“Obesity, in particular, stands out as a modifiable risk factor,” says a recent article on modifiable and non-modifiable risk factors for breast cancer. Why is this phrase, so often used to define obesity, such an irritant?

This is a catchphrase with a lot of history and it’s that history that is the source of friction.

A False Dichotomy

In truth, obesity is both a complex chronic disease and a risk factor for a long list of other chronic diseases. This is equally true for other chronic diseases. Diabetes, for example, is a complex chronic disease that is also a risk factor for heart and kidney disease.

But for a long time, this phrase has been the dividing line for a false dichotomy about obesity. The World Health Organization, until recently, set a bright line dividing noncommunicable diseases (NCDs) from the risk factors that contribute to them. Under that scheme, diabetes was an NCD. Obesity was a modifiable risk factor for it. It was taken as evidence for a poor nutrition and physical inactivity. This perspective fosters false notions that more physical activity and better nutrition can reverse the problem. Thus, obesity was viewed as a modifiable risk factor for NCDs.

Of course, this has proved not to be true. Reversing obesity is not so simple as urging or nudging people to eat less and move more. WHO has recently recognized this and forcefully declared that obesity is a complex, chronic, noncommunicable disease that requires medical care.

The Stigma Factor

If you care to understand why the word “modifiable” is so problematic when applied to the disease of obesity, you must consider the factor of stigma. Ximena Ramos Salas, Chair of Bias 180, explains:

“Obesity, like any other chronic disease, can be a risk factor for other diseases and conditions. It’s the modifiable part that causes confusion. People misinterpret that to mean that it’s a behavioural problem that individuals can simply choose to correct.

“This may sound like mere semantics. But since obesity is so much more stigmatised than many other chronic diseases, language matters.”

These are words to remember. Yes, obesity is modifiable with medical care. But not with implicit scolding.

For further perspective, click here, here, and here.

Babel Tower Construction, mosaic in Monreale Cathedral / Wikimedia Commons