11:33am Wednesday 08 July 2020

Opinion: Obesity is not a disease

As a lecturer at Massey University’s School of Management, I teach this concept to my first-year students – it’s called consultation. But then my poor students become increasingly bewildered, and eventually jaded, as they watch the grown-ups in the ‘real world’ ignore these principles in favour of blind ignorance or the lure of wads of sweaty cash.

The American Medical Association (AMA) recently made one such decision. Last month it officially classified obesity (defined as having a Body Mass Index measure above 30) as a disease. This decision ran against the advice of its own Public Health and Science Committee, which advised the AMA not to classify obesity as a disease just days before the official announcement.

The decision caused immediate and persistent anger amongst many groups, including the Healthy at Every Size movement and financial commentators who recognised the forces of capitalism at work. Search on the Twitter hashtag #iamnotadisease to see the outpouring of sadness. 

Aside from a few in the medical fraternity and many in the weight-loss industry, most informed people do not support the AMA’s decision. In particular, they cite the ridiculousness of the Body Mass Index (BMI) measure and the medicalisation of what can be, in many cases, very normal.

‘Big Pharma’ has definitely played a role in the AMA’s decision as the market for anti-obesity medication is massive and growing. I don’t need to rely on conspiracy theories to prove this; instead I will cite the scholar Harriet Washington.

“The Journal of the American Medical Association (JAMA) bills itself in advertising as ‘a priceless audience at a price you can afford’,” says Washington, revealing how the AMA’s journal lures advertisers. She goes on to suggest that pharmaceutical advertising may account for between 97 and 99 per cent of medical journal income. Clearly, it’s a hard lobby to resist.

I wondered what New Zealand’s Medical Association (NZMA) might have to say about the AMA’s decision to classify obesity as a disease. Nothing, it seems. At least I can’t find any commentary on their website or on the internet. So far, so good. In New Zealand people with a BMI score over 30 are not automatically diseased. 

Using body mass as a classification device simply defies logic. If I were one of the poor souls subject to the American health system I would have been born diseased, and lived virtually all of my life diseased. In fact, the only time that I was not diseased was the year I was in my absolute worst mental health phase as I attempted to live a life akin to an anorexic. I was medicated, obsessed and miserable. 

But the influence of large multinational pharmaceutical companies should not be underestimated. Big Pharma makes every attempt to ‘own’ entities like the AMA because these organisations provide access to the providers, and therefore the consumers, of their products – it is a basic vertical integration strategy, just good business sense.

In many ways New Zealand is immune to this stupidity. We are lucky enough to have Pharmac, a state entity responsible for making sure that Kiwi citizens and residents get access to drugs as cheaply as possible. It works, and it is almost impossible to influence via financial means.

Pharmac doesn’t publish an expensive journal like JAMA. Of course access to pharmaceuticals in New Zealand can be influenced by lobbying, as was the case with the breast cancer medication Herceptin, and to some extent via direct marketing to medical professionals. But the influence of lobbying here is nothing when compared to the situation in the United States.

I believe the immunity offered by Pharmac gives the NZMA a unique license to focus on the fundamentals of medicine – to ‘do no harm’ and practice science over capitalism. Not only should the NZMA refrain from following its American counterpart in declaring obesity a disease, it should also emphatically reject the BMI-based clinical definition of obesity. 

A BMI greater than 30 does not necessarily equate with poor health. Some people with a high BMI are extremely fit, while others with a low BMI can be in very poor shape. Science is continually demonstrating that the measurement is profoundly and fundamentally flawed.

Discarding BMI might increase the workload of medical professionals who will need to look at health more holistically, but that is the burden of science. If a hypothesis proves to be false, then accept the evidence and develop a better hypothesis. 

Dr Andrew Dickson is a lecturer with Massey University’s School of Management. His blog – othersideofweightloss.org – takes a critical view of the weight loss industry. His Twitter handle is @AndrewDickson13

Massey University, Private Bag 11 222 Palmerston North, 4442, New Zealand

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