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Is Obesity a Disease?

Posted Sep 12 2009 10:30pm

By Barbara Berkeley

Recently, Cleveland Clinic CEO Dr. Toby Cosgrove made some news by being outrageous. He told the New York Times thatif it were up to him and if there were no legal impediments, he would not hire obese people.

“We should declare obesity a disease and say we’re going to help you get over it,” he said.

Hmmmm. The Clinic banned the hiring of smokers two years ago without legal repercussions. But no one ever made the claim that smoking was a disease. If obesity is different, if it is a bona fide disease, then Cosgrove must be saying that it’s OK to deny employment to people with certain diseases. Let’s see how that plays out: How about a ban on employees with diabetes or a hiring freeze on those with coronary disease? Seems to me that such policy would be a bit…dare I say it…discriminatory?

As it turns out, I was in attendance as the Clinic hosted its annual Obesity Summit this week. The Obesity Summit is a conference which gives practitioners a chance to see researchers and clinicians from all over the country and to hear about their latest theories and studies. This year, however, Cosgrove’s remarks set the tone. At the beginning of the conference, Cosgrove was asked if he regretted the Times interview. Here’s how the Cleveland Plain Dealer reported the exchange:

On Wednesday, a legal advocate accused Cosgrove of demonizing overweight people, and characterized the remarks as "unfortunate and misguided."

"Do you wish you hadn't said it?" asked Walter Lindstrom Jr., an invited panelist and founder of the Obesity Law & Advocacy Center in California, which fights insurance and job discrimination.

Cosgrove did not retract the comment, but said it was meant to stimulate discussion on the growing costs of obesity. He said the same urgency behind reducing tobacco use is needed to remedy America's weight problem.

"If we are going to deal with this pandemic, the first thing we have to do is recognize it," he said. "We have to raise understanding in the community this is a major social, economic and medical problem."

In response to another questioner, Cosgrove said, "I think a lot of people misunderstood what the point was…I never considered not hiring obese people, but I think we have to do something bold to address the problem."

Readers: Is obesity a disease? And whether it is a disease or not, do employers have the right to deny employment on the basis of a person’s weight? These are real issues, because obesity has the potential to cost employers a fortune. And because of the question of choice, if the Clinic can say no to smokers simply because they “choose” a bad habit, why can’t they say no to those who “choose” to eat too much? I’m sure you will have opinions. I certainly did. What follows is my response to the Plain Dealer article.

To the Editor:

While I am an admirer of Dr. Toby Cosgrove’s forward-thinking approaches to prevention and wellness, I must respectfully disagree with his assessment of obesity as a disease. I have specialized in the care of obese patients since 1988. If obesity is a disease, it is a disease that one out of three people has contracted in the past twenty years. Simple disease generally does not behave so explosively.

While it is easy to attach the disease label, obesity is actually something far more complex. Inappropriate weight gain represents the interaction of a susceptible genetic makeup with an unhealthy food environment. Unfortunately, the majority of human beings appear to have this susceptibility to a greater or lesser degree. Data from Johns Hopkins University predicts that 86% of us will be overweight or obese by the year 2030.

The problem with our current obesity strategies is that they place the burden for treatment on the ability of the overweight person to change and to sustain that change. At the same time, they completely ignore the other (completely crucial) half of the equation: the environment. Exerting control over calories and food choice is nearly impossible in a hyperstimulatory environment that glorifies and encourages overconsumption.

It is true that behavior can change. We need only look to America’s declining smoking rates as an example. However, those who wanted to quit the cigarette habit were aided by many cultural and attitudinal changes toward smoking over the past number of years. Cigarettes became much less readily available. Cigarette machines in restaurants and theaters disappeared. Smoking was banned in public venues and in workplaces. Cigarette ads were taken off TV. Big tobacco companies were examined and legally challenged and their motives aired in public. The government placed warning labels on tobacco. All of these changes combined to make smoking – once glamorous and glorified – a negative behavior. We are very far from creating a similar attitudinal shift toward the habit of food overconsumption.

We will not be able to solve the obesity epidemic as long as the contribution of food producers, restaurants, fast food outlets and food sellers goes unexamined and uncontrolled. Until we do, we are asking individual persons to make changes that are opposed by the messages of an entire culture. Changes such as banning food ads for kids and running health warnings below ads for junk foods (as is currently done in France) are still far in the future. One step that we can take right now, however, is to work for menu labeling in food establishments. We should do this in Cleveland and surrounding areas as soon as possible. Menu labeling laws are in place in many American cities, most notably New York City. Such laws require the posting of calories on menus and menu boards. In addition, calorie information must be displayed in print that is as large as the description of each food item. What has been the result? Initial data collected in New York City shows that food choices have changed, calories purchased have declined, and food sellers have changed the calorie content of some of their items to make them more acceptable to purchasers.

Defeating obesity involves personal choice. It also involves cultural choice. One cannot succeed without the other. Let us make a start with simple education and accountability. There is no room for penalizing obese persons until we have made the task of losing weight and keeping it off a reasonable, possible goal. This will not occur without major changes in the food industry and in our modern cultural attitudes toward eating.

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