Obesity, disease and the social determinants of health

Submitted by Carlyn Zwarenstein on July 4, 2013 - 14:32

With the American Medical Association’s recent decision to reclassify obesity as a disease (it was previously "a condition"), the Canadian Medical Association may well begin considering a similar stance beginning at their August meeting and continuing into the fall. In practice, doctors in Canada may already treat obesity as a disease; however, a formal decision to label it as such would have policy implications.

A review of the CMA’s discourse on obesity over the years appeared in a 2012 issue of the Canadian Journal of Disability Studies, and it highlights some concerns with medicalization of obesity. The author, Angela Eileen Wisniewski (University of New Brunswick), describes how the CMA has often focused on the economic costs of obesity, using the economic size of the problem (so to speak) to validate new research and prioritize obesity among other public health issues. At times this has gone hand in hand with a neoliberal-style focus on individual responsibilities and the need to ration scarce resources. The CMA’s initial use of the term “the obesity epidemic” was reflective of this line of thinking.

At other times, however the CMA has actually, and strongly, introduced ideas of social inclusiveness and equity into policy debates by describing obesity as a structural (still economics-related) problem requiring government intervention such as increases in social assistance rates or regulation of advertising.

Wisniewski suggests that when the CMA argues that it is an issue of equity, a tension exists between disenfranchising obese people by treating them as a collective problem, and raising the notion that there is a collective responsibility, in the form of policy prescriptions, in solving it. She also points out the risks of seeking equity in, for example, the form of pharmaceutical products that can make some patients conform closer to the body size norm (she notes that in 2006 the CMA critically evaluated the use of weight-loss drugs but has not more generally address trends in pharmaceutical prescription and consumption, which are already pertinent in the U.S. following the AMA's decision).  The suggestion is that it might be more effective to focus specifically on eliminating injustice (such as limited access to affordable fresh and healthy foods) rather than on a desired body type.

CMA’s recent move to focus more strongly on the social determinants of health suggests that the Association may be increasingly interested in achieving greater consistency as it seeks to define the relationship of obesity to public health and medical care. It will be interesting to see how the discussion unfolds and whether any of the distinctions made in the CJDS make it into the process.

And here’s another very interesting take on it (focusing on the problems with defining obesity in terms of BMI, and with a nice breakdown of the points of agreement and disagreement in the longstanding debate on medicalization of obesity).

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