The American Medical Association has declared obesity to be a disease. The hoped for result is to direct greater recognition and resources to this, the health problem involving the greatest number of Americans.
I watched as an extremely distinguished panel on MSNBC's "Morning Joe" -- including NBC's medical director, Nancy Snyderman, and health ethics professor and presidential adviser Ezekiel Emanuel, as well as co-hosts Mike Brzezinski and Joe Scarborough -- all agree that this was a good step.
I had several questions myself. Although it might seem a distant fantasy to imagine myself in discussion with these notables, it's not entirely outside the realm of possibility. In fact, it has occurred with one of them. Some years ago (I can't recall how many without further research), while she was at ABC, Dr. Snyderman flew me to Boston to engage in a day's debate with Harvard psychiatry professor Dr. George Vaillant, a man I debated frequently over the years, about the disease theory of alcoholism. I had reviewed Dr. Vaiilant's book unfavorably for the New York Times Book Review in 1983. In 1989, I authored Diseasing of America (which is still in print), in which I discussed the causes and results of America's self-satisfaction in labeling our behavior as diseases and treating them as medical problems.
Here are my questions:
1. Is there any downside to a majority of Americans waking up one day to discover they have a disease they didn't know they had? Joe Scaborough mentioned that two-thirds of Americans are obese. (I believe, more accurately, two-thirds of Americans are overweight or obese.) I wondered if any of the panel participants imagined this might create any problems. In fact, the AMA rejected the advice of its own committee against declaring obesity a disease. Maia Szalavitz, in TIME Healthland, reviewed the reasons to question that such a designation will be helpful. In the drug and alcohol addiction area, those who believe their addiction is a disease are less likely to achieve and maintain recovery since they don't feel that they can control their behavior but instead see themselves as disease victims.
Indeed, as I reviewed earlier on The Huffington Post, use of nicotine-replacement therapy (NRT) based on a medical approach to a behavioral disease was MORE likely to result in relapses among heavily dependent smokers following quitting than if they did NOT use a chemical aid. Why? Presumably because the NRT smokers felt they were fighting an uphill battle to remain nicotine-free, and use of a drug to assist them exacerbated their pessimism. As Szalavitz describes the diseasification process, it "increased pessimism about recovery, probably because people assume that as diseases with biological and genetic bases, they are immutable."
2. (Addressed to Mika Brzezinski) Do you feel you would have achieved the resolution you have for your eating issues if you had been convinced that you had a lifetime disease? Mika Brzezinski has been active in discussing her own eating disorder, during the course of which she binge ate junk food and then exercised bulimically. However, Brzezinski didn't resolve her eating disorder by focusing on the idea that she had a biological or medical problem. Rather, she sought and gained control over her eating and her exercise regimens in order to develop a healthy body weight and self-image, one she strives to create for her own two daughters.
Think of these two memes: "I have an inbred disease that forces me to overeat and to be overweight, one over which I have no control," vs. "I have a problem resisting appealing foods in order to to get my body in balance. I need to learn how to eat and to exercise in a sensible way." I see the second approach as the adoption of a self-empowerment ideology that is the only route to recovery, no matter what addiction a person had. Will people like Brzezinski be empowered to forge similar solutions to the ubiquitous modern malady of overweight when they are convinced that they have a disease, a disease that is spreading? As Maia Szalavitz describes:
When alcoholism is seen as a disease, doctors and patients are also more likely to believe that over-indulging can't be stopped without professional help or attending groups like AA -- and that it must be treated with total abstinence. The disease concept wound up creating a ghettoized treatment system aimed only at severe cases, with few options for the vast majority of people with alcohol problems who don't require such extreme measures.
3. Do you think that other countries -- like Great Britain -- are likely to adopt the policy of regarding obesity as a disease? As my title Diseasing of America indicates, we are the leaders in diseasifying our behavior. In fact, the benefits of this approach are not clear. The British, in particular, seem less inclined to regard various maladies as medical issues. Yet, consider this anomalous finding -- in a survey of health behaviors, disease states, and costs English subjects were almost half as likely as Americans to suffer from every single type of chronic disease (including cancer, heart disease, and diabetes), despite their being more likely to smoke and their drinking more, while only spending roughly one-half as much per capita on health care. The one behavioral area in which the English had an advantage over Americans was obesity and overweight.
And, so, perhaps everyone on this particular panel -- and American public health advocates generally -- are clear on the benefits of declaring a widespread behavioral and health problem to be a disease, but I don't.
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