Obesity declared a disease by AMA

2013-06-19 14:26
AMA votes to redefine obesity as a disease

Obesity has officially been declared a disease by the American Medical Association, which voted for the action on Tuesday.

Accordingly, 78 million American obese adults and 12 million obese children are now considered to have a medical disease that requires treatment.

Before taking a vote, the AMA debated whether making obesity a disease would help by getting more obese patients into effective medical treatment, or hurt by further stigmatizing a condition that is sometimes blamed on a lack of will power to stop eating.

Ultimately, the nation’s leading physician’s organization decided to give obesity new status, declaring it a disease that affects more than one-third of adults and 17 percent of children in the U.S.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately 1 in 3 Americans," AMA board member Dr. Patrice Harris said in a statement Tuesday. "The AMA is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and type 2 diabetes, which are often linked to obesity."

Blacks have the highest rates of obesity at 49.5 percent, followed by Mexican Americans at 40.4 percent, all Hispanics at 39 percent and whites at 34 percent.

Obesity among children and teens has almost tripled since 1980. Among children, there are significant racial and ethnic disparities in obesity rates. Hispanic boys are significantly more likely to be obese than white boys – and black girls are significantly more likely to be obese than white girls, according to the CDC.

So what does Tuesday's vote mean for the healthcare industry in general?

For starters, it will put more pressure on health insurance companies to reimburse physicians for treating the obese, a laborious undertaking that involves discussing the health risks of obesity with patients whose body mass index exceeds 30.

For physicians, it means their diagnosis and treatment of obesity is now a professional obligation; thus, it should motivate primary care physicians to address obese patients about the hazards of their disease, no matter how uncomfortable such a discussion may be.

Indeed, studies show that more than half of obese patients have never been told by a medical professional that they need to lose weight. This suggests a reluctance by doctors to confront the issue for fear of offending the obese patients, not to mention a possible unwillingness to engage in a lengthy consultation that the physician may not be reimbursed for.

The Medicare program, which insures an estimated 13 million obese Americans who are over 65 or disabled, already covers the costs of "intensive behavioral therapy" for obese patients. The federally funded program also covers bariatric surgery for those with additional health conditions. However, coverage for these obesity treatments has been irregular among private insurers.

In the past, the AMA has referred to obesity as an "urgent chronic condition," a "major health concern" and a "complex disorder." The vote to define it as a disease now elevates the status of obesity to new levels above and beyond that of a mere health condition, concern or disorder that raises the risk for all kinds of other diseases.

Declaring obesity as a disease comes on the heels of a dramatic increase in obesity in America over the last 20 years, as well as a rise in public concern over the rising costs of treating health problems linked to obesity.

Indeed, treatment of obesity-associated problems like cardiovascular disease, type 2 diabetes and some cancers has increased the nation's medical bill by more than $150 billion a year, according to the Centers for Disease Control and Prevention (CDC).

Worse yet, a Duke University study recently concluded that projected increases in the obesity rate could raise that figure by an additional $550 billion over the next 20 years.

In support of the decision to redefine obesity as a disease, the AMA's Council on Science and Public Health argued that 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 decision should also affect the FDA, which has only approved two new prescription weight-loss drugs since 1999. With obesity now considered a disease, however, the agency will likely feel the pressure to approve additional weight-loss drugs, which could trigger a cascade of new drug development, as well as more widespread prescribing by physicians, the council said.

"The greater urgency a disease label confers" may also increase support for obesity-prevention programs, the council added. It also speculated that "employers may be required to cover obesity treatments for their employees and may be less able to discriminate on the basis of body weight."

On the other hand, the council also pointed out that declaring obesity a disease could paradoxically increase the stigma associated with being overweight, therefore subjecting some patients to judgment and ridicule, regardless of whether they were otherwise healthy or lost enough weight to improve their health.

Another argument against making obesity a disease is that it could potentially turn the nation's attention toward more expensive drug and surgical treatments – and away from efforts that promote healthy diets and regular exercise, said the council.

Dr. Daniel H. Bessesen, an endocrinologist and obesity expert at the University of Colorado Anschutz Medical Campus, called the AMA's shift "a double-edged sword." While the redefinition of obesity may reflect "a growing awareness that obesity is not someone's fault," he’s concerned that "the term disease is stigmatizing, and people who are obese don't need more stigmatizing."

Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person's weight is greater than what's considered healthy for his or her height, according to the NIH.

SOURCES: 1. The American Medical Association (AMA), AMA Adopts New Policies on Second Day of Voting at Annual Meeting (June 18, 2013); 2. The Centers for Disease Control and Prevention (CDC); 3. NIH: National Institute of Diabetes and Digestive and Kidney Diseases, AMA Press Release Obesity (June 18, 2013).