In a recent class I took, I was asked to answer the question: “Do you think obesity is a disability? Why or why not?” Although I responded that I believe it is, I had to do some research and thoughtful reflection to come to that conclusion. One of my classmates said, “Weight is not always an indicator of health, and withholding accommodations under the guise of discouraging obesity ignores the underlying causes of weight gain. However, another classmate said, “I don’t think obesity should be considered a disability in most cases. Labeling obesity as a disability across the board might take away from the idea of personal accountability. There’s a risk in reshaping systems to accommodate what could be addressed through support and change.” Everyone seems to have an opinion on this, which led me to think: “What does the ADA say about obesity as a disability, and what is the best way to support and effect change for people with obesity, especially in terms of communication?”  

When researching the reasons why obesity can be (and increasingly is) a disability, I now understand why this topic is controversial. The Americans with Disabilities Act defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities” and “substantially limits the ability of an individual to perform a major life activity as compared to most people in the general population.” From these definitions alone, I could classify obesity as an impairment, as many of the accommodation hindrances that face those who have a disability that they were born with or acquired through an accident are the same ones that obese people face. For example, many obese people must use a cane or a wheelchair due to mobility problems. Although the ADA does not consider obesity a disability unless it is linked to a physiological condition, more courts started ruling in favor of obesity as a disability after 2008, when the ADA amended the Act to include a “regarded as” clause, in which a person who is merely perceived as having a physical or mental disability is protected from discrimination at work or in public settings. (This makes sense. If I see an obese person using a cane or wheelchair, I do not know if they are using it strictly because of their weight or if they have another accompanying medical condition).  Still, some people may not see obesity as a disability because this amendment does not cover reasonable accommodations in the workplace, nor does it necessarily mean that the person will qualify for disability insurance. The “regarded as” clause, however, does guarantee reasonable modifications in public places like restaurants, theaters and airlines, but public places do not have to “fundamentally alter” their structure or services. Of course, what constitutes “reasonable modifications” and “fundamental altering” varies according to the person and the public setting.  

After reviewing the ADA’s definition of disability and the ever-changing legal landscape regarding accommodations for people with obesity, I can see why my classmates and I feel that a fine line exists between accommodating and enabling. Several of my classmates alluded to the fact that if obese people took more personal responsibility and got the support and resources they needed to lose weight, then accommodations for obese people would be a non-issue. What should those changes be? I think we can start with changing what the World Obesity Federation calls “global obesity narratives” that affect attitudes and legislation affecting overweight people. For instance, media often portray extremely overweight people as “lazy, gluttonous, unintelligent, unattractive, and non-compliant.” Also, when we talk about diet and exercise as a blanket solution, we are neglecting to acknowledge the role of genetics, socioeconomic status, food insecurity, a safe place for exercise, and mental health. I have done much research on the role of trauma in anorexia nervosa and bulimia, but I did not really consider the role of trauma in obesity until I read Roxane Gay’s “Hunger: A Memoir of (My) Body.” As much as I hate to admit it, when I saw obese people in the past, I would just think that they ate too much and did not exercise, which I know now is an oversimplification.  Also, person-first language is crucial. Just as we should ask other people how they want to identify, we should ask obese people what words they use. Some people, including Gay, like to use “fat” to describe their bodies, while others prefer “of size” or “big.”  Doctor-patient communication is an especially problematic issue. Obese patients have reported that their doctors refrain from touching them and make faces when they see them. They want their doctors to understand their story and get to know them as a person, rather than just tell them that they’re “fat” and need to lose weight. If obese people do not feel supported and encouraged, they are more likely—not less likely—to engage in self-defeating behaviors like overeating. Gay said that after a day of being out in public and being subjected to stares and name-calling, she would go home and eat more because she wanted to disappear. 

When it comes to treating obese people with the dignity they deserve, change happens slowly. The American Medical Association did not even consider obesity as a disease until 2013.  In making this decision, the AMA stated, “The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.” However, most university medical programs are still not addressing obesity as the health pandemic that it is. Whether legislators ever officially recognize obesity as a disability, I believe we can and should make daily life easier for obese people while simultaneously helping them improve. Gay herself acknowledged that while people like her deserve to be treated with dignity and respect, she still wanted to lose weight and be a more active person. Perhaps with the publication of her book, more people with obesity will have the courage to speak about their experiences and feelings. 

I do believe in “personal responsibility,” although I cringe when I hear that phrase because people often use it in political contexts with an air of condescension. However, pushing the importance of personal responsibility without addressing systemic factors only goes so far. We need to lobby legislators to enact more programs to address food insecurity, make healthy foods more affordable and initiate more anti-bullying programs in schools, as obese children often feel self-conscious during physical education classes. If it takes a village to raise a child (and obesity often starts in childhood), I believe it takes a village to address obesity.