Researchers at University College Cork (UCC) and University of Galway are calling for "obesity" to be renamed in order to help the public and policymakers to better understand the disease of obesity, and drive advances to treat and prevent it. Published in Obesity Reviews, the study ‘Philosophically, is obesity really a disease?’ highlights ongoing confusion about the term "obesity," which currently can refer to the disease of obesity or to a BMI range, or a combination of the two.
Dr Margaret Steele, a postdoctoral researcher in UCC's School of Public Health, and Professor Francis Finucane, Consultant Endocrinologist and Professor of Medicine in the University of Galway, explored different or conflicting understandings of the term "obesity."
"Our focus should be on the underlying pathophysiology and not on body size. For people with the disease of obesity, treatment is not optional or cosmetic,” said Steele. “A different diagnostic term such as 'adiposity-based chronic disease' could more clearly convey the nature of this disease, and avoid the confusion and stigma that may occur if we keep using the term 'obesity', which has become synonymous with body size."
The researchers suggest it is time to reconsider whether the term conveys the reality of this complex disease that centres on environmental, genetic, physiological, behavioural and developmental factors, not on body weight or on BMI.
New appetite-control medications are generating phenomenal demand worldwide, but patients with obesity may be sent to the back of the queue on the mistaken assumption that they do not need the medication as much as patients with diabetes. The researchers suggest that clearer terminology could play a role in addressing this inequity.
Professor Francis Finucane described new Irish Medical Council guidance warning doctors against using Ozempic for obesity as morally problematic: "Semaglutide is approved as a treatment for obesity, just as it is for diabetes. There is a deeply stigmatising idea out there that people with obesity are looking for an easy way out, that these medicines provide a low-effort alternative to healthy diet and lifestyle. But for people living with the disease of obesity, these drugs don't make behavioural change unnecessary, nor do they make it easy - they just make it possible."
In the paper, the researchers hypothesise that giving the disease a different name could help to pursue the strategic goals of clinical medicine without causing needless controversy with those who, given their own goals and contexts, understand BMI or body weight in a radically different way.
There is a perception people already think they know what obesity means - having a high BMI or just being fat. However, it is a heritable neurobehavioural disorder of regulation of dietary intake, whereas BMI tells us nothing about the proportion of lean and fat mass, nor the distribution of body fat, or how well it serves as a storage depot for excess “fuel.”
The study authors conclude by stating the ambiguity surrounding the word “obesity” itself remains a barrier to effective communication of that progress and, thus, to much-needed improvements in treatment and prevention.
“When we talk about treating and preventing obesity, our focus should be on healthy food environments, and appropriate treatment for people living with chronic metabolic diseases,” added Steele. “We hope this new research will help drive home the point that this is about helping people live well, not making everyone skinny."
To access this paper, please click here
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