The long article is signed by several dozen obesity specialists. They agreed to redefine the way in which this condition is defined, as well as the problems it represents on a medical level. The subject is very delicate because it regularly provokes bitter debates which go beyond the medical community alone. We know that obesity is associated with a wide range of pathologies such as diabetes or cardiovascular diseases. But for some observers, an obese person can sometimes live in good health and their excess weight should then only be considered as a risk factor.
Contrary opinions
For others, obesity is necessarily a health problem, which must be considered as a disease in itself. This is the view of the World Health Organization (WHO). This debate partly covers questions linked to the fight against discrimination. Some anti-fatphobia activists believe that their bodily appearance should not be stigmatized by deeming it pathological. However, it would be a caricature to summarize the controversy as an opposition between patients and doctors. Among the former, many consider it essential to consider obesity as a disease, in order to be taken seriously and to implement sufficiently ambitious public health policies.
Conversely, for many doctors, we risk poorly meeting the needs of patients if we take obesity as a single disease, instead of a risk factor involved in very variable pathologies of a patient. to the other. These questions become particularly acute with the arrival of very effective treatments for weight loss, including the emblematic Wegovy. While their side effects still raise questions, should they be given very widely or reserved for patients with the most affected health?
BMI is not enough
In the end, “no one is completely right and no one is completely wrong,” said Francesco Rubino, an obesity surgeon who chaired the work of the expert commission, at a press conference. Because the new recommendations seek nuance: in summary, obesity is a disease… But not all the time. The experts first insist on a point which is now a consensus. The eternal body mass index (BMI), which reflects the ratio between weight and height, is completely insufficient.
It would need to be supplemented by other examinations to decide whether a patient is obese: measuring their waist circumference for example, or, using radiology techniques, estimating the quantity of fat in the body. But even if a patient is declared obese, experts do not necessarily judge that this should be seen as an illness. According to them, it is only if organs show signs of dysfunction that obesity becomes “clinical”. Without this, they call for talking about “preclinical” obesity. It would then not be a disease but a condition which essentially requires preventive measures, and not necessarily medicinal or surgical treatments, in order to avoid “overmedicalization”.
In 20 years, overweight and obesity have increased significantly in France
According to the declarations of individuals noted by surveys renewed for two decades by Public Health France (barometers from 1996 to 2017), the levels of overweight (body mass index > 25 kg/m2) and obesity (BMI > 30) among adults in mainland France remain high, justifying the intensification of prevention policies.
Discontent
These conclusions aim to be consensual, but they run the risk of dissatisfying both camps. Among some patient associations, we simply do not want to hear that obesity is not always an illness. “It’s counterproductive on the public health message,” says Anne-Sophie Joly, founder of the National Collective of Obese Associations (CNAO), very virulent against experts disconnected from a “ground reality” experienced by obese patients not finding adequate follow-up.
