Obesity Is Now a Disease: Same Problem, New Label

Tape measure being used on overweight male belly

The American Medical Association (AMA) now officially considers obesity a disease. Prior to the decision by the full association, a special committee within the AMA, assigned to explore the issue further, had just recommended against labeling obesity a disease, so I sense a civil war.

Here are the two sides of this issue: Calling obesity a disease may make it easier for people to obtain insurance reimbursement for treatment. That could get help for more people, because insurance companies often prefer to reimburse only for diseases.

On the other hand, it can be stigmatizing to people to think their obesity means they’re “diseased,” or—the flip side—they may feel it’s now up to doctors and health professionals to cure them, relieving them of responsibility: the “it’s not my fault” syndrome. The AMA naysayers also felt that the typical means by which obesity is determined—the body mass index (BMI)—is unreliable.

Both sides have their points, but here are the undisputable facts:

  • Obesity affects one in three Americans, and another one in three is overweight.
  • Approximately one in seven children is obese, and another one in seven is overweight.
  • Obesity is a “gateway” condition: it severely increases the risk of developing diabetes, hypertension, heart disease and a host of other chronic conditions that are diseases.

As for the reliability of the BMI: true, it’s not always reliable. BMI doesn’t show body composition. A bodybuilder may be overweight but have little body fat and not be obese, even though his BMI says he is. Someone with a normal BMI may have excess body fat but a normal weight. The BMI isn’t terrific, but it’s cheap to determine and it’s generally okay.

What’s in a name change?
Calling obesity a disease has no legal implications, but the AMA has a lot of clout. Insurance companies may now have to take a hard look at reimbursement for obesity treatment.

This is a huge money issue for insurance companies. Americans spend about $190 billion annually in higher medical costs because of obesity.

It makes one wonder why insurance companies will pay for the complications of diabetes treatment, including the amputation of a leg, but balk at paying to help someone lose weight, which might have prevented that leg amputation in the first place.

This brings up a huge issue for reimbursement: insurance companies don’t like paying for conditions that haven’t quite happened yet. Ironically, prevention is precisely the arena in which nutrition and physical activity can have their greatest impacts. But we’ll still need effective treatments for obesity and we may need to think outside the box and tailor treatments to individuals. It’s not a one-size-fits-all disease. People become obese through many different avenues. Still, preventing obesity is where the long-term action is.

Here’s my take
I don’t care how obesity is categorized. I care about what’s being done about it. And while this new label may make it easier for people to be reimbursed for treatments, it isn’t a cure-all. People may simply gain access to more tools. There needs to be buy-in by patients; they need to be willing to use the tools and keep using them. Too often we think treatments for weight loss don’t work. Actually, they work very well—if consumers get involved and stay involved. Managing weight—be it overweight, normal weight, or underweight—is a lifelong matter. It’s not about blame (too much time is wasted here); it’s about action. The sooner we accept this, the sooner we can take control of our health and our lives.

I’m fully aware of extenuating circumstances that can produce weight gain. I often work with people who are nonambulatory or who have impaired mobility. Losing weight is rough, but for these people it’s downright brutal. Their determination inspires and motivates me. The rest of us have it much easier.

We need to stop talking about whether obesity is or is not a disease and start talking about preventing it altogether. I hope that the members of the AMA discussed this issue while taking walks.

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Keith-Thomas Ayoob, ED.D.

Keith-Thomas Ayoob, ED.D.

Keith-Thomas Ayoob, Ed.D., R.D. is director, Nutrition Clinic, Children’s Evaluation and Rehabilitation Center, Einstein associate clinical professor, pediatrics.

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  • Neil Crump July 16, 2013, 6:27 PM

    You are right that obesity being labelled a disease is semantics. Losing weight at its heart is simple: eat right and exercise. I lost 22 kgs over a 10 month period, going from 100 to 78kg, taking my body fat from 22.5% to 8.6%. Everyone asks: ‘how did you do it?’ and appear a bit disappointed when my response is ‘eat right and exercise’. I think that we have as a society made taking control of our weight a difficult and unattainable goal – a mystery. It simply isn’t if you decide you want to take back control, get support from friends and family, set a goal and find an activity that gets your heart rate up and that you can enjoy. I found tracking my improving heart rate and other markers really useful. You quickly see improvement at this level even before the scales start shifting significantly. As a famous sport brand says: ‘Just Do It’.

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