The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference.

Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen.

© 2023 The Authors.

All authors declare no competing interests relevant to this conference report. ADM has received grants or contracts from Fractyl, Novo Nordisk and Randox, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novo Nordisk AstraZeneca, Currax and BI. HP has received grant funding paid to institutions, from Public Health England, the Office for Health Improvement and Disparities, and the National Institute for Health Research; honoraria for educational events from Johnson & Johnson; as well as honoraria for educational materials and accompanying presentations – arms length sponsorship and travel expenses for delivering an educational presentation from Novo Nordisk. She has also had unpaid leadership or fiduciary roles as a British Obesity and Metabolic Surgery Society council member, Obesity Empowerment Network professional steering group co-opted member and NICE weight management guidelines committee member. EFr has received research grants from NIHR (NIHR 152858; NIHR204247; NIHR300773; NIHR133099; NIHR203012; NIHR 13/164/51; RP-PG-0618-20008), and UKRI (BB/V004832/1); Royalties from authorship on an OUP Book from Oxford University Press; travel and accommodation support for attending the UK ASO22 conference from the Association for Study of Obesity, and travel support for attending an NIHR Academy training meeting in London as invited speaker from NIHR. She has also had leadership or fiduciary roles as an Elected Board member for the International Health Economics Association and a Member of NIHR Public Health Research funding panel. SB has received a grant paid to his employer, the Institute for Employment Studies IES, from Novo Nordisk to conduct research on obesity stigma in employment. IES retains full editorial control of all research outputs. AB has received researcher led research support and supported attendance of the Obesity Week/BOMSS 2022 from Novo Nordisk, and researcher led research grants from NIHR/BRC, Rosetrees Trust, MRC, BDA, BBSRC and Innovate UKRI. He has also received personal honoraria for presentations/chairing from Novo Nordisk, personal honoraria from Obesity UK and Johnson & Johnson, institutional fees from PHE and stocks from Reset Health Ltd. He has had unpaid leadership or fiduciary roles as Vice Chair Obesity Specialist Group for British Dietetic Association, Committee member OPEN, Scientific Council for British Nutrition Foundation, and Strategic Council for All Party Parliamentary Group on Obesity. JL has received grants or contracts, paid to institutions, from the National Institute of Health Research and personal consulting fees, support for attending meetings and/or travel, as well as participation on a Data Safety Monitoring Board or Advisory Board from Novo Nordisk. She is also a Current employee of AstraZeneca but was not at the time of this work and AstraZeneca had no role in this work. NI has received a grant from NIHR, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Obesity Empowerment Network, National Obesity Audit, Novo Nordisk and Johnson & Johnson, as well as support for attending meetings and/or travel from SQOT and BOMSS. She has also had leadership or fiduciary roles for Obesity Empowerment Network and BOMSS. ML has received consulting fees from Novo Nordisk and Nestle and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Nestle, Oviva, Roche and Novo Nordisk. SW has had travel costs paid by Novo Norisk for attendance at obesity conferences. KC has received payment for Lecture Apollo Endosurgery and speaking fees from Novo Nordisk. GKD has received research grants from Novo Nordisk and DDM, as well as payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novo Nordisk and J&J/Ethicon & Medtronic. SLB has received direct payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novo Nordisk and Guys & St Thomas Trust, as well as direct payment for expert testimony from Novo Nordisk. JM has an unpaid leadership or fiduciary role in the Association for the Study of Obesity as a Trustee. RLB has received personal payments for consulting fees from Novo Nordisk, Pfizer, Eli Lilly, ViiV, Gila and Therapeutics Ltd; personal payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from International Medical Press, Novo Nordisk, ViiV, Eli Lilly and Medscape; support for attending meetings and/or travel from Novo Nordisk and Eli Lilly, and personal payment for participation on a Data Safety Monitoring Board or Advisory Board from Novo Nordisk, Pfizer, Eli Lilly, ViiV, Gila and Therapeutics Ltd. She also has unpaid leadership or fiduciary roles as Chair of the Royal College of Physicians (RCPs) Advisory Group on Nutrition, Weight and Health, Member of the RCPs Advisory Group on Health Inequalities, Founding member, Trustee and Steering Group Chair for the Obesity Empowerment Network UK, Committee Member for BOMMS, Committee Member for NBSR, Co-opted Trustee ASO, and Co-Chair of NHS England Tier 3 and Tier 4 Clinical Advisory Group.