A reader forwarded an article from Medscape (July 15, 2013) entitled “Fat Equals Sick: Is This about the Money?” Last month the American Medical Association (AMA) decided to label obesity as a disease. On Medscape four physicians speculate as to why obesity has been labeled as a disease and what will be the consequences.
The big question is what effect will this new ruling have on the over one third of Americans who are considered obese? If you are in this category, and you go to your doctor, will s/he be obliged to prescribe a diet drug, two of which coincidentally came to the market shortly before the AMA decided obesity was a disease? Will these drugs become “state of the art treatment” for anyone considered obese? If so then your doctor must prescribe them or be in danger of losing his license to practice medicine.
As family physician, Bradley P. Fox, who has difficulty fitting obesity into the definition of disease, says, “Obesity comes in different shapes and sizes. The strict definition of obesity being a BMI greater than 30 kg/m2 does not always define the actual patient. I have several athletes who have BMIs of 30 kg/m2 or more who are in fabulous shape and health. I would not consider them diseased (and I have a hard time labeling them as obese).”
Dr. Bradley says the definition of disease is, “A disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment.” He has a hard time accepting the obesity as a disease because nutritional deficiency is one of the causes. Other experts believe it is a nutritional deficiency disease—the body craving food in an effort to find nutrients not available in processed and fast foods.
Dr. Fox says to follow the money. Fox says he does not think obesity is a disease any more than he thinks smoking is a disease and he doubts this declaration by the AMA will change the way doctors look at obesity or how insurance pays for its treatment when they are always looking for ways to pay less. He says there is bound to be an explosion of physicians specializing in treating obesity now that it is called a disease.
Dr Robert Morrow, another family physician, agrees with Fox that if obesity is a disease, it is a social one. He says, “Happily, the medicalization of obesity has not progressed among people in general, especially on the pharmaceutical front, as reported in the business section of the New York Times on June 18, 2013. That article reports that no "diet" medication has achieved important sales figures. I presume the AMA pronouncement seeks improvement of those sales figures.”
Page 2 of 2 - Morrow continues, “Obesity is a condition that warrants attention. We know many things about obesity and its relationship to diabetes, atherosclerosis, diet, exercise, social class, physical mobility, and so on. But the attention warranted is social, with an individual encouraged by their health professional to participate in those social reframings. Such reframing involves superficially easy changes in the caloric density of foods and the quantities eaten, matched with increased physical activity. Hold my Nobel Prize -- those changes are complex, of course. But it is embarrassing for me to go to a country such as France, where I look rotund, and a relief when I return to the good old US of fat A, where I look below the mean (for an old man).” He concludes with, “But hold the pills, please.”
Mark E. Williams,MD specializes in geriatrics (treatment of sick old people). He is concerned that we are going to be medicating common human predicaments. He says, “As a geriatrician, I expect that the development of gray hair or the aging process itself to be the next condition considered as a disease. And I wonder about the intent of this new labeling. Is it to draw attention to major risk factors, such as sedentary lifestyle or poverty, or is the intention to justify markets for antiobesity remedies, such as medications or bariatric surgery?”
Another family physician, Charles P. Vega, MD believes the AMA is moving in the right direction. He says, “I support the establishment of obesity as a diagnosis, although with some mixed emotions. With over one third of the US adult population classified as obese, and what we know about the health dangers of obesity, we are long overdue to mount a serious campaign against fatness. The problem is intractable and requires both broad and personalized interventions that are based on science. The most effective means to reduce the scope of obesity is to prevent it. We need to ensure that young people have access to healthy lifestyle choices.”
We need to use caution and think for ourselves where this or any other drug is concerned. Those who join weight control support groups, and change their diet and lifestyle seem to have longer lasting normal weight and better health. There is no quick fix for obesity.
(Janice Norris lives in Heber Springs, has a B.S. in home economics from Murray State University, owned and operated health food stores in Illinois and Heber Springs, and wrote a weekly column in Illinois for 15 years. She can be reached at firstname.lastname@example.org)