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Obesity as a Socially Defined Disease: Philosophical Considerations and Implications for Policy and Care

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Abstract

Obesity has generated significant worries amongst health policy makers and has obtained increased attention in health care. Obesity is unanimously defined as a disease in the health care and health policy literature. However, there are pragmatic and not principled reasons for this. This warrants an analysis of obesity according to standard conceptions of disease in the literature of philosophy of medicine. According to theories and definitions of disease referring to (abnormal functioning of) internal processes, obesity is not a disease. Obesity undoubtedly can result in disease, making it a risk factor for disease, but not a disease per se. According to several social conceptions of disease, however, obesity clearly is a disease. Obesity can conflict with aesthetic, moral, or other social norms. Making obesity a “social disease” may very well be a wise health policy, assuring and improving population health, especially if we address the social determinants of obesity, such as the food supply and marketing system. However, applying biomedical solutions to social problems may also have severe side effects. It can result in medicalization and enhance stigmatization and discrimination of persons based on appearance or behavior. Approaching social problems with biomedical means may also serve commercial and professionals’ interests more than the health and welfare of individuals; it may make quick fix medical solutions halt more sustainable structural solutions. This urges health insurers, health care professionals, and health policy makers to be cautious. Especially if we want to help and respect persons that we classify and treat as obese.

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Notes

  1. It is worth noting that obesity also has been conceived of as an adaptive margin for survival, and the “obesity paradox” nuances the argumentation.

  2. This also goes for conceptions of disease that are based on reduced ability or action failure, but without requiring associated internal mental of physical processes.

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Acknowledgments

I am most thankful to wise comments and suggestions by two anonymous reviewers. Part of this research has been supported by The Commonwealth Fund through the Harkness Fellowship at The Dartmouth Institute of Health Policy and Clinical Practice (TDI). The views presented here are those of the author and not necessarily those of The Commonwealth Fund their directors, officers, or staff or of TDI.

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  1. Centre for Medical Ethics, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway

    Bjørn Hofmann

  2. University College of Gjøvik, Gjøvik, Norway

    Bjørn Hofmann

  3. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA

    Bjørn Hofmann

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Hofmann, B. Obesity as a Socially Defined Disease: Philosophical Considerations and Implications for Policy and Care. Health Care Anal 24, 86–100 (2016). https://doi.org/10.1007/s10728-015-0291-1

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