To the Editor:
Re “Are We Thinking About Obesity All Wrong?,” by Julia Belluz (Opinion guest essay, Sept. 22):
The author rightly underscores the need for a precise medical definition of obesity and its causes, but it is crucial not to question its designation as a disease. Since the American Medical Association classified obesity as a disease in 2013, this designation has led to essential advancements, such as increased funding for research, broader insurance coverage and efforts to reduce stigma.
Obesity requires a comprehensive and nuanced approach that examines its metabolic, physical and psychological dimensions to ensure accurate diagnosis and effective treatment. The American Diabetes Association (A.D.A.) has already established clinical practice standards that address the close relationship between Type 2 diabetes and obesity. These standards offer a holistic diagnostic framework, moving beyond the impersonal, universal approach, and focus on individualized care.
Furthermore, the A.D.A. is actively developing standards of care for obesity to provide additional guidance in this field. This forthcoming work aims to establish clearer protocols for diagnosis and treatment, ultimately improving care and outcomes for those living with obesity.
The wider medical community must also come together to establish uniform standards that provide clarity for practitioners and better care for people affected by obesity. The price of ambiguity is too high for those affected by this complex condition.
Nuha El Sayed
Boston
The writer is an endocrinologist and senior vice president for health care improvement at the American Diabetes Association.
To the Editor:
While this article was interesting, I felt that it missed a huge part of the obesity problem in the U.S. It didn’t connect the problems to our food industry or the standard American diet.
The amount of processed foods high in sugars and fats definitely contributes to obesity in the U.S. The fast-food industry is another contributor.
In most other countries you do not see so many hugely overweight people. Instead of turning to Big Pharma for solutions, we need to look to the food industry to help provide more wholesome food.
Sharon Beddard
Sewickley, Pa.
To the Editor:
Julia Belluz engages in a critical conversation about classifying obesity as a disease. As a physician and the author of “Outsmarting Obesity,” I find her exploration of this debate compelling, particularly as it reflects the growing consensus that the body mass index (B.M.I.) is an outdated and imprecise tool for diagnosing obesity. However, Ms. Belluz only scratches the surface when offering practical alternatives.
While B.M.I. remains a widely used diagnostic measure, it fails to account for critical factors such as body fat distribution and individual health markers. Alternatives such as waist-to-hip ratio, body composition analysis and advanced imaging technologies offer more accurate assessments of obesity-related health risks. A more personalized, data-driven approach could significantly improve patient outcomes.
Moreover, Ms. Belluz’s omission of chronic inflammation’s role in obesity is a glaring oversight. Inflammation is not only a driver of weight gain but also a significant contributor to the metabolic dysfunctions that underlie many obesity-related diseases, including Type 2 diabetes, cardiovascular issues and certain cancers.
Ms. Belluz rightly points to the social and psychological effects of labeling obesity as a disease. However, the economic ramifications are just as important. What if more accurate diagnostic criteria and personalized treatment plans that address inflammation, body composition and metabolic health could reduce the overall costs associated with obesity-related health care, which according to the World Health Organization could rise to $3 trillion globally by 2030?
Without addressing the role of inflammation and considering more advanced diagnostic alternatives, we risk remaining stuck in a flawed, outdated paradigm.
To the Editor:
Re “Grabbing School Gear in Case of a Shooting” (news article, Sept. 22):
All school shootings happen on purpose. Nearly all school fires happen by accident.
Do not dismiss your discomfort with displaying a large “active shooter protection” shield in your school by comparing it to the visibility of a fire extinguisher, as suggested by quotes in the article.
Bulletproofing schools will not stop a school shooting from happening. Bulletproofing schools does not make them any safer.
And giving kindergartners “Tank the Turtle” backpacks and teaching them to “use their shells” are certainly not developmentally appropriate nor evidence-based practices. If you want a surefire way to traumatize your kids as they start their school careers,…