Despite the numerous weight loss and healthy living initiatives introduced to the UK over the past couple of decades, obesity rates have continued to rise, with the proportion of people currently living with obesity doubling since 1993.1 Since ‘healthy eating’ and ‘plenty of exercise’ haven’t quite done the trick, possibly because of the lack of understanding that obesity represents a number of different diseases, then it may be high time for something to change – starting with how we define obesity, and not just referring to it as a poor lifestyle choice.
Deciding on whether or not obesity should be classified as a disease isn’t quite as simple as sticking on a new and improved label. It instead should take into account the experiences and views of those living with it to understand, in-depth, how the new definition can impact treatment approaches and societal attitudes towards obesity. Likewise, the consequences of this change must be taken into consideration, particularly the financial implications it may have if more funding is allocated to improve treatment.
The perception of obesity varies from person to person, with one study – The Stratification of Obesity Phenotypes to Optimize Future Therapy (SOPHIA) – finding that some people believe that obesity is entirely their responsibility, whereas others see obesity as a disease resulting from a number of uncontrollable factors such as genetics.2 If obesity is looked at from a lens that portrays it as just a poor lifestyle choice, people with obesity may be less inclined to seek out medical help, which translates into more consequences if it’s left unmanaged.
Current clinical practice for treating obesity also isn’t linear.3 Many clinicians approach patients with obesity as if they all have the same underlying condition, without recognising that different causes of obesity can influence a patient's risk profile and require tailored treatment strategies.3 This isn’t helped by the fact that the UK doesn’t yet recognise obesity as a disease despite certain organisations within the country stating they do otherwise.
The narrative surrounding obesity needs to change so that it not only holds true value, but can change the perceptions and behaviours of people, clinicians, and policymakers for the greater good. This change comes with significant benefits, both to individuals and to the national health service (NHS). It works in a somewhat cyclical manner: clinicians must understand the value of identifying obesity as a disease to apply chronic disease models to its treatments, this reflects the need for adequate and accessible treatments as they would be for other chronic diseases, and consequently, people living with obesity are more inclined to seek medical help.2
There are many other positives to identifying obesity as a disease, too. The definition can be seen as positive and empowering, relieving some individuals from the stigmas associated with being overweight and motivating them to take clinical action.3 Healthcare professionals may be more inclined to attend further training sessions so that future approaches to obesity are done so in a clinical and personal manner. This, in turn, can encourage a more holistic approach to treatment, which ultimately is the goal.
However, care must be taken not to remove the healthy living aspect of dealing with obesity once a definition has been set in stone. For some people, defining obesity as a disease might not encourage behavioural change relating to sedentary behaviour and overeating, and to a certain extent, may lead to a new type of stigma whereby people with obesity may feel inferior to those of a healthy weight.3
Changing the language used around obesity can help shift some of the stigma attributed to weight, especially in a clinical setting. Patients speaking about their disease rather than their weight can make it easier for them to accept interventions that may otherwise be associated with blame and shame, especially if the term ‘disease’ highlights a perception of severity for a lifestyle change to take place.3
Though times have changed and workplaces are adapting to their employees’ needs, studies show that there is wavering stigma surrounding obesity in the labour market, with many individuals with obesity experiencing workplace stigma and discrimination because of their weight.4 By identifying obesity as a disease, employers will be more inclined to support their staff with the right help.
Obesity is classified primarily by body mass index (BMI). However, this marker isn’t quite as accurate given that it doesn’t factor in the weight of muscle. Instead, obesity should be looked at by the genes it’s associated with.
Obesity can be understood through different phenotypes, focusing on both physiological and behavioural factors. These include three main areas: how we regulate our hunger (homeostatic eating), our pleasure-driven eating habits (hedonic eating), and how our bodies use energy. These can be further categorised into four actionable phenotypes: difficulty feeling full (measured by the amount of food needed to feel satisfied), how long one stays full after eating, emotional eating, and unusual energy expenditure at rest.5
Research has shown that these phenotypes account for 85% of the differences in obesity cases.6 In some cases, a diet tailored to individual obesity phenotypes can significantly boost weight loss and improve health outcomes. Participants in a study following this personalised approach were more likely to shed at least 5% - 10% of their initial body weight within 12 weeks, compared to those on a standard diet—achieving success rates around 15-25% higher.5
The research focused on different obesity phenotypes. For example, those identified with the "Abnormal Satiation" phenotype, who struggle with feeling full, were placed on a high-fibre diet designed to extend feelings of fullness and limit meal times. Meanwhile, participants with the "Abnormal Postprandial Satiety" phenotype, prone to rapid stomach emptying and quick hunger return, were given protein preloads to slow digestion.5 Individuals classified under the "Emotional Eating" phenotype, who tend to eat in response to stress or mood swings, received behavioural therapy alongside their diet plan to better manage emotional triggers.5
The tailored group also saw significant reductions in waist circumference and fat mass, alongside an increase in lean muscle mass, improvements in fasting triglycerides, and maintenance of overall caloric intake.5 This study alone is proof that obesity must be approached as an individual matter, because not all cases of obesity are the same.
We believe that attaining a healthy lifestyle shouldn’t be dictated by generic guidance surrounding food and exercise. Instead, we believe in empowering people to learn how to think healthy, encouraging a new way of life that promotes longevity and reduces disease burden.
Not everybody has access to adequate green space to move more freely, supermarkets selling fresh foods may be scarce in rural areas, and conventionally healthy food may not be affordable for some. We believe that by changing attitudes towards food and movement, we can bring about a behavioural shift that focuses on individuality, helping people find what’s right for them.
House of Commons Library. Retrieved 26 July 2024, from Parliament.uk website: https://commonslibrary.parliament.uk/research-briefings/sn03336/#:~:text=Since%201993%20the%20proportion%20of,in%20the%20least%20deprived%20areas.
Tahrani, A. A., Panova-Noeva, M., Schloot, N. C., Hennige, A. M., Soderberg, J., Nadglowski, J., … le Roux, C. W. (2023). Stratification of obesity phenotypes to optimize future therapy (SOPHIA). Expert Review of Gastroenterology & Hepatology, 17(10), 1031–1039. doi:10.1080/17474124.2023.2264783
Luli, M., Yeo, G., Farrell, E., Ogden, J., Parretti, H., Frew, E., … Miras, A. D. (2023). The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference. EClinicalMedicine, 58(101962), 101962. doi:10.1016/j.eclinm.2023.101962
NHS expenditure programme budgets: April 2020 to March 2021. (n.d.). Retrieved 26 July 2024, from GOV.WALES website: https://www.gov.wales/nhs-expenditure-programme-budgets-april-2020-march-2021
Cifuentes, L., Ghusn, W., Feris, F., Campos, A., Sacoto, D., De la Rosa, A., … Acosta, A. (2023). Phenotype tailored lifestyle intervention on weight loss and cardiometabolic risk factors in adults with obesity: a single-centre, non-randomised, proof-of-concept study. EClinicalMedicine, 58(101923), 101923. doi:10.1016/j.eclinm.2023.101923
Acosta, A., Camilleri, M., Abu Dayyeh, B., Calderon, G., Gonzalez, D., McRae, A., … Clark, M. M. (2021). Selection of antiobesity medications based on phenotypes enhances weight loss: A pragmatic trial in an obesity clinic. Obesity (Silver Spring, Md.), 29(4), 662–671. doi:10.1002/oby.23120
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