Is Obesity a Disease? And What Should Be Done About It?

You have noticed your obese friend suddenly slimmer. You want to know what she's doing, but you don't want surgery or side effects.

My Miami patient Marcia weighed 303 pounds. She noticed newly trim, formerly 325 pound Kim walking the golf course, and asked her how she'd lost weight. Marcia now weighs 190, has quit smoking and a year later, has gained control.

Labeling Marcia and Kim as diseased only makes them victims, and medicalizes their problems. Deciding obesity is a disease stigmatizes the obese, as if they didn't feel enough unwanted attention already.

The "disease" label is about money, not health. It's about getting insurers, including Medicare, to pay for remedies. It's about creating a so-called "fat tax." It's about tariffs on fast food sales and food production. And it's about promoting expensive lifestyle drugs, still being tested. Many doctors do not recommend any obesity drugs, and are worried about their side effects.

Some people think that fat is in their genes. And genes are everything-for infants. For people over age 50, however, 80% of your health is your choices. What you eat changes the proteins your genes make, and help your body protect itself against actual diseases to which you're susceptible, such as heart disease and cancer. Knowing what's in what you eat and finding nutrient-rich, calorie-lean food are personal responsibilities.

The science of obesity is new. Olympian Maurice Greene (5'9" 176#) is overweight, because his Body Mass Index is over 25 kg/m2. Although muscle weighs more than fat, he would be labeled "overweight": an insurance risk. Lenders, employers and insurers may use that diagnosis against you unfairly. Weight distribution and body fat-not pounds alone--should be measured before labeling people.

Neither Marcia nor Kim thought they had a disease when they came to see me. They felt well. Actually, very few obese patients feel ill. Yet they have-and now control-high cholesterol, high blood pressure, diabetes and osteoarthritis. They do it with their personal choices, including individualized diets, self-monitoring, accountability, and structured, step-by-step fitness.

Understanding the risk of overweight comes one person at a time. Obesity is not a disease of deranged genes, willpower or pseudoscience. Obesity is a problem of planning. That's what my patients Marcia and Kim needed. You need a plan-not a label--to succeed.

John La Puma M.D. is co-author of the NY Times bestselling RealAge Diet and Cooking the RealAge Way, with Dr. Michael Roizen. His published recipes are online, and he is Medical Director of CHEF Clinic (http://www.drjohnlapuma.com), a unique, referral-based, nutrition-only national medical practice with patients nationwide who want to lose weight no matter what it takes. He is also an Executive Member at Costco.

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