So I believe if obesity is a “disease,” it is a behavioral disease. And the treatment is changing behavior. Not for everyone, to be sure. Some people have metabolic disorders. (You cannot treat an under-active thyroid with behavioral change.) And some people cannot change their behavior no matter how hard they try. But a lot more obese people should be trying, and trying a lot harder, before they resort to medical or surgical treatment. I teach medical trainees all the time that our interventions should be three things: safe, effective, and cheap. Changing behavior meets all three requirements much better than going under the knife.

Is obesity really a disease? I don’t know. And I don’t think it matters. Call it a disease, or don’t call it a disease, but it is a problem, and for the vast majority of people the solutions lie within themselves, not in the interventions offered by doctors.

Dr. Solomon teaches emergency medicine to residents at Allegheny General Hospital in Pittsburgh and is Medical Editor in Chief of ACEP News. He is a social critic and political pundit and blogs at www.bobsolomon.blogspot.com.