US doctors' group labels obesity a disease

Advocates say AMA's move will boost resources to fight weight-gain epidemic, but others question decision.

Advocates say AMA's move will boost resources to fight weight-gain epidemic, but others question decision.

20 jun 2013—In an effort to focus greater attention on the weight-gain epidemic plaguing the United States, the American Medical Association has now classified obesity as a disease.

The decision will hopefully pave the way for more attention by doctors on obesity and its dangerous complications, and may even increase insurance coverage for treatments, experts said.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three 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."

One expert thinks the AMA's decision, approved Tuesday at the group's annual meeting, could lead to greater coverage by insurance companies of treatments for obesity.

"We already treat obesity as a chronic illness," said Dr. Esa Matius Davis, an assistant professor of medicine at the University of Pittsburgh. "But this decision will bring more resources into the picture because it will, hopefully, allow for more insurance coverage and that really has been the issue of getting people the help that they need," she said.

Treatments for obesity—including drugs, nutritional counseling and surgery, if needed—often don't get reimbursed by insurance companies, Davis said. That means many patients aren't getting the care they need because they can't afford to pay the out-of-pocket costs, she said.

If insurance covered these services "it would increase referrals and treatment and that would be a huge step in the right direction," Davis said.

Right now, Davis gets insurance coverage for her obese patients by diagnosing them with high blood pressure or high cholesterol or diabetes, or other obesity-related conditions. But, that still leaves many obese patients out in the cold, she said.

The Obesity Society, which calls itself the leading scientific society dedicated to the study of obesity, applauded the AMA's decision. "The passage of a new American Medical Association policy classifying obesity as a disease reinforces the science behind obesity prevention and treatment," Theodore Kyle, advocacy chair, said in a statement.

"This vital recognition of obesity as a disease can help to ensure more resources are dedicated to needed research, prevention and treatment; encourage health care professionals to recognize obesity treatment as a needed and respected vocation; and, reduce the stigma and discrimination experienced by the millions affected," he said.

Kyle said the AMA has now joined a number of organizations that have previously made this classification, including the U.S. National Institutes of Health, the Social Security Administration, and the Centers for Medicare and Medicaid Services.

Not everyone thinks the AMA's decision was the right one, however. In fact, the move was opposed by many in the doctors' group, including a committee that had been charged with exploring the issue. It had voted not to recognize obesity as a disease.

One of the objections to labeling obesity as a disease hinges on the way obesity is determined, using the so-called body mass index—a ratio of weight to height—that some health experts think is inexact.

That's not the only objection.

"I have never liked the idea of characterizing obesity as a disease, because disease occurs when the body is malfunctioning," said Dr. David Katz, director of the Yale University Prevention Research Center. "Turning surplus calories into a fat reserve is not malfunction, it is normal physiology."

Katz said obesity is largely a societal problem caused by too much food and too little physical activity. While obesity certainly needs to be treated, the aspects of culture that have led to the obesity epidemic need to be changed, he said.

"Obesity is rampant in the modern world not because of changes in our bodies, but because of changes in the modern world. We are drowning in excess calories and labor-saving technologies," he said.

He thinks obesity treatments deserve insurance coverage.

During the past 20 years, there has been a dramatic increase in obesity in the United States, with more than one-third of adults (35.7 percent) and approximately 17 percent (or 12.5 million) of children and teens considered obese, according to the U.S. Centers for Disease Control and Prevention.

Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.

In 2008, medical costs associated with obesity were estimated at $147 billion; the medical costs for people who are obese were $1,429 higher than those of normal weight, the CDC said.

Blacks have the highest age-adjusted rates of obesity—49.5 percent—followed by Mexican Americans (40.4 percent), all Hispanics (39 percent) and whites (34 percent).

Among children and teens, the obesity prevalence since 1980 has almost tripled. There are significant racial and ethnic disparities in obesity rates among children. 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, the CDC said.

Obesity and overweight are labels for ranges of weight that are greater than what are considered healthy for a given height.

For adults, obesity and overweight are determined by using weight and height to calculate your body mass index, or BMI. An adult with a BMI between 25 and 29.9 is considered overweight, while someone with a BMI of 30 or higher is considered obese.

Someone who is 5 feet, 9 inches tall and weighs between 125 pounds and 168 pounds has a BMI between 18.5 and 24.9, which is considered healthy. That same person who weighs between 169 and 202 pounds has a BMI between 25.0 and 29.9, which is considered overweight. And if he or she weighs more than 203 pounds, they have a BMI of 30 or higher—considered obese.