Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation

Abstract

SummaryThis paper considers the argument for obesity as a chronic relapsing disease process. Obesity is viewed from an epidemiological model, with an agent affecting the host and producing disease. Food is the primary agent, particularly foods that are high in energy density such as fat, or in sugar-sweetened beverages. An abundance of food, low physical activity and several other environmental factors interact with the genetic susceptibility of the host to produce positive energy balance. The majority of this excess energy is stored as fat in enlarged, and often more numerous fat cells, but some lipid may infiltrate other organs such as the liver (ectopic fat). The enlarged fat cells and ectopic fat produce and secrete a variety of metabolic, hormonal and inflammatory products that produce damage in organs such as the arteries, heart, liver, muscle and pancreas. The magnitude of the obesity and its adverse effects in individuals may relate to the virulence or toxicity of the environment and its interaction with the host. Thus, obesity fits the epidemiological model of a disease process except that the toxic or pathological agent is food rather than a microbe. Reversing obesity will prevent most of its detrimental effects.

Defining obesity as a disease

“…by the provision of more resources for novel and effective prevention and treatment of obesity. 4 There is however no evidence for the latter idea, i.e. the utilitarian approach is speculative.…”

“…US advocates mostly refer to the utilitarian argument. 2,4 Taking a European point of view, the authors of the present paper 6 question the disease label. This position is in line with evidence from public health research suggesting that 'obesity is the result of people responding normally to the obesogenic environments they find themselves in'.…”

“…[1][2][3][4] Very recently, the World Obesity Federation argued that 'obesity was considered as a chronic, relapsing, progressive, disease process' that requires intervention. 4 By contrast, although the biological basis of obesity (e.g.…”

“…[1][2][3][4] Very recently, the World Obesity Federation argued that 'obesity was considered as a chronic, relapsing, progressive, disease process' that requires intervention. 4 By contrast, although the biological basis of obesity (e.g. so-called obesity genes, biology of fat cells) and pathological changes associated with the disease process have been characterized, obesity was not declared as a disease because there is no scientifically applicable definition of a disease.…”

A critical analysis of obesity prevention policies and strategies

“…However, we strongly believe that the fields of obesity and weight bias will benefit from further interdisciplinary research and practice. Although our weight bias perspectives are rooted in the framework of obesity as a chronic disease, a framework now adopted by the World Health Organization and other major obesity scientific organizations, 1,[19][20][21][22] we also applied other non-obesity frameworks in our analysis. For example, we applied public health perspectives that recognize stigma as a fundamental driver of population health and health inequalities.…”