Clearing up confusion: Researchers call for obesity name change to avoid misunderstanding and stigma

05 Jul 2023 --- UK-based researchers call for clearer messaging on the disease of obesity to help the public and policymakers better understand it and to improve prevention and treatment. They highlight that the disease centers on mechanisms that regulate dietary intake, not on body weight or Body Mass Index (BMI), which is how people generally define obesity. 

The authors of a newly published article argue that the term “obesity” does not convey that this is a complex disease, which manifests in dysregulated dietary intake, adipose tissue – body fat – and metabolism.

Instead, they support the term “adiposity-based chronic disease” to signify it is not about treating an elevated BMI but a disease influenced by environmental, genetic, physiological, behavioral and developmental factors. 

Addressing the diseases requires medical treatment for affected individuals and environmental measures to reduce population risk, stress the authors. 

“Our focus should be on the underlying pathophysiology, not body size. For people with the disease of obesity, treatment is not optional or cosmetic,” says co-author Dr. Margaret Steele, a researcher at University College Cork, UK. 

“A different diagnostic term such as ‘adiposity-based chronic disease’ could more clearly convey the nature of this disease and avoid the confusion and stigma that may occur if we keep using the term ‘obesity,’ which has become synonymous with body size.”

Treatment options 
Classifying obesity may provide more and better treatment, according to the authors. Drugs like semaglutide and tirzepatide and bariatric surgery typically lead to significant weight loss and improvements in metabolic health. 

Addressing obesity requires medical treatment for affected individuals and strategies to reduce population risk.The authors note that these treatments work by altering the influence of gut- and fat-derived hormones on the parts of the brain that control appetite and that the therapeutic effects are not caused only by weight loss. They urge that medical treatment is tailored to the individual. 

“Semaglutide is approved as a treatment for obesity, just as it is for diabetes,” explains professor Francis Finucane, who developed guidance warning doctors against using the drug Ozempic (containing semaglutide) for obesity as morally problematic. 

“There is a deeply stigmatizing idea out there that people with obesity are looking for an easy way out, that these medicines provide a low-effort alternative to a healthy diet and lifestyle. But for people living with the disease of obesity, these drugs don’t make behavioral change unnecessary, nor do they make it easy – they make it possible.”

Alex Miras, a professor of endocrinology at Ulster University, Northern Ireland, previously told Nutrition Insight that semaglutide has shown cardiometabolic benefits, but these disappear when patients stop taking it and is therefore not a long-term solution. 

“The problem is that the treatment is stopped after two years because it is no longer cost-effective beyond two years. This makes sense regarding cost, but it doesn’t make clinical sense, as we wouldn’t do the same for any other chronic conditions we are treating.” 

Disease or risk factor? 
According to the study, published in Obesity Reviews, the general public understands that “obesity” refers to excess weight measured by BMI. For example, BMI categories are typically labeled regarding weight, e.g., underweight, average, overweight and obese. 

Outside of medicine, the authors see a risk that the claim “obesity is a disease” is misconstrued as “being fat is a disease” by the general public instead of being a risk factor.

The study suggests renaming the disease to clarify that the condition is a heritable neurobehavioral disorder or regulation of dietary intake since “BMI tells us nothing about the proportion of lean and fat mass, nor the distribution of body fat, or how well it serves as a storage depot for excess ‘fuel.’”

Though further discussion is needed on terminologies, the authors state that improved clarity could significantly improve public understanding of the disease and the medical, surgical and other treatments available to address it.

Obesity occurrence 
The authors note that efforts to educate the public about obesity too often ignore why the disease has become so common, instead treating individual behavior change as a cause and solution. 

Using a different term for obesity could clarify the nature of the disease and support treatment.“There were likely always people who had the disposition or tendency toward dysregulated dietary intake, but it was only when large groups gained access to unlimited amounts of food that this disposition could go into effect,” reads the article. 

In addition to treatments, public health has a crucial role in preventing the disease, states the report. 

Prevention should be a combination of population strategies – such as junk food bans or sugar tax – and those targeting high-risk people. These should not only focus on individuals with a high BMI but also display other risk factors, such as family history. 

Earlier this year, the World Obesity Federation predicted that by 2035, 51.1% of the world’s population will be overweight or obese.

Fashionably thin 
The authors point out that the focus in medical treatments of the disease should be on getting sick people well, not making “fat” people thin. 

“This is why we need to clarify what we mean by obesity. Many of the people we see on TikTok or Instagram reporting on their semaglutide journeys do not have the disease of obesity,” says Steele. 

“When we talk about treating and preventing obesity, our focus should be healthy food environments and appropriate treatment for people with chronic metabolic diseases. We hope this new research will help drive home the point that this is about helping people live well, not making everyone skinny,” she concludes. 

By Jolanda van Hal