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Comment: obesity as a disease – some implications for the World Obesity Federation's advocacy and public health activities

In the current issue of Obesity Reviews, the World Obesity Federation publishes its consensus statement defining obesity as a disease process (1). The statement follows a document from the World Obesity’s predecessor body, the International Association for the Study of Obesity, which in 2013 issued a discussion paper, Is obesity a disease? (2), raising several issues concerning the policy implications of classifying obesity as a disease. That paper explains that a rise in the prevalence of unhealthy weight gain is an understandable and predictable biological response in an inappropriate, ‘obesogenic’ environment (3). It also acknowledges that declaring obesity to be a disease could benefit those people who are suffering with obesity and wish to have access to medical advice and support. In this Comment, we argue that recognizing obesity as a disease can serve this function for those already overweight or obese whilst also strengthening the call for dealing with the social determinants, obesogenic environments and systemic causes of individual weight gain. World Obesity has a number of policy-related activities already in action that may be enhanced by describing obesity as a disease or disease process. Current activities include close collaboration with the World Health Organization (dating back to a 1997 joint WHO-IOTF Consultation on Obesity (4) that declared obesity as a disease) and working alongside other international non-profit health organizations advocating on food, nutrition and physical activity at intergovernmental, governmental and local levels. We also participate in research programmes with clinicians and research departments, supporting scientific dissemination and assisting in the interpretation of project outcomes and working with healthcare professionals to promote best-practice interventions to support people with obesity. World Obesity also contributes to major efforts to identify the determinants of obesity and the best forms of intervention to prevent weight gain and to alleviate the disease consequences, including contributing to two Lancet Series on these issues (5,6) and co-hosting the Lancet Commission on Obesity (7). We work on projects to identify disparities and inequities in health and their social determinants, including barriers to obesity treatment, and we host a regular series of webinars and round-tables to alert advocacy organizations and commercial operators to the current issues and concerns in obesity policy development. World Obesity works to reduce weight bias and stigma and has produced a freely available image library promoting positive images of people with weight problems for use by journalists. World Obesity also provides online resources on obesity including a series of educational modules for health professionals promoting best practices in patient care and treatment. We are keenly aware that arguments against the classification of obesity as a disease can be made on the grounds that obesity is primarily a risk factor for other conditions rather than a disease in its own right and that ‘medicalizing’ obesity by declaring it as a disease defines large sections of the population – including more than one-third of American adults and one-quarter of UK and Australian adults (8) – as being ill. There are also fears this perpetuates an arbitrary definition of excess adiposity and emphasizes individualized reliance on costly drugs and surgery while neglecting critical public health measures, many of which lie outside the health system, to address the underlying social and commercial determinants of obesity (9,10).