NAAFA, the premier civil rights organization dedicated to Equality at Every Size, strongly opposes Nevada Bill S.B. 402. Passage of this bill would attempt to define and declare obesity a “chronic disease” and require the Division of Public and Behavioral Health of the Department of Health and Human Services to collect data and prepare an annual report on obesity.

Body weight is not a proxy for health. Assuming so is both unscientific and prejudicial. These assumptions lead to bias and discrimination in education, the workplace, healthcare, family relationships and social dynamics. Physicians’ frustration with their lack of education and resources for treating fat patients results in poor doctor/patient relationships and will not be instantly relieved by declaring obesity a disease.

In 2013, the American Medical Association (AMA) declared obesity a disease against the advice of their scientific council, the Council on Science and Public Health.

 “Without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine conclusively whether or not obesity is a medical disease state,” the council told the AMA’s policy-making House of Delegates. “Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive.” [Obesity is not a disease, AMA Council Says, MedPage Today, 6/17/13]

Yet the State of Nevada wishes to define what the AMA Council says they cannot. As proposed in S.B. 402:

Section 1.1 Except as otherwise provided by specific statute or required by the context, “obesity” means a chronic disease characterized by an abnormal and unhealthy accumulation of body fat which is statistically correlated with premature mortality, hypertension,  heart disease, diabetes, cancer and other health conditions, and may be indicated by:

(a) A body mass index of 30 or higher in adults;

(b) A body mass index that is greater than two standard deviations above the World Health Organization’s growth standard for children who are at least 5 but less than 19 years of age, or greater than three standard deviations above the standard for children who are less than 5 years of age;

(c) A body fat percentage greater than 25 percent for men or 32 percent for women; or

(d) A waist size of 40 inches or more for men or 35 inches or more for women.

Section 1.2. As used in this section, “chronic disease” means a health condition or disease which presents for a period of 3 months or more or is persistent, indefinite or incurable.

Why does the State of Nevada want to define and track “obesity”? They are targeting fat people in order to qualify for grant funding. One might assume that more money coming in to “fight” obesity would lower the number of obese people and lower healthcare costs to the state. But one would be wrong.  A 2013 study from the Truman School of Public Affairs at Missouri University (MU) found that higher state health spending positively correlates to higher obesity rates. Charles Menifield, a professor in the Truman School of Public Affairs at MU, says his findings strongly suggest that governmental spending efforts in fighting obesity have not been successful. [Association of Black Faculty Nursing Newsletter, 2013]

Why should the State of Nevada NOT define and track “obesity”?

BMI screening is not evidence-based. The U.S. Preventive Services Task Force found there was insufficient evidence to recommend routine screening for overweight in children and adolescents as a means to improve health outcomes. It did, however, note potential harms of screening programs, as well as obesity prevention and treatment interventions, including “labeling, induced self-managed dieting with its negative sequelae, poorer self-concept, poorer health habits, disordered eating or negative impacts from parental concerns.”

A 2008 study published in The American Journal of Clinical Nutrition stated that body mass index (BMI) has been shown to be highly heritable and drew the conclusion that “…children come in different shapes and sizes despite having a similar upbringing. What is important is this finding means that ‘blaming’ parents is wrong.”

The pressure for children to reduce their body size is not only extremely difficult, if not impossible, it is BAD FOR THEIR HEALTH.  Stigma and discrimination of children based on their physical appearance or body size is resulting in physiological reactions to this stress. A 2007 study from the Rudd Center of Yale University found that the consequences of weight bias for youth include:  psychosocial consequences such as poor self-esteem, depression, poor interpersonal relationships, socio-economic status and academic performance; physical health consequences such as eating behaviors such as binge eating and chronic dieting, bulimia, unhealthy use of diet pills or laxatives, and poor cardiovascular health outcomes. [Stigma, Obesity, and the Health of the Nation’s Children, Puhl and Latner, 2007]

A report from the C.S. Mott Children's Hospital National Poll on Children's Health examines the possible association between school-based childhood obesity prevention programs and an increase in eating disorders among young children and adolescents. 82% of parents report at least one school-based intervention aimed at preventing childhood obesity within their children’s schools. 30% of parents of 6-14 year-olds report at least one behavior in their children that could be associated with the development of an eating disorder. 7% of parents say that their children have been made to feel bad at school about what or how much they were eating.

Studies show that dieting, even that considered “naturalistic”, among young people lead to weight cycling. [Naturalistic weight reduction efforts predicted weight gain and onset of obesity in adolescent girls; Stice E, Cameron RP, Killen JD. , et al, 2000] 

As stated in a 2014 article, “The most effective method of addressing chronic disease may be to focus on health rather than weight. By encouraging physical activity and healthy nutrition among all individuals, everyone, regardless of weight status, may benefit with respect to health and well-being.” [Obesity, Health at Every Size, and Public Health Policy, Am J Public Health. 2014]

NAAFA supports Health at Every Size (HAES) tenets which state that healthy habits are good for EVERYONE, no matter what their size. Eat well. Pay attention to your natural hunger and satiety cues. Move your body in ways that feel good rather than exercise focused solely on weight loss.

This issue is about the critical need to create environments in which individuals do not feel shame or guilt about their bodies but, rather, are motivated to enjoy healthful eating and active living habits regardless of their body size or shape.

You can find more information about Health at Every Size at https://sizediversityandhealth.org/content.asp?id=152.

We ask that the Governor and the Nevada State Legislature listen to the concerns of the public. NAAFA is offering its assistance in referring experts who may be of service to you and your staff in finding health-based alternatives.