Obesity as a Disease, Not a Behavior
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The American Heart Association (AHA) defines ideal cardiovascular health in its 2020 Impact Goals for cardiovascular health promotion and disease prevention to include a body mass index (BMI) <25 kg/m2, which they recognize as an ideal health behavior.1 We urge the AHA as it begins setting its 2030 goals to move beyond the concept of BMI as a health behavior. Equating BMI with behavior confuses the now widely accepted association between BMI and the mechanistically complex disease of obesity.2 In our opinion, it makes little sense to establish goals and metrics that ignore a broad evidence base that supports the view of obesity as a complex, multifactorial disease and expect to achieve meaningful success in managing BMI to promote ideal cardiovascular health.
Despite the growing recognition of the complexity of obesity, like cancer decades ago, obesity has been treated as a single disease process with universal prevention and treatment strategies, rather than a fundamentally heterogeneous process with numerous underlying mechanisms and etiologies, each requiring unique prevention and treatment modalities. Obesity and related coronary artery disease, stroke, and other sequelae lead to increased health burden and billions of dollars in healthcare costs in the United States. Examining sources of heterogeneity in the etiology of obesity …