COMMENTARY

Obesity as a 'Disease' -- What Americans Think, and Why That's Important

Rebecca M. Puhl, PhD

Disclosures

May 14, 2015

Obesity Achieves "Disease" Status

In 2013, the American Medical Association (AMA) officially recognized obesity as a disease.[1] This announcement spurred national media attention and resulted in considerable debate among medical and public health professionals, who expressed diverse opinions about this new disease classification, with some supporting and others opposing it. Arguments against the disease classification included views that labeling obesity as a disease will lead to an overreliance on medications and surgery for treatment rather than focusing on important environmental factors that contribute to obesity, or may increase stigma toward people who have obesity.[2,3]

In contrast, evidence put forth by scientists delineating reasons to consider obesity a disease state and proponents of the classification argued that it will encourage more clinicians to discuss weight-related health with their patients; lead private insurers to cover obesity treatment and weight-loss programs; and help to reduce stigma of people with obesity, who are frequently blamed for their weight.[4,5,6]

Despite considerable discourse about the AMA's announcement in the medical field and the national press, notably absent was any discussion of public perceptions about obesity as a disease. After all, given that two thirds of Americans are affected by overweight and obesity, this disease classification is relevant to many. It seems important to identify the public mindset on this issue—both from a societal perspective, given widespread American views of "personal responsibility" for body weight, and also from a medical perspective, given that public views about obesity as a disease could have important implications for provider/patient discussions about weight, medical decision-making, and attitudes about treatment.

Public Views on Obesity as a Disease

Where does public opinion fall on this issue? Are public views about obesity as a disease different with respect to such individual characteristics as sex, race, education, or health status?

To answer these questions, our research team at the Rudd Center for Food Policy & Obesity at the University of Connecticut conducted a national survey[7] (just published in Obesity) to examine public opinions about obesity being classified as a disease. In the months following the AMA's announcement, we collected news reports, national blog postings, articles from medical websites, and press statements from advocacy groups and medical organizations, extracting dozens of statements in support of or opposition to the disease classification.

After collecting sufficient arguments and perspectives on both sides of the debate, we used this content to develop a list of survey questions to field to the public. In total, the survey consisted of 17 statements in support of the disease classification and 16 statements against the classification. The survey presented these statements in random order, and simply asked people how much they agreed or disagreed with each statement.

Our sample consisted of 1118 US adults, recruited from a national online panel of more than 2 million Americans. Quotas were established so that our sample resembled US census demographics for sex, race, age, income, and education. We fielded the survey in January 2014, 6 months after the AMA announced the new disease classification.

Our findings showed that most respondents (51%-61%) agreed with most of the statements in support of the disease classification, and 58% agreed that there is a medical basis for obesity to be classified as a disease. Most respondents agreed that classifying obesity as a disease will lead more physicians to spend time discussing weight with patients (61%), help people gain access to obesity treatment (59%), encourage more resources to obesity research (58%), and improve reimbursement for weight loss counseling (55%).

In contrast, a minority of respondents (31%-47%) agreed with 15 of the 16 statements opposing the disease classification. This included views that labeling obesity a disease will lead to an overreliance on medications or surgery to treat obesity (47%), shift the focus away from efforts to encourage healthy eating and physical activity (44%), and lead physicians to rely too much on a patient's body weight to determine his or her health status (40%).

The average percentage agreement across statements in support of the disease classification was 51%, whereas the average agreement for statements opposing it was 39%. So, despite more people supporting the disease classification than opposing it, our findings suggest that views differ among the general population, just as they do among professionals in the fields of medicine, obesity, and public health.

Respondents in our study also expressed different views on whether the disease classification will increase or reduce obesity-related stigma. More than one third (37%) of respondents agreed that the disease classification will reduce the stigma experienced by people with obesity, but 31% agreed that this stigma will increase. And although 45% believed that the disease classification will encourage physicians to address obesity with more compassion and respect, 37% felt that it won't change how physicians see their patients. Time will tell whether change occurs in either of these directions, and it will be important to monitor whether patients' perceptions of healthcare experiences improve.

Of note, we found that support for the disease classification was unaffected by respondents' sex, body weight, education, income or self-perceived health status. However, African Americans expressed more support for the disease classification than other racial/ethnic groups. We also found, across the sample, that people who attributed less blame and personal control for obesity were more likely to support the disease classification. Finally, when we asked respondents whether they were aware of the AMA disease classification, 69% reported that they had not known that the AMA classified obesity as a disease. Of interest, those who had known about it were more likely to oppose it.

Implications for Practice

What knowledge can we take from this study?

First, people have different perspectives about obesity as a disease, and their opinions may have nothing to do with their own body weight or perceived health. Healthcare providers should be prepared for diverse opinions from patients as they approach discussions about obesity and weight-related health, especially in the context of obesity being officially recognized as a disease.

Second, the way people think about the causes of obesity can influence their views about it being a disease. This, too, has implications for provider/patient discussions about weight, and it may be useful for providers to discuss with patients the complex etiology of obesity, and challenge common misperceptions or oversimplified notions that obesity is a simple lack of personal discipline or self-control.

Third, many, if not most, patients may be unaware that obesity is now considered a disease. Healthcare providers may want to inform patients of the disease classification and discuss the implications that this has as a paradigm for diagnosis and treatment.

It is not yet clear how the disease classification will influence treatment outcomes for obesity, or the stigma experienced by individuals who have obesity, but it seems warranted to monitor any progress in these areas as systematically as possible. At the very least, healthcare providers can begin to include patients in discussions about the disease classification and how it may (or may not) affect their treatment for obesity.

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