Dr. Arnold Saperstein & Katherine Gustafson
Obesity in the Spotlight: More Than a Weight Issue
Obesity is often in the headlines these days as GLP-1 medications help people the world over reduce their weight and risk of cardiometabolic disease. While many patients seeking out these drugs may be motivated as much—or more—by the desire to appear thin than they are by the medical benefits of the intervention, these drugs’ potential to vastly improve many people’s health cannot be overstated.
Ultimately, health is watchword when it comes to obesity, which is now classified as a chronic disease unto itself. This is not because fatness per se is problematic so much as excess body weight reliably indicates an increased risk of a range of diseases with potentially serious detrimental effects on health.
Let’s look at obesity’s role as a chronic disease, why it is an alarming red flag for many Americans, and what patients and providers can do to address the problem.
Why Obesity is Now Recognized as a Chronic Disease
Obesity has been with us humans for centuries, but our understanding of the condition as a disease subject to medical intervention is a mere decade old. In 2013, the American Medical Association (AMA)—the country’s most influential medical association—officially recognized obesity as a disease. While the National Institutes of Health had done so in 1998, and the American Obesity Society in 2008, the AMA had been cautious. In fact, only in 2012 the AMA’s own Council on Science and Public Health had declared that there was insufficient data to support the assertion.
The AMA’s hesitancy reflected widespread skepticism on the matter. A number of commentators met its 2013 announcement with disbelief, anger, and even ridicule. “If obesity truly is a disease, then over 78 million adults and 12 million children in America just got classified as sick,” wrote a doctor in The Atlantic who wondered facetiously if we should all send our obese friends and relatives flowers and “get well” cards.
A decade later, the question still causes disagreement despite much new research on obesity’s problematic health impacts and an unabated increase in the globe’s obesity epidemic. Some continue to argue that obesity is a simple failure of willpower, while others see a complex interplay of intertwined dysfunctions of metabolism, fat tissue, and diet that results in specific risks and impairments within the body—read, a disease. These two groups tend to talk past each other. As two Irish doctors write in the journal Obesity Reviews, “when medical experts say, ‘Obesity is a disease,’ the majority outside medicine inevitably takes this to mean ‘being fat is a disease.’”
Obesity is More Than a Lifestyle Choice
But being fat isn’t a disease so much as fat appears to be the center of gravity in a universe of bodily dysfunction. In 2017, the American Association of Clinical Endocrinology (AACE) tried to refine the conversion when it classified obesity as an “adiposity-based chronic disease (ABCD),” a name meant to highlight its chronic nature and the fact that the accumulation of body fat is a key indicator—and likely primary driver—of disorder.
For the medical establishment, fat is not a superficial or moral problem, but a clinical one: The accumulation of body fat is associated with a breakdown in health.
How Obesity Drives Cardiometabolic and Chronic Disease
Obesity strongly drives the rise in cardiometabolic conditions, which have increased in step with the accelerating obesity epidemic.
Metabolic syndrome in the U.S. population has increased from around 25% in 1994 to as high as 34%, according to one 2025 study. Metabolic syndrome is characterized by a person having three of the following characteristics: abdominal obesity, high blood pressure, high blood sugar, high blood triglycerides, and low HDL (good) cholesterol. It is often a precursor to diabetes, which affects more than 1 in 10 Americans, and heart disease, the leading cause of mortality in the U.S. that accounts for 20% of all deaths. About half of all Americans currently have some form of cardiovascular issue, including coronary heart disease, heart failure, stroke, and high blood pressure.
Obesity’s Ripple Effects
Obesity and its associated metabolic disorders contribute to a variety of comorbidities. Studies have found obesity to be strongly correlated with a high risk of many types of cancer, as well as associated with respiratory symptoms and diseases such as exertional dyspnea, sleep apnea, obesity hypoventilation syndrome (OHS), chronic obstructive pulmonary disease (COPD), asthma, pulmonary embolism, and aspiration pneumonia. Meanwhile, those with diabetes are more likely to develop chronic kidney disease, vision impairment or blindness, and depression.
So, while the discussion continues over whether a high body mass index (BMI)—the metric typically used to measure obesity—is itself a disease, there is solid evidence that obesity is a bright red flag indicating potential ill-health.
What Providers Can Do: Clinical Vigilance and Patient Education
Considering that obesity is a driver—or at least an indicator—of a variety of cardiovascular and other diseases, providers must treat it as a condition in need of serious and sustained intervention. Part of that job is educating patients on the risks associated with obesity, in particular the extreme risk presented by heart disease. Notably, a recent American Heart Association survey found that 51% of U.S. adults aren’t aware that heart disease is the leading cause of death in the U.S., despite it having held that status for more than 100 years.
Patients who are well educated on the risks they face with a high BMI are most likely to proactively seek preventative care and take on lifestyle interventions to reduce weight and cardiovascular risk. They will benefit from consistent and early screenings, such as checking for abdominal obesity and inflammation, and measuring blood pressure and cholesterol. They will understand the need for healthy diet and exercise, and are more likely to work with their care provider to establish a plan they can maintain. And those who do pursue the new GLP-1s as part of that plan will be more likely to adhere to their medication regimen over time.
Tackling Stigma: Why Virtual Care Matters
Providers should know, however, that productively addressing weight concerns with patients can be difficult due to stigma and shame around the topic. Virtual integrated care can be an effective option, as it enables patients to build a relationship with an expert clinician they are comfortable with linguistically and culturally, whose specialized knowledge they feel confident in, and whom they can meet from the comfort of home.
This is why Cecelia Health, as a virtual specialty medical practice, is a leader in obesity care and lifestyle-first clinical interventions for cardiometabolic health. Our interdisciplinary care team understands this difficult and controversial terrain, and helps our patients understand it too so they can find and maintain health.