Obesity should be called a disease and not simply a condition, the American Medical Association’s policy-making House of Delegates voted on Tuesday, June 18th, 2013.
I wanted to give this topic a little bit of breathing room before I replied. It’s not a simple problem with a simple answer. The people and groups in support of obesity as a disease make valid points as do those who say obesity should have been left as a condition rather than a disease.
First, what is obesity? The Obesity Society says “Obesity is defined as excess adipose tissue.” The most prevalent method of determining this excess is by body mass index (BMI). Those with a BMI of 30 or greater are classified as obese according to the World Health Organization. To calculate your BMI use this link.
BMI is simplistic and flawed because it’s based on a calculation using only height and weight. Opponents of using BMI as the base determinant of obesity make their case by saying BMI doesn’t look at the person’s true health, it doesn’t look at other disease risk factors that may or may not be present and it doesn’t take into consideration a pregnant or lactating woman nor does it account for a thickly muscled athlete who may be incredibly healthy with a low body fat. However, by and large BMI provides a quick, easy assessment that is far more right, as a general determinant of body-fat status, than wrong. Most people with a BMI greater than 30 are not thickly muscled and even if someone with a BMI greater than 30 doesn’t presently have medical issues it doesn’t mean they aren’t at substantially greater risk.
Body fat measure is another method of determining obesity. Levels in excess of 32% for women and 25% for men are generally considered to indicate obesity. However, accurate measurement of body fat percentage is much more difficult than measurement of BMI. Several methods of varying accuracy and complexity exist.
Is Obesity a Problem?
Obesity isn’t just a cosmetic problem. It poses health and financial risks. Obesity is a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like Type 2 diabetes and cardiovascular disease. Being obese increases risks of:
- Coronary heart disease
- High blood pressure
- Type 2 diabetes
- Abnormal blood fats
- Metabolic syndrome
- Sleep apnea
- Obesity hypoventilation syndrome
- Reproductive problems
Obesity costs Americans more than $190 billion annually in higher medical costs, and possibly as much as $450 billion in indirect costs, such as lost productivity.
But is obesity a condition or disease?
“A condition leads to one set of solutions. A disease might lead to another,” said John Armstrong, MD, a delegate of the American College of Surgeons, which co-sponsored the resolution that would call obesity a disease.
One might think that answering this question would be pretty simple especially for medical experts. The dictionary definition of disease is apparently too simplistic. In the medical community there isn’t even a clear, specific, widely accepted and scientifically applicable definition of “disease.” In the end there is no consensus among medical experts over whether obesity is a disease or not. The AMA made their recent declaration largely on utilitarian grounds that the social benefits of calling obesity a disease will outweigh the costs.
Benefits of calling it a disease
The premise of the AMA declaration is that it will focus more attention on obesity; this could increase the amount of research dollars allocated towards obesity, expand obesity-related public health initiatives, and help improve reimbursement and services for obesity counseling and education, drugs, and surgery. In addition other benefits of classifying obesity as a disease proposed by the AMA and others include:
- Increase obesity-related research funding
- Increase obesity-related public health initiatives
- Improve access to obesity education and counseling services
- Increase medically-centered obesity treatment
- Medical coverage for obesity-related treatment
- Medicare coverage for obesity-related treatment
- Private health insurance coverage for obesity-related medical services
- Reduce the stigma of obesity (stems from the widespread perception that it is simply the result of eating too much or exercising too little)
Dr. David Katz M.D., Director at Yale University Prevention Research Center says “Diseases get respect in our society, unlike syndromes, which are all-too-readily blamed on the quirks of any given patient, and other conditions attributed to aspects of character. Historically, obesity has been in that latter character, inviting castigation of willpower and personal responsibility, and invocation of gluttony, sloth, or the combination. Respecting obesity as a disease is much better.”
Drawbacks of calling it a disease
- May increase overtreatment (since one-third of Americans now have a “disease”)
- It’s unlikely to reduce healthcare spending–and it may increase it
- Could worsen health outcomes (by increasing reliance upon drugs and surgery)
- May increase civil suits against the food industry (short-circuiting a more promising cooperative approach of producing foods with more nutrition and fewer calories)
- May increase insurance premiums for individuals and employers (someone has to pay for the extra medical services treating obesity)
- May undermine prevention efforts and will do little to impact its treatment (puts the focus on treatment rather than prevention)
- Allows people to throw up their arms and surrender and do nothing (gives people an out not to take personal responsibility)
Opponents generally have a rough time calling obesity (BMI > 30) a disease when someone isn’t symptomatic or “sick.” However, when we consider coronary heart disease and diabetes, two widely-accepted, bonafide diseases, there are stages before full manifestation of the detectable disease that warrant treatment. One may think of obesity in a similar vein. Just because another risk factor hasn’t presented itself or been detected yet doesn’t mean the person isn’t “sick.”
Others are concerned that “medicalizing” obesity takes the emphasis away from where it should be–and that is on lifestyle medicine. Dr. David Katz M.D., Director at Yale University Prevention Research Center, writes “So, do we skip right past concerns about access to produce and just make sure everyone has access to a pharmacy? Instead of helping people on SNAP find and afford broccoli, do we just pay for their Belviq (a weight-loss drug) and bariatric surgery?”
The AMA calling obesity a disease raises awareness and may reduce some of the stigma for the obese by recognizing that while personal responsibility still matters it’s not the sole determinant and cause of obesity. Their declaration may also help the treatment portion of managing our obesity epidemic. What remains to be seen is whether this new classification positively impacts the prevention portion as ultimately obesity prevention and lifestyle-management are more likely to create beneficial outcomes for everyone.
Obesity is a consequence of abundance, convenience and underlying biology. It might also be viewed as the perverse outcome of constantly expanding ‘choice’. What is certain is that this epidemic of ‘passive obesity’ is unlikely to come to a natural end, i.e. without intervention.
Tackling obesity is fundamentally an issue about healthy and sustainable living for current and future generations. This is only likely to be achieved if there is a paradigm shift in thinking, not just by Government but by individuals, families, business and society as a whole. There is therefore an urgent need for leadership, vision and, above all, sustained commitment.