What is a disease? (And does that include obesity?)

Earlier this week I was reading an interesting article on the medicalization of previously “normal” human conditions.

If you watch television in the evening, you know what I’m talking about. Have you heard of “opioid induced constipation?” There’s now an FDA-approved drug to treat that. So now we have treatments to address side effects from previous treatments. And of course this can keep going, creating a complex web of pharmacological interactions.

So the article I was reading referenced a fascinating 2012 study that asked more than 6,000 laypeople, doctors, nurses, and Members of Parliament a very basic question: what is a disease? The interesting part though is they asked these four groups separately, so they could compare perceptions across them.

Researchers posed that question pertaining to 60 different “states of being” and asked them to rate on a five-point Likert scale how strongly they believed it to be a disease state.

Here are the results. Each condition includes a green-red spectrum. Green indicates a “yes” (I believe the condition is a disease) and red indicates a “no” (I don’t believe the condition is a disease). There are four horizontal bars for each condition, representing the results from each of the four distinct stakeholder groups.

states of being

The results for “obesity” I found particularly interesting. I isolated the results for obesity below. Though the image quality isn’t great because the original was so small, you can still see the general trends. The top bar is laypeople, followed by doctors, nurses, and then MPs at the bottom.
obesity perception

What I find interesting is the fairly low proportion who “strongly agreed” that obesity is a disease, shown by the dark green on the left. The light green is for “agree.” For those two categories combined, we’re talking about roughly 20-30 percent, depending on the category.

On the other side of the spectrum we see a much larger proportion who “strongly disagree” and “disagree.” For laypeople and MPs, this is around 50%.

Now, a couple things to consider.

First, this study is from 2012, and with obesity being such a priority issue on a global scale currently, (in fact, obesity is a major topic right now that’s being discussed at this year’s World Health Assembly) I wonder what results would look like for 2016.

Second, the study’s participants were European. And though the US and Europeans agree on many health topics, they also disagree on many also, not the least of which is whether health (or access to healthcare) is a right.

Combining these two points, we’ve seen several developments on the US front which make it pretty likely these results might look quite different today. I referenced this in my previous blog post, “Obesity isn’t a behavior: let’s stop framing it as such.”

In particular, the American Medical Association’s defining obesity as a disease has likely swayed perceptions quite a bit. The interesting question would be just how much and if perceptions vary considerably across the same four stakeholder groups as above (or if, for example, this notion is mainly confined to healthcare professionals).

What do you think? I’d love to hear thoughts or if you know about research on these two questions. Please feel free to leave them in the comments below.

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