It’s been all the rage — celebrities and physicians tout GLP-1 inhibitors, like Ozempic and Wegovy, as miracle drugs for diabetes management and weight loss. But some still believe weight loss is a function of personal control and view these drugs as taking the “easy way out.”
While the rise of weight loss drugs is controversial, medicalizing obesity shouldn’t be. Many who struggle with chronic weight-related conditions finally see a light at the end of the tunnel. Viewing obesity as a medical problem that can be treated with medication and as a chronic condition with complex causes more accurately reflects new research, destigmatizes seeking treatment, incentivizes the development of new treatment tools, and increases overall well-being.
Is Obesity a Disease?
Yes. Obesity is a medical problem characterized by having excess body fat. The American Medical Association and National Institutes of Health recognized obesity as a disease years ago. Yet the claim is still contentious; some believe people with obesity are solely responsible for their weight gain and therefore solely responsible for losing weight by eating less and exercising more: since an individual’s behavior can remedy the problem, obesity is not a disease.
But research has shown there are genetic differences and environmental factors that play a major role in obesity, making it a disease that should be viewed like any other. After all, nobody would accuse someone with breast cancer to be responsible for their diagnosis as a result of their behavior. Since research has shown that most individuals are unable to change the progression of obesity through modifications to personal behavior alone, obesity should be called a disease. This characterization of obesity as a disease is a huge step toward medicalizing obesity.
Etiology of Obesity
Medicalizing obesity is consistent with new research that personal choice is not the only factor that impacts weight. On the one hand, weight gain is a function of consuming more calories than expending. Eating foods that are heavily processed and high in fats and sugars also contributes to obesity. But research shows that accumulation of fat can be the result of numerous other factors, which sometimes work in tandem and can include genetics, age, metabolism, gastrointestinal microbiota, pregnancy, and menopause. Therefore, two individuals consuming an identical number of calories per day and expending the same amount of energy will deposit adipose tissue differently over time and have differing levels of insulin resistance and inflammation.
Destigmatizing Seeking Obesity Treatment
Medicalizing obesity empowers those who want to lose weight to alleviate their chronic conditions. But the stigmatization of GLP-1 inhibitors as a way to “cheat” and avoid the responsibility of independently reversing their condition harms the mental health of those with untreated obesity and in turn only further complicates treatment. And mainstream media citing Ozempic misuse by Hollywood celebrities for superficial weight loss further delegitimizes these medications. On the other hand, individuals who have been able to access GLP-1 drugs have seen major mental health benefits. They feel less stress and stigma around their personal choices including diet and exercise. They are empowered to make lifestyle changes.
Some patients fear that weight loss drugs are a lifelong commitment, akin to committing to a lifelong crutch. However, lifelong treatments are typical for chronic conditions, including diabetes and hypertension. And lifelong treatment is not necessarily the case for everybody. Regardless, medicalizing obesity can mitigate bias and fear over lifelong treatment.
Advancements in Obesity Diagnosis and Treatment
Medicalizing obesity and prescribing GLP-1 drugs requires a reevaluation of how obesity is diagnosed; otherwise, weight loss drugs will not be adequately prescribed to those who need them. Body Mass Index (BMI), a height to weight ratio, is used. However, this measure often does not accurately measure body fat. Muscular athletes often measure in the BMI range of obese, and individuals BMIs frequently measure in the “healthy” range despite maintaining excess body fat. This is not unsurprising given BMI’s history: it was developed almost 200 years ago from studies that included mostly white men. The simple calculation does not consider age, sex, racial, ethnic, or genetic differences. And it was never intended to provide the basis of a diagnostic criteria for drugs.
Recently, researchers have considered introducing the Body Roundness Index (BRI) which takes height and waist circumference into account without weight. Research suggests that BRI is a promising indicator of mortality and more accurately assesses fat distribution than BMI. This is especially important in diagnosing obesity as a medical condition, since central and abdominal fat is more closely linked to chronic conditions. While there are still challenges in adopting a new measure of body fat given how cheap, easy to use, and easily scalable BMI is, BRI is a promising measurement that is driven by modern research while being as convenient to put into practice as BMI.
Future Benefits
If diagnosis is improved and treatments for obesity are widely accepted, there will be numerous future benefits. Since obesity is a risk factor for numerous comorbid chronic conditions —including heart disease, diabetes, high blood pressure, sleep apnea, and cancers — treating obesity can prevent or reduce comorbidities and future chronic disease. Discriminatory prescribing patterns of treatments can also be alleviated. Using BMI as the metric for weight loss drug access inaccurately qualifies and disqualifies individuals from receiving medically necessary treatment. Revising the definition of obesity allows pharmaceutical companies to use new metrics to define eligibility for their drugs to reach those who need them.
Medicalizing obesity is consistent with new research on causation and disease progression. All patients deserve to benefit from advancements in diagnosis without stigma and improved well-being.
Jessica Samuels is a third-year dual degree law and public health student at Harvard University. (J.D./MPH 2025). Her research interests include genetics, environmental health sciences, novel biotechnologies, and the FDA regulatory process. She has previously published work on the accuracy of ultrasound in predicting malignant ovarian masses. At HLS, Jessica is co-president of the Harvard Health Law Society.