Here I must make a disclosure. I have struggled all my adult life to maintain ideal body weight. I have had two periods of my life characterized by unhealthful lifestyle (poor diet, little exercise) when I gained many pounds, and reversed course only after being confronted with evidence that overcame my denial. The second (and more dramatic) time this happened was a bit more than a decade ago. A few years “off the wagon” wrought their havoc, over which time I found myself repeatedly buying clothes in bigger sizes with nary a thought about why that was happening or that I should do something about it. When back pain from a herniated lumbar disk caused a dear friend who is a radiologist and was reviewing my MRI with me to look me in the eye and tell me to lose weight, that finally broke through my denial.

So I took this fat bull by the horns and adopted a regimen of healthful diet and regular calorie-burning exercise. In 12 months, I lost just over 100 pounds. Nine years later I’m still fit. My diet could be more prudent some days, and I still tend to eat when I feel stressed, but my exercise regimen has kept my physique – and, I believe, my health – where it belongs.

I believe I am no better than anyone else at breaking old habits or forming new ones. In fact, I’m probably not as good at that as most people. So my own experience has convinced me that the “cure” for this “disease” lies in behavioral (lifestyle) change, not surgery or drugs.

In recent decades we have medicalized so many things. And behavior is foremost among them. When I was a youth, a lad with a bad temper was said to have a bad temper and was dealt with using punishment for bad behavior and rewards for self-control. Now we label it “intermittent explosive disorder.” Are psychiatrists and other mental health professionals any better at dealing with this than caring and persistent parents and teachers? I’m not convinced. When a young person consistently flouts authority and is constantly disobedient, does it help to give it a diagnostic label (“oppositional-defiant disorder”) and send the youth to sessions with counselors and therapists? And does drug therapy help any of this? Again, I’m not convinced.

We have medicalized alcoholism. We call it, and treat it as, a disease. Likewise for other forms of substance abuse and dependence. If you go to a meeting of Alcoholics Anonymous, you will hear participants refer to it as a disease. But look at the Twelve Steps. They describe taking a “moral inventory,” and the alcoholic works toward (and seeks help with) the removal of “shortcomings” and “defects of character.” There is nothing in the Twelve Steps about a disease. Now, of course, the Twelve Steps were around for a long time before the disease model appeared. But AA has not revised the Twelve Steps. I think that’s because they work.