14 OPINION
5 MINUTES * 1,2
14 OPINION
15 SEPTEMBER 2023 ausdoc . com . au
Insight
A new name for obesity ?
Paul Smith Editor at Australian Doctor .
Is renaming ( and rethinking ) obesity as easy as ABCD ?
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THE clinical debate on the status of obesity as a disease has been protracted . But in the past decade ,
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References : 1 . Bousquet J et al . J Allergy Clin Immunol Prac 2018 ; 6 ( 5 ): 1726 – 1732 . ( Funded by MEDA Pharma GmbH & Co . KG ). 2 . Dymista ® Allergy Product Information . Dymista ® is a Viatris company trademark . Copyright © 2023 Viatris Inc . All rights reserved . DYM-2023-0365 . DH . DYM-003906-00 . Date Prepared : June 2023 . medical organisations around the globe — from the WHO to the World Obesity Federation — have issued position statements declaring that the condition is a complex , chronic , relapsing disease process .
It is significant given that , in the social sciences , this medicalisation of obesity is often claimed to contribute to weight stigma , fatphobia and the marginalisation or oppression of people of higher weight .
This was echoed recently by Taryn Brumfitt , the Australian of the Year and body image advocate , who suggested that GPs risked turning patients off seeking care by raising issues around their weight
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Corticosteroid during short consults . This could reflect that obesity as a disease is still conflated with ‘ fatness ’ as a disease in the public mind and the idea that obesity medicine is therefore about trying to make “ fat people thin ”.
This is the argument of endocrinologist Professor Francis Finucane — from the Centre for Diabetes , Endocrinology and Metabolism at
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University Hospital Galway , Ireland — and philosopher Dr Margaret Steele ( PhD ), from the University of Galway .
“[ Outside ] of medicine , the claim that obesity is a disease will almost inevitably be misconstrued as the claim that excess weight is a disease or , more colloquially , being fat is a disease ,” they write in the journal Obesity Reviews .
“ This , in turn , confirms a long-held prejudice that those with higher BMI have , by definition , failed to protect their health , a claim which is often used to justify weight stigma .”
‘ Obesity ’ as a clinical term needs to change , they say , citing examples of other shifts in medical terminology that have been made to eliminate the social stigma linked to medical diagnosis and care .
“ Over the course of the 20th century , terms like ‘ feeble-minded ’ and ‘ moron ’ were dropped from medical usage because they had started to be used in a pejorative way in the wider culture ,” they write .
“ Although ‘ obese ’ may not be thrown around as a casual insult in the way ‘ imbecile ’ or ‘ moron ’ came to be , there is evidence that it carries negative connotations , as we have seen , and some people consider it a slur .”
The authors say ‘ corpulence ’ has been suggested as an alternative diagnostic term .
But their preferred option is adiposity-based chronic disease , or ABCD . It acknowledges the role of adipocyte dysfunction , which often , but not always , arises from enlargement of the adipocyte as a result of excess dietary intake , they claim .
The level of dysfunction can also be quantified by measuring adipocyte-derived hormones , such as leptin and adiponectin .
“ Such clarity could significantly improve public understanding not only of the disease but also , crucially , of the medical , surgical and other treatments now available to address it ,” argue Professor Finucane and Dr Steele .
And through this neologism , the term ‘ overweight ’ would also be rendered obsolete in a clinical context , they add .
“ It would mean we no longer refer to ‘ weight management ’ when describing specialist clinical services for patients with obesity complications ,” they write .
“ In short , it would serve to emphasise the reality that obesity medicine is about getting sick people well , not making ‘ fat ’ people thin .”
Obes Rev 2023 ; 6 Jun .