Obesity - A Chronic Disease

Obesity is now considered a chronic disease because it is a complex, relapsing condition driven by genetic, metabolic, hormonal, and environmental factors that persistently dysregulate energy balance and adipose tissue function . It causes progressive, multisystem harm — including type 2 diabetes, cardiovascular disease, and certain cancers — and requires lifelong, individualized management with lifestyle, pharmacotherapy, and surgery, as no single intervention yields durable remission. Recognizing obesity as a chronic disease aligns with its biology, reduces stigma, improves access to care, and supports sustained, multidisciplinary treatment.

Pathophysiological basis for chronic disease classification

Obesity is characterized by persistent dysregulation of energy balance, involving complex interactions among genetic, metabolic, hormonal, and environmental factors. This dysregulation leads to chronic inflammation, insulin resistance, and adipose tissue dysfunction, which are hallmarks of chronic diseases.

- Genetic predisposition: Multiple genes influence susceptibility to obesity, affecting appetite regulation, energy expenditure, and fat storage.

- Hormonal dysregulation: Hormones such as leptin, insulin, and ghrelin play critical roles in appetite and metabolism, and their dysregulation contributes to chronic weight gain.

- Chronic inflammation: Obesity is associated with chronic low-grade inflammation, which contributes to insulin resistance, cardiovascular disease, and other chronic conditions.

Clinical evidence supporting chronic disease classification

Obesity is associated with a wide range of chronic health conditions, including:

- Type 2 diabetes mellitus: Obesity is a major risk factor for type 2 diabetes, and weight loss interventions can significantly reduce diabetes risk and improve glycemic control #ref-ef324e6e.

- Cardiovascular disease: Obesity increases the risk of hypertension, coronary artery disease, stroke, and heart failure.

- Certain cancers: Obesity is linked to increased risk of several cancers, including breast, colon, and endometrial cancers.

- Chronic liver disease: Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity.

These associations demonstrate that obesity is not merely a risk factor but a direct cause of chronic health conditions, further supporting its classification as a chronic disease.

Chronic, relapsing nature of obesity

Obesity is characterized by a chronic, relapsing course, similar to other chronic diseases such as diabetes and hypertension. Weight loss interventions often result in initial success, but long-term maintenance is challenging due to physiological adaptations that promote weight regain, including metabolic adaptation, hormonal changes, and increased appetite.

Impact on healthcare systems and public health policies

Recognizing obesity as a chronic disease has significant implications for healthcare systems and public health policies:

- Healthcare resource allocation: Classification as a chronic disease justifies increased healthcare resources for obesity prevention, treatment, and management.

- Insurance coverage: Chronic disease classification improves insurance coverage for obesity treatments, including pharmacotherapy and bariatric surgery.

- Public health policies: Recognition as a chronic disease supports the development of comprehensive public health policies aimed at preventing and managing obesity.

Current medical guidelines and consensus statements

Several major medical organizations have formally recognized obesity as a chronic disease, including:

- American Medical Association (AMA): Recognized obesity as a disease in 2013.

- World Health Organization (WHO): Recognizes obesity as a chronic disease.

- European Society of Cardiology (ESC): Recognizes obesity as a chronic disease with significant cardiovascular implications #ref-334c4681.

These organizations emphasize the importance of comprehensive, long-term management strategies, including lifestyle interventions, pharmacotherapy, and bariatric surgery.

Implications for patient care and treatment strategies

Classifying obesity as a chronic disease has significant implications for patient care:

- Comprehensive management: Emphasizes the need for individualized, long-term management strategies, including lifestyle interventions, pharmacotherapy, and bariatric surgery.

- Reduced stigma: Recognition as a chronic disease helps reduce stigma and discrimination associated with obesity, improving patient engagement and adherence to treatment.

- Improved outcomes: Chronic disease classification supports ongoing monitoring and management, leading to improved health outcomes and reduced risk of obesity-related complications.

Obesity is now considered a chronic disease due to its persistent dysregulation of energy balance, chronic inflammation, and strong associations with multiple chronic health conditions. Recognizing obesity as a chronic disease has significant implications for healthcare systems, public health policies, and patient care, emphasizing the need for comprehensive, long-term management strategies.

Sources:

- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01210-8/abstract. Lancet. (2024).

- https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.16263?af=R. Diabetes, Obesity & Metabolism. (2025).

- https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00138-9/abstract. EClinicalMedicine. (2022).

- https://pubmed.ncbi.nlm.nih.gov/39210706. European Heart Journal. (2024).