a direct result of physical injury.”1 Obesity, in which excess body fat has accumulated to such an extent that health may be adversely affected, meets that definition, and the World Health Organization has considered it a disease since 1936.2

Obesity has rapidly increased in prevalence and now affects 29% of the population in England.3 Metabolic complications include type 2 diabetes, fatty liver disease, and hormone dependent cancers; mechanical complications of joint pain, arthritis, increased obstetric risk, and sleep apnoea are common, and obesity may adversely affect mental health, partly because of stigmatisation.3 Genetic and environmental factors contribute to its aetiology and influence the underlying biology of weight regulation, the sites of fat storage, and the risk of complications.4


Studies in twins show that 40-70% of the variability in weight is inherited. More than 200 gene variations influence weight, and those that increase weight are more common in people with severe obesity5 and less likely to be found in people who are thin.6 Most of these genes, including those with variants that cause early onset obesity, are expressed in the brain and involved in appetite regulation.7 Fat distribution, which contributes to risk of metabolic complications, is influenced by genes mostly expressed in adipose tissue.8 Thus body weight, fat distribution, …

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