‘Obesity: Decision Or Disease?’ Billboards Oversimplify The Issue

obesity disease billboard in Indiana

The root causes of America’s obesity problems are too complicated to distill into simple sloganeering like “Obesity is a disease, not a decision.” Yet that’s exactly the tack an Indiana hospital is taking with a series of billboards designed to attract people to its weight-loss and bariatric surgery services.

The billboards, erected by St. Mary Medical Center of Northwest Indiana, have stirred up more than just new recruits: They’re also causing a backlash from people who believe the hospital’s message is irresponsible and removes personal responsibility from the obesity equation. St. Mary’s director of bariatric services, Lorri Field, said the hospital has been receiving angry phone calls and emails from people offended by the billboards’ message. Here’s one sample:

“There is no disease that causes your body to drive to McDonald’s to go get some fries. There is no disease that makes your hands unwrap a candy bar. It’s all habits.”

Field said she “didn’t expect such an ugly debate.”

I’m not surprised. At a time when nearly three-quarters of this country is on track to be overweight or obese, the question of whether obesity should be treated like any other medical condition or whether it’s a ‘lifestyle choice’ always tends to stir up strong opinions. Like the debate over alcoholism or other forms of addiction, however, framing obesity as either one or the other, disease or decision, is too simplistic to be of much use beyond marketing. I guess maybe St. Mary’s billboards are kind of irresponsible—not for suggesting that obesity is a disease, but for painting the debate in such starkly black-or-white terms.

Ultimately, it’s impossible for an outsider to tell how much nutrition, genetics or other factors contribute to an individual’s obesity—it’s often a complicated interplay between many things. Calling obesity a ‘decision’ is way too flippant—you’d be hard-pressed to find many obese people who say, yes yes yes, I really want all these extra pounds! And yet personal responsibility does factor in. Calling obesity a ‘disease’ takes into account genetic factors that influence a person’s likelihood to carry extra weight. Yet unlike, say, ovarian cancer, obesity can often be managed or mitigated by lifestyle choices. And neither of these frames takes environmental or cultural factors—both big contributors to obesity in and of themselves—into account.

While the controversy these billboards are causing may not be entirely surprising, it does make you wonder how we got to this polarizing point, doesn’t it? So maybe you don’t agree with the hospital’s conclusion that obesity is a disease—is that really a cause for anger or offense? Why do so many people feel such a personal stake in the obesity issue?

Let’s hear your thoughts in the comments …

Photo: MyFoxOrlando.com 

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    • jen

      There actually is a disease that causes your body to drive up to McDonalds for some fries or unwrap that candy bar. It’s called binge/compulsive eating disorder, and it’s as real as anorexia or bulimia and MUCH more common. I have it, and I’ve spent years in therapy trying to get my symptoms under control. I am admittedly a more extreme case than most, but before I got help, I had no more control over driving through McDonalds than a schizophrenic person has over listening to the voices in their head. And, similarly to a schizophrenic person, I needed intensive treatment to get better – and ongoing, less intensive treatment to maintain.

      The worst possible thing for a person with an eating disorder is to judge and ridicule them. A lot of eating disorders are already rooted in poor self esteem. How about, rather than judging, we simply encourage people to get the help they need (and increase access to it)?

    • A.S.H. Brown II

      honestly, I feel that a lot of these articles (I’ve seen literally over a dozen of them linked from other articles on this site alone) don’t help at all. They’re all basically passive ways of encouraging obesity in ways ranging from “you can be overweight and healthy” to “obesity is the new smoking and that’s ‘good’ for the U.S.” …really, now?

      Some people do have “flawed” genes–meaning its just their body types. Some are naturally larger, robust individuals–I don’t think we’re all meant to be one body type, personally. Some have problems such as thyroid issues. But some people over indulge, and industries such as the fast food and the insurgence of the ‘foodie’ culture and the cooking shows associated with it, matched with the fact that people are, in fact, very sedentary and drive almost everywhere, make obesity happen for people not naturally at risk.

      Hasn’t anyone noticed the obesity jump up within the last decade? I have. I’ve even watched people I have known personally become overweight, as well as just looking outside at people around me. I can’t say I believe it’s all from natural causes. It’s lifestyle choices in a culture like ours that propogates obesity in lots of cases. Though I am not as insensitive as to say that all people are simply “fat”, but I won’t downplay, or cater to those that really are because they choose ways to -not- avoid it.

    • Leanne Hoagland-Smith

      From the 30,000 foot perspective, IMHO we are too anxious to label a behavior a disease and then treat it with medication. From the research I have read, the minority of obese people and overweight people indeed suffer from genetic to other conditions such as arthritis, etc. that may keep them from exercising. However, the majority of people just eat too much to eat the wrong foods and then fail to exercise. Today I eat far less than I ate even 5 years ago. As one ages, the metabolism slows down and requires extra exercise. Sitting in front of a computer or some electronic game does not provide enough exercise. To me this sign just gave permission to a lot of people to not be accountable for their behaviors. What was even sadder is a hospital published this message.

    • pmc

      Actually, obesity is a disease – and not a psychological but an endocrine one. Studies with monozygotic twins who were reared apart have demonstrated that BMI is mainly determined by genes. Energy intake and expenditure is not, in the long term, under voluntary control, neither on obese people nor on thin ones, who maintain their weights without consciously intending to do so.

      You can, by sheer will power restrict your eating… and you can hold your breath – with the same long-term success.

    • Joe

      We all care because running extra costs through the healthcare system is not what we need. Some people do likely have a disease, but far more people choose habits that lead to being overweight or obese. Maintaining one’s weight is hard work – for anyone who tries to do it. Most people today are afraid of hard work and give up when it gets tough.