So Is It a Disease? United Airlines to Double-Charge Obese Fliers

By Melissa Lafsky | April 16, 2009 5:14 pm

fat manNothing like a new airline policy to fan a raging societal debate. United, the country’s third largest airline, has just announced that it’s joining Southwest, Continental, and Alaska Air Group by making obese coach passengers buy two seats, rather than infringe on the space of other passengers. And if a flight is packed, overweight fliers may have to get off the plane and wait for one that’s less crowded. If that happens, the airline will waive fees it usually charges for changed travel plans.

Cue the outcry from obesity doctors and activists (not to mention the gleeful cackles from plaintiff’s attorneys hungry for discrimination suits). They take the stance that obesity is a disease, and thus any action that negatively affects people inflicted with that disease is unethical. One such protester is Dr. Caroline Apovian, the director of nutrition and weight management at Boston University Medical Center and an obesity treatment adviser at Everyday Health, who told DISCOVER:

Obesity is a disease, there is no question about it. If weight watchers worked, everyone who wanted to would lose weight—but the circuitry in the body is such that it’s not possible. Surgery is not providing a solution for enough people…This would be the first time that someone is being punished for having a disease.

While the last statement is categorically untrue, the fundamental issue remains: Is obesity a disease? Or merely a condition/state of being that can be altered by behavior?

According to the Medical Dictionary Web site, a disease is defined as:

any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown.

Obesity, of course, sits smack in the gray area, with some doctors insisting that it falls under the disease rubric—that it’s a malfunction of the eating system, just as diabetes is a malfunction of blood sugar control. On the other side, health care professionals (and even some pro-fat advocates) argue that fat is within a person’s control, and being overweight can even have some health benefits. The best argument for “pro-disease-ers” is that obesity, regardless of how it got there, causes a whole host of serious medical problems once it’s there—though those problems can also be caused by factors that have nothing to do with weight.

Of course, there’s also the matter of treatment: If obesity is declared a disease, only doctors would be qualified to treat it. Which goes against the whole argument that it can be offset by lifestyle.

And so the debate rages on among health care professionals, academics, the public, ethicists, etc.—while people are only getting fatter.

Until we can decide on an answer (which may never happen) we’re left to deal with the problem (and it’s one hell of a problem) as best we can—and punishing people for weight may not be it. Sticks (rather than carrots) have been the preferred method of handling obesity thus far, but what about the possibility of rewarding socially “good” behavior rather than punishing “bad”? There’s always offering skinny people ticket discounts, priority boarding, more preference on seat assignments—or even letting them sell part of their seat space to larger passengers.

Image: iStockphoto

MORE ABOUT: airlines, obesity
  • http://esns.blogspot.com/ Borja

    Apprecite your work, great. I will continue reading your posts. I don’t think it’s a way of handling those matters, but at least is better than doing nothing.

  • Clive

    Let’s stop calling them “obese” and refer to them as what they are: disgusting fatbodies. Who the heck wants to be in the same plane with one of these wheezing, gasping, jiggling tubs of goo, much less sitting next to them?
    It’s not rocket science, people! Eat less = Weigh less! Stop forcing handfuls of french fries down your thick gullets followed by gallons of sugary soda, pick up a carrot stick and drink some water, and you won’t be so extremely socially unacceptable. It is just rude to be overweight. Rude. You have no consideration for yourself and no consideration for others. If you choose to kill yourself with the Biggie fries and buckets of fried chicken, have some common decency and never leave your house. Preferably you should live alone or cluster together in colonies of fat-bodies. Then when one of you inevitably dies of one of the many, many diseases that are in store for you you can either eat that person or just let them rot in a bathtub until enough of them has dissolved away so the coroner can come in without the aid of a forklift or the need to bust out the wall to haul your dead whale carcass off to be stuffed, sausage-like, into a casket or packed into a cremation oven.

    Although, when a disgusting fat-body does die, if they are cremated we’re talking hours upon hours and perhaps days worth of valuable blubber being burned away… perhaps we should offer some sort of blubber exchange program and give the fat-bodie’s family the proceeds of the sale of that valuable commodity. At least at that point the shifting, wiggling mass of flesh and failure will have contributed something instead of just wantonly consuming every free-roaming calorie they can find and force-packing their vomit-inducing frames into a seat on a plane next to me.

  • Les

    I don’t want loud people on my plane with me. They’re adults, they should be able to control themselves.

    Wait, should they be charged more too?

    I’m not sure how I feel about this.

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  • MissPrint

    You wrote: “Of course, there’s also the matter of treatment: If obesity is declared a disease, only doctors would be qualified to treat it. Which goes against the whole argument that it can be offset by lifestyle.”

    I cannot disagree more. There are plenty of conditions that are treated by changes in lifestyle, and many times lifestyle changes are prescribed before drugs or surgical options. And, to the opposite end, there are people who need more than lifestyle changes to get control of their weight. Some medical and bariatric experts believe drugs and surgery (which can change how a person’s hunger hormones & metabolism work, depending on the type done) offer tools that people really need.

    I support defining obesity as a disease. It’s time that the treatment of this very serious deadly health condition remain solely in the hands of medical professionals with real advice and help and solutions that work. Time for all the quackery to end — it’s a multi-billion dollar joke. No other health condition is left to so many amateurs and snake-oil salesman. If this country was really serious about fighting the “obesity epidemic” then these things would have already happened. The way we’re headed, our medical and financial system cannot afford for us not to take these actions.

    Oh – airline seats: United says they’re making this change because 700 people complained last year? Give me a break. I’m sure that many people complain about the lack of good service, water, blankets, or food every single day – you don’t see the airlines changing those things. I think United is being opportunistic and discriminatory.

  • Dayana

    how comes that obesity is so widespread in the US, has anybody noticed that in regions of the world where people still buy raw ingredients and then cook those at home in a process that involves more dedication and self-love then pushing two buttons on the microwave utility, there are less obese people even though the fat levels contained in various home prepared foods might be higher then the one contained in “light” processed foods, so obesity is no sickness, just a vicious circle fed by the inability of obese people to honor their bodies as the home of their souls and to take proper care of themselves, these people do not need light labeled products, pills or surgery… they need to connect with the real life on this planet and correct their abnormal psychological attitudes, nobody would tolerate people to smoke on a plane either…….

  • http://healthhabits.wordpress.com DR

    Obesity is NOT a disease.

    However, it IS a symptom of disease.

    It is the symptom of a disease with both genetic and epigenetic components.

    The fat acceptance crowd wants to cling to any genetic link to obesity. And there are links.

    However, we also know that those “fat” genes require a pro-fat lifestyle to cause them to leap into action. Just this week, another study came out showing that identical pro-fat cells required insulin to force them to begin hoarding fat.

    Control the insulin and you control your fat genetics.

    here’s the study – http://healthhabits.wordpress.com/2009/04/15/obesity-insulin-trumps-genetics/

    With that being said, I still don’t understand why an airline has to offer preferential treatment to obese passengers. You would think that during this time of recession, we might remember that every faceless corporation is made up of people. And when we enact legislation that unfairly punishes a corporation (because we don’t like corporations) we end up punishing the little guy.

  • Jo

    Obesity is not a disease — it’s a consequence of a species that evolved to survive amidst scarce resources. It’s why we love food, and why we have to drag ourselves to the gym. We’re exhibiting behavioural (and metabolic) traits that served us well in the past, and, for many people, still do.

    But having said that, I understand that the designation is a practical one. Telling people to abstain from overindulgence is like telling people to abstain from sex. Good luck. Blaming the individual is not entirely fair.

    But it doesn’t absolve responsibility, either. Sigh. I’m back on the fence.

  • http://www.genyblogger.com Chloe

    I think its discriminatory. Sure, UA says that their policy is to
    make all passengers more comfortable – but they are picking on obese
    people. I wrote about this on my blog at:
    http://genyblogger.com/2009/04/16/i-think-united-airlines-passengers-requiring-extra-space-is-discriminatory/

    If they equally pick on smelly, sick and annoying people, then I will
    believe their rhetoric!

  • WAYNE

    I HOPE ALL THE AIRLINES GO OUT OF BUISNESS. OUR SICK GOVERMENT WILL BAIL THEM OUT TOO.

  • Sloop John B

    Once again America succumbs to stupidity! The airlines are totally to blame for MOST of the complaints people have from sitting next to an overweight person, who oozes over into the next seat. Why??? Because the airlines call for seats that are way too small for many of us. I’m NOT talking about the hugely obese people ( 300 ish lbs. ). They should have to pay extra! Sadly, the Airlines, in their greed for $$, pack people into these “missles” in seats only the skinniest of people can fit into properly. Check the width of 1st Class seats against Coach and you”ll see a few more inches across and a lot more leg room. So in effect, what the airlines are saying is : pay us a couple hundred more and we”ll treat you like a human being…or pay less and be cramped and miserable as we pack you in like sardines!

    The interesting thing is how the Airlines hace turned the blame away from themselves, and miss-placed it on their very Bread & Butter where most of the plan’s $$ is made! Great selling Job! Maybe when America wakes up and sees the REAL TRUTH, they”ll boycott flying long enough to put you ibto your “next carreer…car sales! Make seats realistic and stop passing the buck!

  • http://twitter.com/loxosceles beth

    “Is obesity a disease? Or merely a condition/state of being that can be altered by behavior?”

    Why the false dichotomy? There is plenty of evidence that obesity is a condition/state of being that, while not a disease, cannot usually be altered by behavior.

    Note that United’s policy, and the size of their airplane seats (come on, have you flown recently?), penalizes people who aren’t necessarily “obese”. And it affects wide-hipped women while not applying to wide-shouldered men who overhang their seats just as much.

  • karl

    Why should airlines have broader seats? I want to fly as cheap as possible. If they install only 5 fat guy fitting seats instead of 6 usual seats per row, the fare will increase by 20%. Why should we all accept such a fare hike because some 350 pound guys cannot prevent themselves from eating a dozen cheeseburgers and driking 4 liters of coke per day.

  • G.K.

    United Airlines’ decision is atrocious. Obesity is often caused by a condition, namely low metabolism. People with this conditon try very hard to lose weight by eating less but it just doesn’t work like it does for people whose metabolism is normal. It is not their fault that they are overweight. Also, and most importantly, most obese people are very self conscious of their size, and are often treated rudely by others. To humiliate them further by walking them off a crowded airplane is cruel, if not heartbreaking. If it happens on a flight I am on, I will make my views known loud and clear to the flight attendants before I too walk off and never again fly that airline.

  • http://fromthemindofj.wordpress.com From the Mind of J

    QUESTION:

    If a plane is packed full and a passenger occupies more than one seat, and there are no additional seats available to accommodate that person’s body, what is the airline supposed to do?

  • bob c

    replying to G.K.’s comment, it is possible to change how your metabolism functions by changing your lifestyle. Your comment about how people with low metabolisms try VERY HARD to lose weight by eating less but it just doesn’t work is pretty foolish. Very few people can lose weight by eating less along. HELLO PEOPLE you have to combine HEALTHY eating (not starving yourself) with regular exercise. If you just stop eating as much, your body will slow its metabolism down even more as a survival technique. People who are overweight becasue they are too lazy to exercise or get off the couch should definetly be charged for an extra seat because they are making their laziness affect other people. If someone does have a legitimate disease or conditon that prevents them from exercising/losing weight than informing the airline beforehand and having medical proof of your condition should be enough to give the person a complimentary extra seat. Don’t blame the airlines for having to change your flight or charge you more if you are the one who is going to be infringing on other PAYING CUSTOMERS flight. I sympathize with the social stigma of being overwieght, but for the majority of people it is preventable and therefore becomes their responsiblity to control and their burden to bare. Oh yea, its also up to you on whether or not you want to fly.

  • http://fromthemindofj.wordpress.com From the Mind of J

    I still haven’t gotten a reply as to what airlines should do.

    I suspect it’s because the answer is so loathsome that the people who piped up in the first place can’t even bring themselves to say it as it would mark them as equally loathsome. That answer is that they expect people to simply have to share part of their seat with someone’s oversized ass. They expect other, fit customers to sacrifice some rights for another person. They are nothing short of communists. It’s sickening.

  • http://www.radianthealthmentoring.com Lauriann

    What is really sad is that the pharmaceutical companies, weight loss companies, diet food industry etc make money off of something that understanding physiology can fix. To the people that are quick to condemn all obese people as over eating slobs, your comments show a lack of compassion, to those that say it is a disease and people are blameless, that too is misguided. Obesity is the result of hormones/metabolism being out of balance. Many hormones involved in a vicious cycle that keeps people trapped. If a person does not understand this, he is doomed to dieting and exercising to no avail. A more important consideration for obesity than how much and the type of food they are eating is finding out what is stressing the body and raising cortisol levels. Cortisol has a direst influence on insulin, estrogen/testosterone balance, thyroid, liver detoxification and many, many more important factors to take into consideration. Many things can cause an elevation in cortisol: a hidden food allergy (wheat, dairy, egg, soy being most common), emotional and mental stress, OVER exercising or exercising in an acid producing heart rate, injury and sickness, inflammation, etc. These all create extremely difficult vicious cycles that are nearly impossible to overcome if one is not aware. Unfortunately, the US is unlikely to change since we are in the grip of Big Pharma, Big Food, and other lobbies that don’t make money off of healthy people, only sick ones.

  • http://www.radianthealthmentoring.com Lauriann

    Lest someone read my above comment and think that I am saying that lifestyle and the kinds of food and beverages that one consumes, I want to add that I regained my ability to enjoy life again after a car accident and subsequent diagnosis of fibromyalgia by changing my thinking; switching to a mostly raw,alkaline diet; adding a regular, gentle exercise routine; meditation; and drinking good quality water, and using high quality supplements (with understanding of what I was doing). We are bags of chemical and electrical reactions. Anything that we eat, drink, think changes our chemistry, it just depends on which direction – healthy or unhealthy. For some people, simple life style changes CAN make a great deal of difference. For others, it requires more detective work to find the underlying “WHY(S)”.

  • Dave in Calif

    So, how are the airlines determing who is obese, BMI? Fat calipers? impedance, tossing them in a tank of water? Asking them what their belt size is, or dress size is and if your belt or pants is say, >38 or your dress size is >14 you are considered obese and must buy two seats? Will the person at the airline counter have a tape measure and have the “suspected” fatty stand on what used to be the luggage scale and do a quicky BMI?

    Or maybe you have to have a card (or on your drivers license, you betcha the DMV would be able to handle this) from your health care provider stating you are obese or not. Yep, I am now a card carrying fat person and can prove it! The state can even make the ID cards thicker and round!! Why not just make them (you disgusting fat people) take trains only, you can stuff a LOT of fat people in those box cars.

    We are about to have universal healthcare why not universal health camps? All the fat people who are increasing the carbon foot print by eating too much can be put in them and shown (or forced) how to eat less.

    Humm it seems to me this was tried around 65 years ago, but I can’t seem to remember where or if it worked or not..box cars and camps…? hummm…

  • Chicago Guy

    Wow. First a cogent article about airlines and the decision they have made to handle obese passengers. A well balanced look at the discussion as to whether or not the condition known as obesity should be rightfully classified as a disease.

    That is followed by enough bullshit from uninformed morons and hate filled self loathing sacks of shit to fertilize every field on the planet. How is it that so many stupid people read science magazines and still don’t have a clue. Are you all so incredibly clueless that your own bigoted opinions must now pass as religion to be crammed down every one else’s throats? You don’t have the problem so, since your are the yard stick by which all of humanity must be measured, no one has the problem? There are some disgusting people in the world alright but to see them most of you need to stand in front of the mirror. And since you’re probably too stupid to realize I’m talking about you… Clive, Dayna, karl, From the Mind of J, bob,…

  • geeta

    A lot of diseases are preventable/curable by a proper life-style choices of oneself. Some, like cancer could often be a result of someone else’s lifestyle choice, that pollutes others’ natural resources. Eating less and getting exercise is an easy choice, except for the ones that choose to be lazy and depend on medication for illnesses being lead by the overly weight.
    That said, the airlines policy is based on pure logic and reasoning – the cost of flying an airplane is largely dependent on the weight it carries and the number of people it can comfortably carry depends on the extent of containment of each person in his/her own seat. Over-sized, over-weight people, especially shorter and heavier ones (height that adds to a person’s weight is not quite controllable), must pay a higher fare simply because it is more expensive to haul them around.

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  • Pat

    Obesity is NOT a disease; it is an addiction. I am obese and am addicted to food when stressed. Please people, take responsibility for your own actions. Alcohol is NOT a disease, it is an addiction. Quit making excuses for overweight people. Help people to get exercise and change their diet; this the only way to lose weight and keep it off. Hearing that obesity is an addiction just infuriates me. Get REAL…

  • http://fromthemindofj.wordpress.com From the Mind of J

    I guess Chicago Guy is having his period. Or was. Or whatever.

  • Achmed zhu (im chinese)

    i dont like obeses people one stole my peanuts

  • Apu Nahasapimapetalon

    I must say about the obese peoples in America that they are taking too many seats on our planes, and the skinny people cannot sit anywhere. In my country, you get kicked off the plane when you are too fat! My mother suffered that problem many times, and I know that it hurts, but fat people shouyld pay for three seats! i hope they don’t have a window seat!

  • AJ’s Two Cents

    I’m going to weigh in (ha ha) on the side of the obese folks. Since I am one. And some of it is due to poor choices I made, and some of it is probably genetic (obese people run in my family… or don’t run, I guess) and some of it is other health issues I’ve been struggling with over the last year or so. Do I blame myself? Heck yah. Now, last fall I had to travel on business. My employer only bought me one seat although I clearly indicated I’d require two. I would purchase two seats myself any time I traveled (although I don’t agree with FORCING obese people to do this, personally, I don’t want to inconvenience someone) and have on the bus in previous times (speaking of things with small seats!). Anyway I was very fortunate as none of the flights but one was full, so the flight attendants and the people stuck sitting beside me were able to be moved around so we’d all be more comfortable, and on that full one we rearranged seats so my co-worker could sit beside me, bless her heart. At least that way I wasn’t inconveniencing a total stranger!

    I guess the point of my story is – most obese people know what we are. Sometimes we don’t have a choice (like my employer leaving me dangling) but we certainly are aware that we are inconveniencing others. Am I working on losing weight? Heck yes, with healthy lifestyle changes and exercise. Is it going to make me skinny tomorrow? Heck no, no diet in the universe can do that. Would life be easier if people were more understanding and less judgemental of the obese? Definitely.

    Oh and for those weighing in on the disease vs. choice debate and saying that doctors should be treating it – most doctors see an obese person and diagnose “Fat Hypochondriac” when you go see them. I’ve been struggling with something not related to my weight, most of the struggle being to get someone to see past the weight to actually try and treat me. NOT ONE of the doctors I’ve seen has done anything to help me lose weight except to say ‘lose weight’. NOT ONE. No nutritional guidance, nothing. Even when I’ve asked for help and options. I finally went to a naturopath (and I would recommend finding a good licensed one to ANYONE, what a fabulous experience). Anyway, I don’t think doctors should be the exclusive ones to treat obesity as they are all to apt to ignore it or throw drugs at it which don’t solve the problem in the long run.

  • Angie

    I have never seen the word “obese” used that often before. Somebody in here finds “fat people disgusting”. That´s funny. I find people who show their hairy bellies and/or backs disgusting. Obese people usually wear huge clothes hiding their bodies (at least those I have seen), so how are they supposed to be disgusting? I don´t get it. I am surprised by the amount of hatred people seem to display towards obese people. Don´t we all have this image of a nice, fat cook in our heads cooking lovely food? Hey, it might be just me! Isn´t our dear beloved Santa Claus a tad overweight? What happened to all of those positive images of overweight people? I am glad I am not overweight, as I wouldn´t want to receive all of that hatred!

  • Angie

    Did you guys know, that many people in Western and Eastern Europe die of hunger? Not because they can´t afford to buy food, but because they are working that hard at being skinny. So try not to go from one extreme to another. Before you idealise other countries, attempt to consider, that people in other migration countries (Australia and Canada) also complain about having lots of obese people. So who´s left? Third world countries. As we all know, these people suffer neither from anorexia nor from obesity. But lots of them die of economically caused hunger.

  • JTM

    I suggest that anyone who supports the argument that (a) it’s a disease and, therefore, (b) you cannot treat the obese any differently from the non-obese consider the following:

    You are already seated on the plane when your two row-mates arrive. The first is wrapped in bandages and smells slightly of rotting flesh and sulpher. The second is wearing a blue hospital mask and coughs a few times per minute. Enjoy your flight, since your row-mates – who, by your logic, cannot be treated any differently than those who don’t have leprosy or H1N1 – are not going to be moved.

  • Hilo

    Here’s my modest proposal. The government mandates that people maintain a healthy weight. This weight will be established by medical professionals and be measured annually. People with genuine medical conditions may apply for exemptions through their primary care physician.

    Those who exceed their weight limit up to 50 percent face fines until they bring themselves back below the threshold. Those who exceed the 50 percent mark are issued a warning: if they cannot bring their weight under control within one year, they will be euthanized.

    Airlines will no longer have to charge people for two seats, and you and I will no longer have to pay higher insurance premiums and taxes to cover the cost of preventable medical conditions.

    “Desperate times call for desperate measures.”

  • Rachel

    I am overwieght, have severe Hypothyriodism that has not been able to be corrected with medication since I was 21… I am 35. My cholestrol is 137. You speak as if being overwieght is a choice for all… You are wrong and I am living proof. My best TSH has been 10.4, which is bad. I eat about 900 calories a day… I am discriminated against because people assume I suck and eat poorly. You people really need to get educated.

  • Rachel

    Just wanted everyone to know… I flew United 3x since May 03, 2010 and I did not have a problem with the seats, they are in fact the roomiest seats I have ever flown in! AND yes, they were coach, not even the Plus seating, standard coach!

  • david B

    in response to # 3, Yes — Sur-Charge all above cataglories so I don’t have to pay more of my hard earned money. Not only charge Obese people who can’t fit in their seat. Yes, fine abnoxious people too. If a person needs to be subdued, make them pay for that cost so it doesn’t reflect in higher airline fees for the rest of us. also in the united states we believed in bathing. If they stink 10 aisles down, they should not be allowed on the plane. Its not anti-discrimination or offending ones culture to kick a stinky, disgusting person off the plane. Last but not least. Sur-charge the hell out of someone that yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, yaps, on the cell phone.

  • http://www.harleystreeturology.com/ Alec

    I get charged £60 for taking an extra Kg of weight on a plane even though I am quite light and even combined with my luggage dont weigh as much as some passengers.

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