Should obesity be recognised as a disease?
Currently there is a national debate about whether obesity should be recognised as a disease in the UK. Most people are unaware that obesity is already classified as a disease in the UK, however, is not recognised as a disease. The implications of this is that healthcare settings do not approach, measure or where appropriate treat obesity in the same way that they do other diseases, and healthcare professionals therefore are not mandated for their actions. This debate has been bubbling away for some time, and very recently the Royal College of Physicians announced their backing for obesity to be recognised as a disease.
How will recognition be beneficial?
A major issue in the UK is that people with obesity do not receive advice, care and where appropriate treatment in healthcare settings. Indeed, research evidence has demonstrated that people with obesity are stigmatised and experience discrimination in healthcare, of which this research dates back over 30 years.
From a patient perspective, it is hoped that recognising obesity as a disease will increase healthcare services available and improve the support and treatment people living with obesity receive. Available healthcare services in the UK are few and far between, and very much a postcode lottery.
What do we still need to know?
For obesity to be recognised as a disease, there is a need to clarify how people will be diagnosed. To date, a body mass index (BMI) above 30kg.m2 is classified as obesity. Given the limitations of BMI in determining obesity, there is a need to provide clarity on how obesity would be diagnosed as a disease (i.e. what objectives measurements and therefore values would mean that a person is in a diseased state).
A key discussion points is that recognising obesity as a disease will reduce weight stigma and discrimination. Weight stigma and discrimination is pervasive in the UK and is reported across a range of settings, by people of all ages. It is so widespread, that people with obesity experience weight stigma on almost a daily basis, and this can have an impact on physical and mental health concerns such as depression, poorer body image and increased cardio-metabolic risk factors, and can reduce motivation and adherence to health behaviours. Thus, it is imperative that experiences of weight stigma and discrimination are reduced. Appreciating the complexity of obesity will help to reduce weight stigma given that the foundation of these attitudes is perceptions that obesity is simple, easily modifiable and is purely within a person’s control. This is far from the case, with many factors outside a person’s control contributing to weight status. However, to date, there is no evidence to inform that weight stigma will reduce from disease recognition.
Moreover, research shows that the majority of people living with obesity who lose weight will regain it and potentially more. This is due to a range of factors that are, for instance, genetic, psychological, social and economic, the majority of which are unknown to the general public. This is where the importance of public campaigns designed to educate the public on the science and complexity of obesity is crucial. Improving education about the causes of obesity, in particular, beyond those that are within an individual’s control (e.g. environment, genetics), has been shown to reduce weight stigma.
Today, we are attending the All-Party Parliamentary Group on Obesity’s International Conference. The focus of the conference is to explore whether obesity should be recognised as a disease. It is only be continuing the discussion on this topic that we will be able to drive change and , ultimately, improve support for patients.
Dr Stuart Flint and Sarah Le Brocq
*Sarah Le Brocq is a Director of Helping Overcome Obesity Problems (HOOP UK)
Dr Stuart Flint is a psychologist with a specific interest in the psychosocial effects of obesity; in particular obesity stigmatisation and discrimination, conscious and unconscious attitudes, body image, attitude and behaviour change and factors that influence exercise participation. Stuart previsouly lectured at Leeds Beckett.