Is Obesity a disease?

Is Obesity a Disease?By Professor Dr Pandiyan Natarajan https://medium.com/@pandiyan1_39083/is-obesity-a-disease-6ccccca1cc9b“When physiology collides with modernity, the body bears the consequences.”Obesity is absent in wild animal populations and uncommon in traditional societies untouched by modern food systems. This is not coincidence. It is a signal. Medicine has a long history of medicalizing what it does not fully understand — masturbation was once classified as a disease, described with clinical solemnity, and treated with surgical earnestness. We should look at the AMA’s 2013 classification of obesity with the same sober self-reflection — before, not after, the consequences unfold.A Vote Against the EvidenceThe AMA voted to classify obesity as a disease against the explicit recommendation of its own Council on Science and Public Health. Diseases are not created by ballot — yet this is not the first time professional consensus has outrun the evidence.Where Is the Lesion? The Bradford Hill ProblemDisease requires an identifiable lesion, a disrupted mechanism, a causative agent. Anaemia is a sign, not a disease — clinicians always ask why. Obesity deserves the same discipline. Excess adipose tissue is a measurement, not a pathology. The Bradford Hill criteria demand biological plausibility, specificity, and a coherent causal pathway. Obesity satisfies none of these independently. To classify the sign as the disease is a category error with profound consequences.The Cause We Refuse to NameObesity is a condition of refined carbohydrate and caloric excess — a metabolic statement, not a moral one. Ultra-processed foods override satiety signaling, reshape the gut microbiome, and alter dopamine pathways. The downstream biology — leptin resistance, hyperinsulinaemia, hypothalamic dysregulation — is consequence, not cause. To point to it and call it a disease is to confuse the wound with the weapon. By locking treatment into a reductionist paradigm, we medicate the sign and never address the plate, the food environment, or the society.Behaviour Shapes Biology — But Whose?Epigenetics shows that maternal diet, paternal nutrition, and the first thousand days shape gene expression for decades. A child’s biology is altered before any autonomous choice is possible — not by disease, but by adult behaviour: maternal diet, industrial food design, government subsidies, absent nutrition education. The biology is real. The cause is behavioral. The responsibility lies with adults.The Children: Medicine’s Moral ReckoningIn 2023, the AAP recommended bariatric surgery and semaglutide for children with obesity. A child shaped in utero, fed ultra-processed food from infancy, in a food-insecure home — did not cause their condition. Adult dropout rates for GLP-1 agonists reach 85% at two years, with rapid weight regain and the harms of yo-yo cycling. To intervene surgically and pharmacologically on children who bear no responsibility for their circumstances demands the highest ethical scrutiny.Compassion Without AbsolutionObesity is not a disease. It is the most visible condition of how we feed our children, structure our food systems, and govern our industries. We can treat individuals with dignity, support families with education, and regulate industry with courage — without a disease label that risks serving those who profit from chronic illness more than those who suffer from it.“The children who carry this burden did not earn it. But the adults who created the conditions for it must own it.”.