Obesity has generated significant worries amongst health policy makers and has obtained increased attention in health care. Obesity is unanimously defined as a disease in the health care and health policy literature. However, there are pragmatic and not principled reasons for this. This warrants an analysis of obesity according to standard conceptions of disease in the literature of philosophy of medicine. According to theories and definitions of disease referring to internal processes, obesity is not a disease. Obesity undoubtedly can result (...) in disease, making it a risk factor for disease, but not a disease per se. According to several social conceptions of disease, however, obesity clearly is a disease. Obesity can conflict with aesthetic, moral, or other social norms. Making obesity a “social disease” may very well be a wise health policy, assuring and improving population health, especially if we address the social determinants of obesity, such as the food supply and marketing system. However, applying biomedical solutions to social problems may also have severe side effects. It can result in medicalization and enhance stigmatization and discrimination of persons based on appearance or behavior. Approaching social problems with biomedical means may also serve commercial and professionals’ interests more than the health and welfare of individuals; it may make quick fix medical solutions halt more sustainable structural solutions. This urges health insurers, health care professionals, and health policy makers to be cautious. Especially if we want to help and respect persons that we classify and treat as obese. (shrink)

This article draws on Ellul’s analysis of propaganda in understanding propaganda in the helping professions. Key in such an analysis is the interweaving of the psychological and sociological. Contrary to the discourse in mission statements of professional organizations and their codes of ethics calling for informed consent, competence of professionals and taking advantage of research findings, in everyday practice we find a variety of avoidable lapses, including decontextualized problem framing, bogus claims concerning risks, accuracy of assessment measures, and effectiveness of (...) interventions. Perhaps most troubling is obscuring the causes of human problems, for example, framing problems-in-living such as anxiety, alienation, and loneliness that result from living in a technological society as brain disorders, so mystifying the causes of distress. (shrink)