In 2013, the American Medical Association recognized obesity as a disease. Dr. Peter Ubel, writing in his blog on the Forbes website, thinks this was a bad idea. He fears that calling obesity a disease will result in people having less motivation to lose weight and cites a study, which found that people who were told that obesity is a disease tended to be less concerned about their weight and when offered a hypothetical sandwich for lunch, chose less healthy food.

Although he gives good reasons why obesity should not be considered a disease, he says he would favor retaining the disease label because he thinks it would help reduce the stigma attached to obesity and build public disability support for programs to conquer obesity. I am not sure about either premise.

Back in December, the BBC reported that the European Court of Justice heard the case of a 352 lb Danish childcare worker who was fired from his job because he couldn’t bend down to tie children’s shoelaces. He denied the allegation.

The European Court “ruled that if the obesity of the worker ‘hinders the full and effective participation of that person in professional life on an equal basis with other workers,’ then obesity can fall within the concept of ‘disability.'” Danish courts need to hear the case and decide if the worker is truly disabled. The ruling affects all countries in the European Union.

The Editorial Board of the Chicago Tribune commented on the issue in a piece called “the dangers of treating obesity as a disability.” It mentioned a Texas case in which a court said a company that dismissed a 600 lb materials handler could not do so because they had not tried to “find ways to help him perform his duties.”

The Tribune article pointed out that one-third of Americans are obese, with 15 million (7% of the population) classified as morbidly obese. The board felt that this was a potentially very costly expansion of the Americans with Disabilities Act, which they say was intended to help those who were disabled not by individual decisions, but rather were “victims of fate.” It did not address the fact that many are disabled from smoking-related emphysema. Are they victims of fate or poor choices?

A recent editorial [full-text here] in the American Journal of Medicine took it up another notch. The author, Dr. Robert M. Doroghazi, blamed obesity on eating more calories than one burns—a hypothesis held by many. Regarding the war on obesity, he said, “We will not make progress until we tell obese patients they eat too much, and it is their personal responsibility to eat less.” Too harsh?

Is obesity a disease, a disability, both or neither? What’s your opinion?

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

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