It’s time for us to start changing the way we think about “fatties” — especially because so many of us now fit into that category. At its recent annual meeting in Chicago (June 16-19, 2013), the nation’s largest physician group, the American Medical Association, officially recognized obesity as a disease — in fact, as a complex disorder — and not just a fashion drawback.
The classification of obesity as a disease may help remove part of the stigma and shame associated with being overweight. Patients may benefit from this approach in the same way alcoholics and drug addicts have gained self-esteem by the removal of harmful fault-finding from their clinical picture.
“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, stated.
The federal Centers for Disease Control and Prevention determine overweight and obesity ranges for adults by using weight and height to calculate a “body mass index.” An adult who has a BMI between 25 and 29.9 is overweight. An adult who has a BMI of 30 or higher is obese.
By these definitions, current statistics show that about a third of Americans are at normal weight, another third are overweight, and the last third are clinically obese. Nonetheless, exceptions exist: some people with a high BMI are healthy; and others with apparently normal BMI have morbid body fat and the metabolic problems that usually accompany obesity.
Morgan Downey, an advocate for obese people and publisher of the online Downey Obesity Report, was quoted in The New York Times as concurring with the association’s decision and connecting its usefulness to the insurance and pharmaceutical worlds.
“I think you will probably see from this physicians taking obesity more seriously, counseling their patients about it. Companies marketing [weight reduction products like the new Qsymia from Vivus and Belviq from Arena Pharmaceuticals] will be able to take this to physicians and point to it and say, ‘Look, the mother ship has now recognized obesity as a disease.’”
Another factor the AMA House of Delegates took into account was that their recommendation would carry weight for patients needing obesity drugs, surgery, and/or counseling to receive reimbursement. The Internal Revenue Service does consider obesity treatments tax-deductible. Less than a decade ago, however, Medicare’s coverage manual directly stated that obesity was not a disease. Medicare Part D still rules out paying for weight loss drugs.
Interestingly, the AMA’s own Council on Science and Public Health studied the issue over the last year and recommended against disease classification for obesity. Its objection: the body mass index used to measure the condition is limited in its scope and may not “result in improved health outcomes.”
Other medical groups, notably heart and endocrine specialists, had previously adopted a resolution declaring obesity a “multimetabolic and hormonal disease state” that leads to Type 2 diabetes, cardiovascular disease, some cancers, and other poor outcomes.
“The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.”
The AMA House of Delegates rejected the Council’s recommendation and agreed with the earlier resolution of the specialist groups.