Obesity: a preventable, treatable, but relapsing disease.

Abstract In 2013, the American Medical Association completing the recognition of obesity as a disease, led to a growing scientific, social and political interest. In 2016 in the United States, prevalence rates of pre-obesity and obesity exceeded 60%, also in Italy they exceeded 40%. Total costs related to excess weight reached 9.3% of US gross domestic product, while in Italy only the total cost of diabetes was estimated at 20.3 billion euros/year. The expansion of adipose tissue and visceral fat causes compression, joint stress, metabolic disorders, organ dysfunction and increased mortality. The increase in peripheral and central fat mass is a chronic and potentially reversible process with appropriate diagnosis and treatment. Conversely, fattening can turn in chronic relapsing form, complicated by comorbidities and cardiovascular events. The increased risk of mortality and morbidity can also affect metabolically healthy obese subjects, if the condition is underestimated, with disease progression. Due to BMI inaccuracy, it must be replaced with the body composition for obesity diagnosis. The chances of obesity reversibility are closely linked to improving the diagnosis and timely nutritional interventions. Generalization and stigma hinder the treatment of the obese. The recognition of obesity as a disease and institutional interest can shift the focus on obesity and not on the obese, with improvements in adherence to prevention plans. Anthropogenic factors and gut microbiota can influence the human behavior and food choice, such as food addiction. Obesity has all the criteria to be recognized as a disease. Proper clinical management will lead to cost and complications savings, such as diabetes.