by guest blogger Pam Peeke, MD, MPH, FACP, best-selling author and expert on health, fitness, and nutrition
In a landmark decision after years of arguments about whether or not obesity should be classified as a disease, the American Medical Association's (AMA's) House of Delegates voted to recognize obesity as a disease. As the dust settles on this heated debate, multimedia channels have lit up like Fourth of July firecrackers. Was this a good decision, and how will this potentially affect the millions of people designated obese?
The AMA is the largest and best-known physician organization in this country, so even though their decision carries no legal weight, it has a huge impact on how doctors approach obese patients. By declaring obesity a disease, members are hoping to encourage third-party payers to increase coverage for treatment as well as fund research, and to elevate obesity to a more serious and respected level of understanding and engagement by medical providers, insurers, and the general public alike.
The AMA resolution states that: "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." This statement speaks to the complexity of the reasons people become obese, including the newly emerging science on food and addiction.
The AMA's Council on Science and Public Health disagreed with the designation, based upon the fact that the measure commonly used to define obesity, the body mass index (BMI), is flawed, mainly because BMI is a measure of your weight compared to your height. It doesn't address body composition--whether you have a lot of muscle mass or a lot of fat--and many problems associated with weight are associated not necessarily with the amount of fat you have, but where it sits on your body (for instance, your upper body, belly, or lower body). Scientists have found that the waist-to-hip ratio provides a better risk assessment for heart disease and diabetes. But in general, physicians and medical scientists overall are positive about the AMA's dictum. The World Health Organization, the Food and Drug Administration, the National Institutes of Health, the American Association of Clinical Endocrinologists, and the American College of Cardiology all agree with the decision.
The average public, on the other hand, had mixed reactions to the decision. Many people have voiced concerns that obesity will now be "medicalized" and fall into the same algorithm as other "diseases," including the use of more pills and surgical interventions. Some argue that this will further stigmatize people who are obese. Rather than elevating obesity to a higher level of respect among the populace, it may become another label to add to the stereotypic perception of obese people as lazy, undisciplined, and to blame for their own demise. Others realize how complex obesity as a condition truly is. Frances Kuffel, author of Passing for Thin, wisely notes, "Bariatric surgery to reduce weight is GI surgery, not brain surgery. Once done with the surgery, you still have to contend with those demons in your head, still addicted to sugar, still listening to the voices that tell you you're not worthy."
What does all of this mean to you? Here are my thoughts:
1) As a physician, I get why so many of my brethren are fervent about their support of the AMA declaration. Most fully agree that the recommended BMI is not optimal. Instead, they are frustrated with the constant challenge of trying to find support for obese individuals who are seeking preventive as well as treatment support, but whose insurance will not cover obesity management. They also know that although blood pressure, blood sugar, and cholesterol may presently be normal in obese patients, many are experiencing other issues, including reproductive, orthopedic, and mental conditions. And many want an entrée to a discussion with their patients about weight and feel that a designation of obesity as a disease will help to infuse more seriousness into their conversation and--hopefully--a better weight-management outcome. All of this reasoning may be grossly flawed, but it's the current reality that it is an opinion held by many, if not a majority, of healthcare practitioners.
2) It's about time that we ditch the simplistic "eat less, move more" approach of the past. Obesity involves a very complex psycho-social-cultural-biological process, including genetics, neuroscience, addiction, and environment. Scientists hope that the new designation will open up an avenue of discussion to include more comprehensive prevention and treatment programs.
3) All healthcare providers, as well as the population as a whole, need to examine their own biases toward those who are obese. The present and profoundly hurtful stereotype needs to be replaced with compassion, understanding, and a realization that people with a BMI of 30 or more need to be respected and honored as individuals trying to live their life as best they can, just as folks of average weight.
The debate will continue as the impact of this decision becomes felt in public health and policy arenas. Nothing has been solved with this AMA ruling. Nothing about it is perfect, either. Only time and continuing discourse will tell if any good and benefit will result from this declaration. I encourage everyone to hop right into the discussion and have your voice heard as well.
What do you think? Should obesity be labeled as a disease?
Pamela Peeke, MD, MPH, FACP, is a Pew Scholar in nutrition and metabolism, assistant professor of medicine at the University of Maryland, and a fellow of the American College of Physicians. A triathlete and mountaineer, she is known as "the doc who walks the talk," living what she's learned as an expert in health, fitness, and nutrition. Dr. Peeke is featured as one of America's leading women physicians in the National Institutes of Health Changing Face of Medicine exhibit at the National Library of Medicine. Her current research at the University of Maryland centers on the connection between meditation and overeating. She is the author of many best-selling books, including Fight Fat after Forty. Her new book is the New York Times best-seller The Hunger Fix.
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