A double-edged sword

Argentina has moved to declare eating disorders a disease.

They have also moved to declare obesity a disease.

It's quite the double-edged sword here. I think it's good that people are saying that eating disorders are real diseases, worthy of coverage in both the public and private health care sector. Because they are.

However, I don't know that obesity is a disease state. You can be obese and be healthy- I see it all the time. But the definition of disease means that condition X directly causes your health to decline. There are diseases (heart disease, cancer, etc) that have been putatively correlated with obesity in the medical literature* but obesity itself isn't a disease. It's a description.

An AP story said the following:

Patients can now seek treatment [for eating disorders and obesity] under Argentine health programs. The law also prohibits the media from releasing diets that aren't backed by a health professional and requires that high calorie food carries a warning label.

I'm doubtful that this law will change much. Lots of whacky and simply unhealthy weight loss programs are advocated by "professionals." And food with warning labels (!!) will likely create more issues and angst. I'm glad nations are moving to address eating disorders, but they seem to be shooting themselves in the foot to do so.

*Some of these correlations seem slightly on the dubious side, but even if they are true, it wouldn't affect my argument.


Anonymous said...

Do you seriously not think that obesity is a disease? For someone who runs an ED site, I would think that you would know that obesity is considered "disordered eating" and to some professionals, it is considered an actual eating disorder (yes, I know there is a huge difference between disordered eating and eating disorder). Obesity is directly linked to an entire slew of health problems. In a sense, obesity is no different than anorexia or bulimia; they are all diseases that are ultimately controllable, but they are also diseases that take such a firm grip on the individual that it's hard to escape.

JenP said...

Regarding anonymous' comment, I think that there is a distinct difference between obesity and binge eating disorder or any type of related ED/NOS. Eating disorders should be classified by the psychological factors behind over/under-eating and one's relationship with food, rather than someone's actual weight.

mary said...

The good in all this is that if someone does have an ED related to obesity they will be able to obtain help. There are skinny people who don't have ED's just as there are bigger people who are exactly the way they are supposed to be...I get that and respect it. Still, we have to respect both sides of this coin. Sometimes weight gain is a health problem.I'd hate to see this become another country that puts it's people on scales and scolds them, or worse, uses someone they think is a prettier face to voice a song from another with a beautiful voice. I'm still steaming and I think the "real" little singer was beautiful and if she wasn't it would be IRRELEVANT! Of course this is off topic but I've been real slow in posting and needed to get caught up....whew. So, any luck finding a new place yet? What does Aria think? I know,where you go she's happy to go along.

Carrie Arnold said...


Binge eating is an eating disorder. You can be obese for a variety of reasons, but it's not a disease state *in and of itself*. You can be obese and perfectly healthy. You can't be anorexic and be healthy.

Go to www.fatrant.com and watch the first video by Joy Nash (or search for it on You Tube). She's clinically obese, but she doesn't have an eating disorder. Or disordered eating. Look at www.kateharding.net

Part of defining a disease means defining signs and symptoms. Certainly weight is a part of AN and obesity. But there are other things that are parts of eating disorder definitions (body image distortion, etc). You can be underweight and not anorexic. How would you define obesity as a disease?

And eating disorders are not controllable, not entirely. I think of them as no more (and perhaps no less) controllable as cancer. An ED isn't a choice you make, or something you really unmake. Perhaps you can explain what you mean by "controllable". Because I have a feeling we might be using it in two different ways.

I do think excessive weight gain can be a problem. Just like excessive weight loss. But to say "obesity is a disease" is way too blanket of a statement.

Allison Clare said...

I agree with the first comment. So many people, including myself, have jumped from anorexia, to bulimia, to compulsive overeating, and back again. The mindset with ALL eating disorders is so very similar, so incredibly painful and difficult to recover from.

Think about this: in the USA, rates of anorexia AND obesity are increasing.

I also think it has to do with compassion. I think it is difficult for people in our culture to find compassion for overweight people. I have endured this myself. In my anorexia, people would look at me like "oh poor thing, etc." But in other stages of my ED, others viewed it as more of a gross thing. The reality is that it is all the same addictive behavior and the same obsession with body weight, shape, and food.

Carrie Arnold said...

I think here is the difference: binge eating is an eating disorder. I don't think obesity is. Not all obese people overeat or have a pathological dieting mindset. Do people who binge eat tend to be overweight/obese? Yes. But not all- and I don't want to make those assumptions.

I agree that binge eating disorder is real, valid, neurobiological and should be classified as such. But a fat person isn't inherently diseased or sick or ill. They're just fat.

A:) said...

I think you are both arguing the same point. . .

All Carrie is really saying is that the term "Obese" (BMI30+) is a descriptor and CAN be a symptom of an ED -- whether it is bulimia, BED, etc. . .

Similarly underweight is not a disease and either is emaciated -- they are descriptors or symptoms/signs of different illnesses. . .

People with ALL ED's should be able to get help for whatever disorder they have -- perhaps Argentina has mislabelled BED and COED as "obesity" or it may be a slip of the article. . .


Jane said...
This comment has been removed by the author.
Jane said...


You make a very good point with the distinction between obesity and binge eating disorder. Obesity just means that someone falls within a certain BMI range (and that's just a height-weight ratio). It doesn't tell us much.

A BMI in the obese range doesn't necessarily even mean a person is "fat", at least not by my definition.

Shaq most obese
in NBA? So says BMI
Height-weight formula doesn't appear
to hold up in assessing basketball players
Jim Mcisaac / Getty Images file
At 7-foot-1 and 325 pounds, Miami Heat star Shaquille O’Neal had the NBA’s highest BMI, 31.6, in the AP analysis.

By Malcolm Ritter
updated 4:45 p.m. ET, Wed., March. 9, 2005

NEW YORK - Last week it was obese football players. Now it’s ... overweight basketball players?

Yep. If you apply a widely used criterion to the published heights and weights of NBA players, nearly half qualify as overweight.

Only four players assessed using the body-mass index (BMI) by The Associated Press made it all the way to the “obese” range, most notably — you guessed it — Miami Heat star Shaquille O’Neal.

But the notion that 200 other NBA players out of 426 are even within a 3-point shot of tubby might make one wonder: Just how good is the BMI at telling if somebody is too fat?

The finding follows a study of football players published last week in the Journal of the American Medical Association. That research concluded that according to BMI standards, more than half of National Football League players are obese, and nearly all are overweight. The study’s validity was questioned by an NFL spokesman.

Allison Clare said...

Thank you Carrie and A for the clarification. I think we are both on the same page.

Anonymous said...

Hi, first poster here. I wasn't very clear in my original post - so let me clarify. Obviously, there are people who are considered significantly underweight (with a BMI 18 or lower) who are not anorexic; they eat and exercise and live like all the rest of us do, but their genetics prevent them from gaining weight. These people are not anorexic, despite their low BMI. On the same note, there are people who are considered clinically obese who don't have disordered eating - they may eat and exercise like the rest of us too, but perhaps genetics or a disease of some sort is causing them to gain too much weight. What I was trying to say in my first post though is that there are underweight people who suffer from anorexia or bulimia and obese people who suffer from binge eating disorder, bulimia or compulsive over eating. ALL of these disorders are dangerous, life threatening, and should be treated with the utmost care. I felt you were implying in your post that there are no obese people who have an eating disorder - simply just obese due to lack of control, etc. The bottom line is, is that an eating disorder cannot be defined by one single shape, one single word, one single treatment. Each person is individual, and only him/her truly know if they need help or not. Obesity is linked to numerous health problems, just as anorexia is. An individual can have a very high or very low BMI and be PERFECTLY healthy and not necessarily eating disordered; however, another individual could have the same high or low BMI and be completely UNHEALTHY and be suffering tremendously from disordered eating.

Carrie Arnold said...


Thank you for the clarification.

You can be obese and be ill, it's true. But obesity itself isn't an illness (if you define it simply as a BMI greater than 30). It could be an issue with translation, where in the original Argentinian version binge eating translated as obesity.

Ai Lu said...

I'll add my own two cents to this one as someone who has lived in Argentina.

Argentina, like the U.S. and like neighboring Brazil, is a very image-conscious society. There, even more than in the U.S., women are expected to adhere to a certain beauty ideal: slender, tanned, European-looking. An Argentine article that I found about the new law (http://www.clarin.com/diario/2008/08/14/sociedad/s-01737127.htm) stated that, after poor people and Bolivians, Argentines discriminate the most against the obese. Arghhh! This attempt to medicalize the condition seems to be viewed by some Argentines as a good thing, to the extent that obese people can now get the "help" they need.

Although these attitudes about weight and image may contribute to disordered eating among Argentine women, we all should know by now that media images alone are rarely enough to send someone over the ED threshold (diathesis-stress, anyone?).

And even though we might want to give them the benefit of the doubt, the Argentine legislators are probably not distinguishing between obesity and binge eating disorder. The new law very clearly covers "obesidad, bulimia y anorexia" -- "obesidad" is
the same as "obesity" (NOT binge eating). At least one senator has said "This is not an aesthetic issues, it is a serious medical condition." As in many lower- and middle-income countries, obesity was not common in Argentina until recent decades, and I would venture a guess that it is poorly understood there, scientifically speaking, and, as already noted, highly stigmatized, (even worse than in the U.S.). The article in the Argentine newspaper said that this law was passed after the appearance of a very popular reality television show in Argentina that recruited obese participants and helped them lose weight. So -- probably not a very well-thought-out law.

What the AP article didn't mention is that this new legislation also prohibits the media from using images of "extrema delgadez" (extreme thinness) to promote their products. This would seem to be a helpful step to take, similar to some European countries' decisions to not allow extremely thin models to participate in runway shows. Not a bad idea, I think.

As for obesity and health, I'm less sure of what to think, having done some research recently into epidemiological trends in the developing world. Obesity is clearly ASSSOCIATED with diseases and conditions like hypertension, diabetes, cardiovascular disease -- but as we learn in research methods 101, CORRELATION IS NOT CAUSATION. As the disease burden shifts in developing countries from infectious disease (malaria, typhoid, etc.), we see more and more people in lower- and middle-income countries developing the aforementioned diseases -- but also asthma and allergies, which are usually not considered related to obesity. We are probably most likely looking at a disease CLUSTER, where obesity may be a trait associated with certain diseases -- but the connection is not yet clear.

Whew. Sorry to go on and on like this. Too much graduate work in health stuff.

Harriet said...

I'm late to the party, as usual. But Carrie, you said it so very well. Obesity is not a disease. Binge eating disorder is. Double-edged sword indeed.

Carrie Arnold said...


Thank you for breaking things down for me. I wasn't able to get ahold of the original, and my spanish is a bit rusty (I was almost fluent 10 years ago...but that was 10 years ago!).



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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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