Hello Richard, just an opinion of course but I suspect labeling obesity as a disease will have little or no impact on primary prevention efforts. Reason is, those efforts have been ongoing for a while now - at least 20 years - where obesity has been treated as a disease by many, including pharma etc. "Official" labeling may increase some of this of course and lend credibility to calls for more primary prevention, more drugs to prevent this disease, etc. - but take a look at the literature and you can see that the new, official label is kind of a belated attempt to legitimize what's been going on for some time already.

I agree with Alan's comment. I think labelling obesity as a disease will only be effective if it means policy measures that change our obesogenic environment become easier to introduce. The evidence base for policy measures such as restrictions on marketing and distribution, and excise taxes, is robust but the political will to act on the evidence is weak. I hope reclassifying obesity as a disease will galvanise policy action, but I am not optimistic of this outcome, at least in my country (New Zealand) where the mantra of individual responsibility still reigns supreme. I hope other countries will be better able to provide leadership and that we will soon see wider adoption of data-driven policy measures, just as we are seeing increasing commitment to introduce plain packaging as a tobacco control measure.

Hello Ricardo. In my opinion great efforts are being made to prevent obesity in childhood and I do not believe that simply changing the understanding that it is a disease can decrease their advance. Radical changes need to be made of global nature involving health policies related to interventions on food companies and massification of physical activity, established as the most important aspect in combating this disease. The shares shall be construed as if it were a war against this pandemic. Only in this way will be achieved gradually decrease the global obesity.

I certainly agree with the comments made thus far. A further concern about a disease label are the consequences of medicalizing another life circumstance issue. We could note the medicalization of cholesterol levels and the racqueting down of 'safe' levels with concomitant appearance of health concerns and increase in drug treatments. Childhood obesity is a matter of environments and social conditions and the kinds of food available to those on low incomes.

Labeling childhood obesity as a disease is not going to check its progress. The battle should start at home and at the schoold which are the environment of the childresn. The efforts from the parents and the teachers are the major forces ; through them only control measures can be populirized. . Public health on obesity need to be taught at homes and schools. The parents and teachers have great responsibilities in changing the attitudes and practises of the children. I belive that health promotion on children obesity starts at homes and being followed at shcolls. Laitha kabilan

Labelling child

Labelling obesity as a diseae is not going to check its progress. The battle for obesitty in children should start at home and at the school, which are the main environments for the children. The parents and the teachers have the responsibilies to educate the children on obesity and -related risks. Helath promotion starts at homes and being followed at schools. Enabling environments for control of obesity need to be provided at homes and schools. We can not rely on policy makers. lalitha akbilan

Labelling obesity as a diseae is not going to check its progress. The battle for obesitty in children should start at home and at the school, which are the main environments for the children. The parents and the teachers have the responsibilies to educate the children on obesity and -related risks. Helath promotion starts at homes and being followed at schools. Enabling environments for control of obesity need to be provided at homes and schools. We can not rely on policy makers. lalitha akbilan

Poetically, "a rose by any other name or label would smell the same." When I was growing up there were a few kids that were overweight. None in my public school were obese. I cannot recall one classmate or for that matter anyone I heard of or saw that was autistic. Why, temporally speaking, would that be? Kids then were more active. We walked to school or rode our bikes. (Like the Dutch where it is uncommon to see obesity). Our food tasted like food; it was healthier; fruit and vegetables were not picked before they were ripe and had nutrient value. Tomatoes tasted like tomatoes. Fish was not farm fed, nor beef grain fed. (In many parts of the world where food has not become "lifeless", obesity is uncommon." Perhaps, just a thought, obesity and overweight are the body's response to not getting the nutritional value that is needed i.e., a compensatory mechanism like up-regulation of receptors in the setting of a deficiency (soluble transferring receptor ↑ in the setting of iron deficiency".

Now add in the propensity to feed many families with the high carb composition of fast foods. Toss in television and the contribution of sitting on one's duff and stuffing our mouths while watching high anxiety episodes of serial killers, etc. Think about the brain-washing of our society's media where everything is oriented towards buy this, eat that, drive this i.e., it's all about getting, taking in, possessing. We now live in a world where TV shows about diners, drive-ins, cooking high caloric meals flourish. We even have TV shows that highlight obese characters. News programs interview one obese person after another. America, the land of the free and the home of the brave has become the land of entitlements, what's in it for me, and a meal of burgers, fries, and soft drink for only $5.

So what do you think? Labeling obesity as a disease will change anything? Perhaps when healthcare premiums are dramatically less with ideal weight, BMI or waist circumference that will change. Perhaps when are city planners make every third street a bicycle only or a shared bicycle-pedestrian street that will change. Perhaps when we move water from areas that flood every year and create a new great lakes system in the SouthWest and grow organic crops, and mandate grass-fed beef that will change; and when citizens demand less brutality and violence-oriented TV (note second-hand stress now in the news) that will change.

The chances of the above happening are next to nothing. Sadly, our American society and elsewhere are "emulating" the decadence that characterized the fall of the Roman empire. But who knows, the story is not over until the "fat lady sings."

obesity like smoking is a problem of our societies in the pursuit of satisfaction, comfort, feeling good, being happy, profit etc. We are a race too often seduced by self gratification on many fronts. Obesity is a function of eating .. yet we cannot declare eating a disease. I agree that labelling is not very helpful in this context and a better route would be early education - but what an education it has to be in the face of such an advertising and commercial onslaught. Add the complication of stigma generation, and you run the risk of stigmatising the too thin and the too fat - the better question is how can we reward healthy body mass, healthy living, and healthy eating without stigma. tax breaks, promotion, cheaper hospital treatments ....? or mayber just keep up the rage!

obesity is a disease in children and adults; and is mostly due to overeating it is associated with diabetes, hypertension and other cardiovascular diseases. Making it known as a dangerous disease will create awareness and certainly will reduce the prevalence. No body will like to kill his/her child with food.

Obesity is not a disease and should not be treated as such. This puts the onus on health services to rectify a problem that should not exist. Only a few people have underlying medical conditions that cause their weight. As Stephen said, there were few overweight children 50 years ago, nor were there the high fat and high sugar foods! People were poor, my Mum struggled to feed a family of five on agricultural wages, but she knew how to cook and this made all the difference. With training people can see how easy and quick it is to prepare a cheap and healthy meal. Motivation may be a different matter! Obesity has increased along with the increase of unhealthy foods. Individuals choose what they eat and given the tools and incentive to provide healthy foods for their family would make a difference. Raising awareness of the dangers of smoking has not stopped people.

I agree with the fact that the issue of childhood obesity is complex and multifaceted. I also feel that calling it a disease may open up the ability for some to get insurance assistance to start to deal with the issue. Yes times have changed and there are components that make it harder than ever to address this issue but if this issue requires education, motivation and alternative activities why not have the ability to access them in an affordable fashion. We know that the incidence of obesity is higher in lower socioeconomic neighborghoods. Why not make it a disease so help (including coaching and education and or fitness programs) can actually be covered. Who sais that it has to be medication or surgery? Substance abuse is not treated that way and it is a covered benefit. I disagree with the statement about smoking. I was a smoker and the campaigns that have come about made me feel like an outcast and did help me stop. It may have not have been the treatment that helped me to quit it but it truly was a motivator to find a method that would help!!

I also agree that obesity should be considered as disease. It's reasonable to consider a condition that leads to such high morbidity as a morbid itself. Obesity as a disease will probably draw the general public awareness and the health authorities to give more support to involved professionals. Tackling obesity remains however a difficult task as its prevalence in several countries is higher low income families, a situation that requires policies that only politicians can design with our help. making access to public swimming pools, fitness centers, reviewing the role that school should play in prevention and management, etc. will need to be decided together. I see several children in my clinics, dieticians' advise, my own intervention are insufficient; when I suggest children practice sports, parents are limited by financial problems, etc. A disease will get more support and probably better management organisation although I recognize this is not a easy task for all of us. I could write more but an open discussion is needed to find solutions together !!!

When we teach children the goodness of fruits and vegetables, to eat less simple carbs and self regulate their intake the problem of obesity will increase.

There are some benefits in allocation of an ICD code - it alllows those who are at disadvantage to have access to health services. However, whether it should or should not be classified is another strategy that clouds the necessary actions that are required - it is noise and distraction. We need direct action regarding the (re)formulation, distribution, advertising and availablity of our food, we desperately need to improve health lieracy, we need to minimise car dependancy. We don't need more noise.

I agree with much of what has been said, overweigh is a risk factor, and obesity a disease. It is helpful to have it considered so, to build and strengthen awareness with many sectors and the public of the dangers to health, in children, teens and adults. As with smoking, when smoke free spaces were institutionalized, so with junk food and sweetened beverages, when they are not allowed in school and public places, it is a powerful message that it is not acceptable, it is harmful to our health! Overeating is not only an individual choice, it is also cued by advertising on TV and elsewhere, glamorizing and spurring people to eat empty calorie snacks. There is a mental and emotional health component to overeating, as many children and adults are compensating for unsolved issues in their lives. For many years obesity was mainly treated with diet, now we also understand the role of physical activity, we need to also understand the role of sleep, stress and emotional aspects surrounding obesity. Finally the role of settings, the environment where we live,study, work and play influence tremendously how active and healthy we can be, how supportive the quality of our environment can be of our opportunities for healthy eating and active living is critical for the population to move forward toward healthier outcomes and reduction of chronic illness.

There is evidence to suggest that the environment has very little influence on obesity. Certainly for some there may be personal issues, but can this explain the rapid increase in obesity of the last 30 years? Are people that smoke ill too? If all these people are ill, then no amount of "powerful messages" will, or have, change behaviour.

I agree that no matter what environment one comes from, healthy choices and better choices can be made. Addiction is an illness. It has components that have exacerbated the use and its consequences for many. Not every smoker has the same level of addiction, nor does every drinker or eater. Not every smoker is ill and not every overweight person has an illness but it would be negligent to negate the different components that contribute to these issues and dismiss them as less than an illness. There is no single reason that there is such a rapid increase in obesity. It could be the faster pace of todays society, the processed foods, the unsafe parks, technology, and the list goes on. There is science that demonstrates that there are real issues and long term behavioral findings alike. It is interesting to see everyone's take on this. I also think that we could never pidgeon hole a direct cause for this but what could it hurt to put a disease model in place for the massess that are obese and are subsequently becoming ill from it.

What ever the cause or reason for obesity, it needs to be tackled at several fronts i.e., At the level of society - mass awareness

At the level of home - strictly cutting on fast food

At the level of laboratory - searching for new drugs.

PREVENTION IS BETTER THAN CURE

Obesity has been a disease for decades now and I could be due to over nutrition, genetic and also related to and inactive life style. Obesity especially in children is increasing in very rapidly and needs to be prevented else will come a time when obesity 1:2 for every healthy human. Do I blame negligence sometimes' Yes I Do. parents and school needs to control what children eat and their eating habits. Children also needs to be encourage by schools and parents to engage in some physical activity to improve quality of life other than buy games and toys and make children grow horizontal (fatter) other vertical (tall) and smart. I work with sedentary obese women and I have seen the benefits of exercise and good nutrition and we need to translate this to children too. The willingness to be on a good diet and exercise needs to be emphasized, change of behavior and sometimes environment. Taking away the genetic factor, exercise and diet would be the best way for prevention of child obesity. Exercise and diet particular different form of resistance exercise can also regulate those genes, mircoRNAs and inflammatory cytokines expressed in obesity

I agree that you have got a modest success in tackling the obesity by non-medical means, but that shall not be our sole approach. I had already mentioned in my earlier response the 3 pronged strategy:-

At the level of society - mass awareness

At the level of home - strictly cutting on fast food

At the level of laboratory - searching for new drugs.

PREVENTION IS BETTER THAN CURE

I agree that obesity is a disease.

However, as many coleagues said: considering obesity as a disease does not mean that we should only focus on pharmacological therapy. In fact, lifestyle change is essential even in overweight than obese subjects. Obesity should not be "treated" with expensive surgical procedures or pharmaceuticals. This disease necessarily should be managed with regular exercise, adequate nutrition, and body-mind therapies to avoid stress, anxiety and depression.

Easier said than done.... What strategies do you advise for dysfunctional families where none of these can happen?

Yes indeed Obesity is a disease and I like all previous discussion. I would like to stress the forms of obesity. Etiologically speaking, obesity is accounted of (3-5%). This can be as secondary to hormonal diseases, lesions in the hypothalamus, and altered genes, and Prader-Willi Syndrome (Early-onset hyperphagia, pathologic obesity) (fat cells accumulation in number and size the first 6 years of age)

The other form is multi-factorial obesity which results from an interaction between inherited predisposition and environment (epigenic). Therefore, the ability of an organism to develop in various ways are depending on the particular environment or setting. Babies whose mother smoked during pregnancy are at risk of becoming obese, even though the babies are usually small at birth. Coming back to the issue of reducing fat, it is not only to speak about, it is to act about. Changing our lifestyle is inevitable; the way of living from sedentary to active, from eating any food to selecting a nutrient food, from sleeping less to have sufficient sleep at early of night, and relaxation away from stress of any kind. Is this easy to be done? I don’t think so. A strategy to combat OBESITY is a matter of policy makers and leadership in the society. A protective plan to educate parents and kindergarten teachers in early child hood should be adopted as well. Doing a play as and a regular exercise is a natural thing for kids and we should instill healthy habits from early childhood.

Dear Dr Hashem,

congratulations for your very meaningful commentary.

Obesity should be treated by drugs, but the real and sustainable intervention is to change lifestyle avoiding sedentary behavior and stress and fostering the regular practice of exercise and a healthy diet.

For clinical purposes drugs are useful, but for public health lifestyle interventions are crucial.

Syndromic obesity is often obvious as it is associated with other signs that draw clinicians' attention. This remains however rare in daily practice. Most children we deal with are obese as consequence to their have been large for GA or overnutrition along with lack of physical exercices. Offsprings of immigrant parents often turn obese as consequence to changes in feeding habits, etc. We all advice families to consume fruits, vegetables, etc just walk in a market in our developed cities to find how expensive these can be....Obesity in addition to having epigenetic factors affects children with poor social conditions denying this is a mistake. Fighting obesity needs sounds clinical skills that we have, but the social aspects are very important unless one finds a miracle solution. Public health lifestyle intervention remains a corner stone for management and it requires political involvement to reach the largest number of children and their families.

Obesity is a metabolic disorder and hence is a common risk factor for most metabolic diseases thus making childhood obesity also a disease. There is lot of literature available globally on the increasing trend of childhood obesity. In India, we face a double burden of diseases and this is most commonly seen in children where the spectrum of 'malnutrition' covers both ends - on one hand under nutrition and the other hand over nutrition. Though under nutrition in children is more commonly reported as it increases mortality in children, overnutrition resulting in overweight and obesity is not reported because in India 'a fat and chubby child is considered healthy!!" As a behavioral and public scientist working with children and adolescents it is a constant battle to convince parents and teachers and family members along with the child that a healthy body weight is a must and both under and overfeeding should be avoided from a young age.

Obesity is a chronic condition, affecting populations worldwide, and resistent to most conventional treatments. It is associated with many other health disorders including hypertension, diabetes, heart disease, sleep apnea, ostroporosis, stroke, GERD, colon polyps, colon cancer, esophageal cancer, ovarian cancer, breast cancer, and more. Obesity has caused health care costs to escalate in recent decades. Classifying obesity as a disease reduces the stigma that society sees obesity only as overeating problem. Obesity is a very complex disorder, involving numerous pathways. Disease state also heightens individual and societal awareness of it's impact.

In addition to what I have mentioned above, the lessons we learn from prevention efforts for other diseases, is that Childhood obesity definitely needs a multi-sectoral approach! Many experts above have mentioned specifics but for people working in the field also know the ground realities of how much easier it is to list and say things than get it done. At the family level - awareness and attitude among parent's and family members regarding obesity, unless the parent's have healthy habits do not expect the child to have one. At the society level, I would include school and peers and their influence. Then we have the built environment which is huge. In developing countries, we have various types of junk foods besides the western ones. Street foods are very common and more cheaper and almost 80% of children and adolescents are found to have these atleast 3 times a week. Either they buy it themselves or someone is buying it for them. Accessibility to parks, clean grounds to play, time to play (due to pressure of studies) all this is an influence of the built environment. Finally Media is BIG! as all ads target kids so the choice of unhealthy foods is in abundance and kids can take their own decisions and they influence their parent's decision to buy various foods. Thus, in summary, all of the above only points to the fact that Childhood obesity interventions needs a multithronged effort for sustainable results.

The weight of a child at birth is a critical determinant of neonatal morbidity and mortality and the risk of metabolic disease throughout the life span.  Those who have rapid catch-up weight gain in early childhood are at increased risk for adult-onset type 2 diabetes, hypertension, preeclampsia, dys-lipidemia, and ischemic heart disease.

Likewise, large for gestational age infants (fetal macrosomia) are predisposed to childhood weight gain, type 2 diabetes, and the metabolic syndrome.

Labeling obesity as a disease will create awareness that will enable prevention strategies to be developed by scientists and also enhance compliance by members of the public. It is interesting to note that many Africans accept Obesity as a sign of affluence and therefore encourage it.

Several women , especially those who are transiting from poor families to affluent  families through marriage tend to indulge in high calorie diets that are easily obtained in fast food restaurants and become obese. The rural woman who indulges in large quantities of high glycemic index diets such as cooked fermented cassava are not spared. When these women become pregnant, they continue their dietary habits and the outcome is hyperinsulinemia, large for date babies(fetal macrosomia) and gestational hypertension, which may develop into preeclampsia in susceptible persons. This results in a need for high rate of obstetric intervention which may be unavailable in medically underserved areas. Unabating high maternal mortality rates are probably related to this phenomenon, There is therefore a need to label obesity as a disease to enable a directed action especially in the developing world where facilities are inefficient and insufficient.

The American Association of Medical College's statement represent a tremendous step in redefining the obesity crisis in North America. There is a pendulum related to obesity as a disease, on one hand it triggers the manifestation of disease and disorder such as diabetes, heart disease, high cholesterol and certain cancers etc.  On the other hand a person may be obese yet, not manifest any of the disorders.  There are many obese person with healthy cholesterol levels, and many non-fat individuals with high cholesterol such as observed in the Asian populations.  We need to look at multiple measures associated with obesity,  specifically in terms of genetics, genome sequencing and other risk factors to determine those links.

Weight essentially reflects energy intake minus energy expenditure. I think it is wrong to focus on energy intake. We should direct our attention to energy expenditure. A sedentary lifestyle in itself is a strong risk factor for disease and also for obesity. Concentrating on energy intake is rather useless if we do nothing to increase energy expenditure. The latter is probably also much easier to change whereas changing energy intake has at best a short-term but marginal effect on weight.

It will certainly have an impact both positively and negatively.

Obesity is functionally a disease due to its biological, psychological and social implications.

However, it is disturbing to be labeled as obese and, consequently, suffer segregation.

In no way is obesity good, its predetermined genetic causes are greatly influenced by certain environmental conditions.

Childhood obesity is closely related to healthy and intelligent family consumption.

Something about smart consumption has been analyzed in:

Chapter Quality of life and education in the knowledge society