Clinically Fat

To America’s overweight:  Rejoice!

You have long been tarred as a group of undisciplined, lazy gluttons in desperate need of lifestyle refinement and reform.

But no more.  As of today, you are all officially diseased.

On Tuesday, the American Medical Association voted to classify obesity as a disease, following a yearlong study by the organization’s Council on Science and Public Health, which concluded precisely the opposite and recommended the AMA do no such thing.

While one might wonder why the country’s largest group of physicians would disregard its own findings, the discrepancy is no big mystery.  In its official statements this week, the AMA has made it clear the vote to establish obesity as a disease, rather than a mere disorder or condition, was a matter of practicalities rather than science.

“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” explained Dr. Patrice Harris, an AMA board member.

Morgan Downey, author of a recent report on the subject (unaffiliated with the AMA), said, “I think you will probably see from this physicians taking obesity more seriously, counseling their patients about it […] Companies marketing [anti-obesity medication] will be able to take this to physicians and point to it and say, ‘Look, the mother ship has now recognized obesity as a disease.’”

In other words, the fact that so many Americans are fat axiomatically justifies altering our understanding of fatness itself, as if medical science were some sort of popularity contest, rather than a set of objective truths amendable only in the face of empirical evidence.

The trapdoor that allows the AMA to get away with playing fast and loose with scientific definitions is the fact that, properly speaking, there is no agreed-upon scientific definition for “disease” in the first place.  The concept is so broad, even within the medical community, that it can essentially be made to mean whatever one wants it to mean.

Accordingly, if the AMA wishes to exploit this linguistic loophole to coax doctors into medicating their patients thin, it is free to give it the old college try.

Unfortunately, there are a couple of actual scientific facts on the subject of fatness from which we cannot completely will ourselves free.

To wit:  The Council on Science and Public Health’s primary argument against reclassification was to point out that, from the start, obesity has been a highly problematic gauge of one’s overall health, perhaps deserving less attention from the medical profession than it currently receives, rather than more.

The word itself, along with “overweight” and “underweight,” simply encompasses a particular range of body mass index, or BMI, which is the ratio of one’s body weight to one’s height.  As countless experts have argued for years, such a formula to assess an individual’s physical wellness is limited at best and counterproductive at worst.

By design, BMI does not reflect the nuances of one’s diet or exercise routine, nor does it distinguish between good body fat and bad body fat—the muscle vs. the flab.  A person in prime physical condition—someone who spends all afternoon at the gym, consumes hundreds of grams of lean protein and could easily live to age 90 and beyond—can nonetheless be termed “obese,” thanks to the collective weight of all that muscle mass.

In other words, this entire conversation is based upon a faulty premise.  Whatever definition one might devise for what constitutes a “disease,” we can probably agree that any such condition is inherently undesirable and unhealthy.  Obesity, by its sole defining variable, does not meet even this most basic of standards.

Of course, we shouldn’t be overly cute about this.  Most people who qualify as being overweight are, in fact, the blubbery couch potatoes we envision whenever the term “obesity epidemic” pops up.

By making the concept more clinical, the AMA and its supporters are hoping to remove the stigma that packing on a few hundred extra pounds is caused by eating too much and exercising too little, insisting that the truth is more complex.  For some people, the argument goes, maintaining a healthy body weight is beyond one’s control.  While my own experience has shown the reverse to be the case—without fail, eating less ice cream and going on more bike rides has yielded a slimmer waistline, and vice versa—I would not presume myself to represent everyone else.

In any case, if the aim of this semantic silliness is to induce Americans to be healthier, I cannot mount an argument to the contrary.  Epidemic or not, physicians ought to inform their plainly out-of-shape patients of the dangers of eating crap and never getting any exercise, and encourage behavioral modifications.

Nonetheless, one should remain skeptical that establishing fatness as inherently toxic is either the right or useful means of bringing a healthier America about.

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