Is obesity a disease or not?

Dr Lustig tried to convince the audience at 23:34 minute that obesity is not a problem, it is irrelevant and it is a marker of the problem, not a disease itself: 

He said the problem was the metabolic syndrome that comes along obesity: diabetes, hypertension, dyslipidemia, cardiovascular disease, cancer, dementia, non-alcoholic fatty disease, because these metabolic dysfunctions are what people die from, not from obesity - he said. So why the abdominal obesity is a feature of the metabolic syndrome? Anybody can have excess fat stored in their abdomen, even apparently slim person, but obese definitely have excess fat in there as well, only the more fat around their body masks this feature. 

Have you heard about a morbidly obese person who has got a heart failure because the heart could no longer work so hard to pump the blood through the massive body full of fat? The person might have been metabolically healthy - as Dr Lustig said later that 20% of obese people are metabolically normal and without the inflammation, but the heart was weakened by the enormous effort to pump a higher volume of blood through the very distant and massive fatty tissue. Obese person also has a lot of internal fat, which squeezes the organs, preventing them from functioning properly, including the lungs and - the heart, despite they may be metabolically normal at a given time. 

Obstructive sleep apnea is also often a result of excess weight and disappears, or improves at least, when the person loses weight. That is why obese people often sleep with the oxygen mask to prevent their death during sleep. Now tell me that people do not die of obesity. Not all of them die because of that, of course. Their sleep, however, is so affected by the frequent asphyxia (lack of oxygen) due to apnea that they cannot function properly during the day and that often results in other health problems, including a hypertension which might not have occurred with a normal weight otherwise. 

Or, how about arthritis due to excess weight and the premature wear of the cartilage in the knees? Obese people suffer this quite commonly while not having other disease markers in their medical card.

And if I have not convinced you yet, maybe the American Medical Association will. Although there were many protests and reasoning why it should not be so, I agree that obesity itself should be considered a disease, at least for the reasons I have mentioned above.

Look at the diagram below. You could have already seen it in my other articles but it also has its meaning in this post. 

This diagram shows the main argument of Dr Lustig why obesity is not a problem per se. I think that trying to support that claim this way is silly because this does not disprove the point. People get sick from the diet, wrong diet, lack of nutrients and non-nutritive protecting compounds, smoking, stress, lack of sleep, not-exercising and other dietary and non-dietary factors. Obese people have just overdone it with the calories more than others and stored them as fat, bringing additional burden on them on top of the diseases they may share with the non-obese group.

Probably the simplest reason why obesity IS a disease is that the excess adiposity itself can promote inflammation without the factors of other diseases present (yet). And this inflammation further promotes other diseases such as diabetes or atherosclerosis and subsequent cardiovascular diseases. Only 20% of obese were reported as having a normal cellular metabolism, as you could read in another article.

So why being so reluctant to accept the obesity as a disease on its own? It was right in front of our/your eyes from the beginning: 80% of obese people are NOT metabolically healthy. For the majority of the remaining ones it may be just a matter of time. Just because somebody pools all the chronic and metabolic diseases into one oval as is in the diagram, it does not mean that excess adiposity does not represent health issues on its own. And I have already explained to you, how flawed that diagram is and so are the claims associated with it. 

Or, let's try a different example: Smoking. Everybody now accepts that smoking kills. You can read it on every box of cigarettes or tobacco. Nobody argues against it. But does smoking kills 100% of smokers? Or at least 80%, by any associated disease, might it be a cancer or cardiovascular disease? Not really. Dr Lustig once said that it was 50%. Can we therefore say that smoking is not a problem and that it is the cancer or emphysema that kills people or makes them permanently disabled? Try it. Not all people with lung cancer smoked in their life either. 

Yet Dr Lustig keeps repeating in different lectures that obesity is not a problem and he even said that we have to fix the disease associated with obesity first and then the obesity will go away. Really? Keep this claim in mind, I will discuss it in one of my future articles. 

And, finally: Why Dr Lustig works at a clinic for obese children trying to make them slimmer and healthier? Or does he only focus on those that have the inflammation or NAFLD present, leaving the others to their fate, despite being obese? Is it healthy to remain obese with no metabolic illness present at a given time point? That is the question.