When American actor James Gandolfini, better known as Tony Soprano, died of a heart attack last week, I was surprised he was so overweight. I knew he was a big man, but at almost 300 pounds, his heart attack seemed less surprising, even though he was just 51.
It was a coincidence that in the week of his death, the American Medical Association voted to classify obesity as a disease. One wonders whether Mr. Gandolfini would have benefited if the medical establishment had recognized obesity as an illness a few years earlier, but in this case, I doubt it. Mr. Gandolfini had acknowledged that he felt more comfortable when he was heavier and never liked losing weight for some of his roles.
There’s no doubt that calling obesity an illness will focus both medical and public attention on the plight of the obese; a number of prominent Canadian obesity experts have come forward to support the move by the AMA, even though its Canadian counterpart has yet to follow suit.
So did the AMA make the right decision at their annual conference in Chicago last Tuesday?
Counter arguments can be made. Although the AMA’s membership supported the move, its own research arm – the Council on Science and Public Health – opposed the decision. To start, both the terms “disease” and “obesity” are ill-defined. The body mass index, BMI, is the most common way to measure obesity, yet the cutoff level of 30 is arbitrary. Anyone with heart disease, cancer or influenza is sick, but not all obese people are ill.
Defining it as an illness could further stigmatize and shame the overweight. The obese can now say, I’m not obese but “I have obesity.” What will that do to the image of those struggling with their weight? Do we really want to see obesity as a new disability sanctioned by the medical establishment?
And it’s not as if there is a stream of drugs waiting to cure the obese. Doctors have a limited arsenal of medications when it comes to controlling obesity, other than trying to change eating and exercise habits. Obesity isn’t typhoid. Not only are there few medications, a recent study by the Canadian Medical Association found that almost half of primary care physicians felt qualified to treat obesity.
Although the AMA’s decision was no doubt a medical one, let’s not underestimate the role of politics. Part of the motivation was to get the insurance companies to pay a greater share of obesity treatment. Classifying obesity as an illness will also surely end up giving opponents of Big Food more ammunition to pressure governments to interfere in our food choices. In the cover story of the July issue of Atlantic magazine, science writer David Freedman argues that fast-food companies may actually be part of the solution, rather than the sole cause of our poor eating habits.
Weight gain is a complicated business that keeps an army of medical researchers busy day and night. It may come as a surprise, but researchers can’t tell with any certainty why we gain weight or how to lose it. But we do have evidence that higher taxes and more restrictions on selected foods and drinks have, at best, marginal effects on obesity. Greater state controls simply diminish personal freedom and consumer choice.
The intentions of the AMA ruling are laudable, but if one of our objectives is to diminish shaming the obese, labelling excess weight as a disease will have a rash of unintended consequences.
Patrick Luciani is co-author of XXL: Obesity and the Limits of Shame, which was shortlisted for the 2011 Donner Prize in Public Policy.