21 Jun 2013 AMA declares obesity a disease
The nation’s leading physicians organisation took the vote after debating whether the action would do more to help affected patients get useful treatment or would further stigmatise a condition with many causes and few easy fixes.
Americans are classified as obese if they are 35 or more pounds overweight – a condition that resulted in $147 billion in medical costs in 2008. Critics of the AMA classification claim that it suggests obesity is an uncontrollable condition, free from personal responsibility. Supporters believe it will simply help overweight Americans acquire the help they need.
In the end, members of the AMA’s House of Delegates rejected cautionary advice from their own experts and extended the new status to a condition that affects more than one-third of adults and 17% of children in the United States.
“Recognising obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately 1 in 3 Americans,” said Dr Patrice Harris, an AMA board member.
The vote is certain to step up pressure on health insurance companies to reimburse physicians for the time-consuming task of discussing obesity’s health risks with patients whose body mass index exceeds 30. It should also encourage doctors to direct these patients to weight-loss programs and to monitor their often-fitful progress.
The AMA’s decision essentially makes diagnosis and treatment of obesity a physician’s professional obligation. As such, it should encourage primary care physicians to get over their discomfort about raising weight concerns with obese patients.
Studies have found that more than half of obese patients have never been told by a medical professional they need to lose weight — a result not only of some doctors’ reluctance to offend but of their unwillingness to open a lengthy consultation for which they might not be reimbursed.
“Obesity is more than just a matter of carrying around too much fat.”
So comments Dr Michael Joyner, an exercise physiologist at the Mayo Clinic in Rochester, Minn.
“The fat cells themselves we thought of for a long time as just warehouses for energy,” Joyner says. But they also secrete chemicals, including chemicals that can cause inflammation, raise blood pressure and that down the road help harden the arteries.
“More widespread recognition of obesity as a disease could result in greater investments by government and the private sector to develop and reimburse obesity treatments,” the AMA said in one statement on the issue.
“Employers may be required to cover obesity treatments for their employees and may be less able to discriminate on the basis of body weight.”
The downside, the AMA says, is that people may expect that should be able to take a pill and “cure” obesity.
That clearly isn’t going to happen, Joyner says. Pharmaceutical companies have tried and tried, but just a very few drugs are approved for weight loss and even they don’t produce spectacular results.
“It is very, very difficult, once people get fat, to lose fat and keep it off,” Joyner says. “We live in a low-physical-activity, high-calorie, high-food-variety environment,” he added. “We are bombarded with images of food.”
But designating obesity as a disease could make it easier for policymakers to make changes. This has happened before with public health – once with smoking, and again with driving safety.
With smoking, first the US Surgeon-General declared that smoking could cause disease, then gradually workplaces and then public places began banning smoking. Taxes on tobacco and restrictions on who could buy tobacco products helped – and smoking rates plummeted from above 40 percent in the 1960s to 18 percent now.
With traffic safety, first speed laws, then requirements for vehicles to have seat belts and air bags helped reduce deaths, Joyner said.
Now something policy measures are needed for obesity, the AMA says.
“It changes the ways society looks at things. It gives people maybe a new set of tools,” Joyner adds.
Sources: LA Times; NBCNews.com