Intended for healthcare professionals

Rapid response to:

Head To Head

Should obesity be recognised as a disease?

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4258 (Published 17 July 2019) Cite this as: BMJ 2019;366:l4258

Rapid Response:

Classifying obesity as a disease could reduce stigma

The decision to define obesity as a disease does not only have implications for healthcare professionals, but also for the wider public. Obese individuals are often highly stigmatised, seen as being lazy or responsible for their own condition[1]. Far from motivating them to make healthy lifestyle changes, it has been demonstrated that adults and adolescents who are subjected to weight-related stigma are more likely to binge-eat[2] and to have low levels of physical activity[3]. Unsurprisingly, stigma can also be emotionally detrimental, and is associated with psychological distress[4].

Stigma can be a significant problem for obese patients within healthcare settings as well, even now that it is now commonly acknowledged that a range of determinants outside of an individual’s control, including heritable, environmental and socioeconomic factors, can contribute to weight. Many obese patients report feeling that they will be negatively stereotyped by their doctors and held personally responsible for their weight, even without ever having suffered stigmatisation from healthcare professionals[5].

Classifying obesity as a disease may help to reduce this sense of stigma within and outside of healthcare settings. While we do need to be careful not to over-pathologise otherwise healthy people, it is important that we find a way to allow them to seek help without feeling that they have failed, alleviating blame that they may feel has been placed upon them. Mental health education often emphasises that mental illness is a disease process rather than a personal failing, empowering sufferers to seek help without viewing it as weakness, and simultaneously encouraging support in those around them. Similarly, acknowledgement of obesity as a disease outside of healthcare settings may facilitate understanding in the wider public, reducing the day-to-day prejudices that make it harder for obese individuals to alter their lifestyles and find support before they reach the point of developing other health problems.

[1] Puhl R, Brownell KD. Bias, discrimination, and obesity. Obesity Research. 2001;9(12): 788-805. Available from: doi:10.1038/oby.2001.108
[2] Ashmore JA, Friedman KE, Reichmann SK, Musante GJ. Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-seeking adults. Eating Behaviors. 2008;9(2): 203-209. Available from: doi:10.1016/j.eatbeh.2007.09.006
[3] Storch EA, Milsom VA, Debraganza N, Lewin AB, Geffken GR, Silverstein JH. Peer victimization, psychosocial adjustment, and physical activity in overweight and at-risk-for-overweight youth. Journal of Pediatric Psychology. 2007;32(1): 80-89. Available from: doi:10.1093/jpepsy/jsj113
[4] Friedman KE, Ashmore JA, Applegate KL. Recent experiences of weight-based stigmatization in a weight loss surgery population: psychological and behavioral correlates. Obesity. 2008;16(suppl_2): S69-S74. Available from: doi:10.1038/oby.2008.457
[5] Brown I, Thompson J, Tod A, Jones G. Primary care support for tackling obesity: a qualitative study of the perceptions of obese patients. British Journal of General Practice. 2006;56(530): 666-672. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876632/

Competing interests: No competing interests

28 July 2019
Katherine J Read
Medical student
London, UK