Table 1:

PCP opinions on whether obesity should be considered a disease

Obesity should be considered a disease because:
Concept	Quote
1. It meets the criteria for something that should be considered disease	“It seems to me that many of the other diseases or conditions or ailments, with regard to comorbidities, stem from the first place called obesity, overweight, morbid obesity, super obesity, whatever. That, in and of itself, seems to really lead to all these other issues and factors that are called separate conditions, illnesses, diseases. So, to me it seems, if this is at the root of all that, that’s what disease is: It’s pathology that leads to these other factors.” “It’s pretty clear that it’s something that will shorten your life, compromise your life. Using those criteria, it’s a disease.” “I think a lot of what we’re learning, too, about the biology of people who are morbidly obese, the interplay of different hormones, it has to be a disease, of course. The biologic functioning of someone who is morbidly obese is different than people who are not, apart from any secondary diseases related to their obesity.”
2. It creates a framework to discuss treatment options with patients	“I think if physicians look at [obesity] as a disease, they will address it when they see patients. I try to put it in my patient’s problem folder every time I see that. It’s something that I talk about. ‘How are you doing with the exercise plan?’ That’s something that keeps it on our mind, because we’re a disease-focused profession.” “Having it identified as a disease, so patients are aware that they have it….many of my patients aren’t aware that they are overweight or obese until we talk about it. I think it’s, ‘Oh. Not me, everybody else. This is a big problem in our society, but it’s not me.’ Until we label it and call it what it is.”
3. It will encourage treatment by improving physician reimbursement for obesity-related services	“As physicians, it’s advantageous to have it be a disease. Because then you track it and you can bill for it. The one problem is right now, because of the fee-for-service models that we’re mostly under, we often don’t have the time necessary to help with the motivational change and other things that’s required, and it’s very costly.”
4. It will help foster research and innovation	“The other advantage of tracking it as a disease, is that you actually can look at more population health versus individual encounters. Now you have a structured field that you can find, you can search out, and you can draw out and those kinds of things.” “I guess the positive aspect of considering it as a disease, referring to it would get your attention. And I guess it de-stigmatizes it in a way and also creates the opportunity for better research and study funding than just considering it a social problem.”
Obesity should not be considered a disease because:
1. It is a risk factor for disease but is not itself a disease	“I don’t think of it as a disease per se; I think of it as a major risk factor for a lot of diseases. But you know, technically, obesity is excess fat deposit in certain parts of your body and being over a certain percentage of what you should weigh. Now, I mean, is a disease that per se? It doesn’t make people sick, but there are so many things associated with it--you know, insulin resistance, pressure on the joints, vascular complications of diseases that are linked to being obese. But to call obesity itself a disease? It’s really plugged into some very dysfunctional lifestyles and habits. So in that sense, maybe it would be like calling alcoholism a disease. But, I don’t know, I tend to think of a disease as something that’s more directly affecting the bodies function or causing pain or disability. Obesity, unless it’s massive, usually doesn’t do the trick. I think indirectly. So, I’m not sure I would think of it as a disease.” “It is unclear if obesity is a cause or effect. We have a lot of patients with not very many coping strategies. If they’re depressed, they’ll eat, if they are lonely, they’ll eat, if they’re under stress, they’ll eat.”
2. Patients may lose accountability for their behavior	“If they don’t have ownership of it, it’s something they can’t change. Sometimes you throw up your hands and say, ‘Well, it’s not my fault; it’s my genetics.’ Or I’ve heard people say that, ‘Oh, my mom was fat, my dad was fat, I’m destined to be fat. So, I’m not going to go out and exercise or try to lose weight.’” “You get rid of the responsibility, too, don’t you think? It’s not your fault; you have this disease. So, don’t be motivated to do anything about it, because it’s out of your hands.”
3. It will not lead to better coverage for obesity treatment	“I almost feel like I have the opposite kind of experience where, even if I put obesity as a diagnosis, it’s not going to matter for a lot of my patients based on their insurance. I still can’t get them into nutrition. It doesn’t do anything for them. I think of it more, when you talk about coding--- that was my first thought or response was, it doesn’t do anything for us! I think that’s changing with, now maybe with Medicare at least. But, that’s a huge frustration.”
4. It may have a negative effect on patient-physician interactions	“I realized that people are reading our problem lists through MyChart and getting offended [that obesity is included on their problem lists]. So now, I just put ‘overweight’ and I’ll put the ideal body weight in there in a little box and you can see how much over the [ideal weight you are]. I don’t call it obesity because I think it’s got a pejorative implication for a lot of people. They don’t like it.”