Posted on 08/08/2013 at 06:21:36 PM by Student BloggerThe ASN blog was created as a forum for the latest topics in nutrition. In light of the goal to provide fresh perspectives on the hottest nutrition news, ASN initiated a point/counterpoint series on topics selected by the bloggers.
AMA Declares Obesity a Disease: Should We LIKE this decision?
By Sabrina Sales Martinez, MS, RDN
Recently, the American Medical Association (AMA) stated that obesity should be classified as a “disease.” Although, they are not the first organization to do so, it certainly has brought a lot of attention and discussion to the topic of obesity and its treatment. The AMA's decision legally does not change much; however its professional clout may have implications for how obesity is treated. Obesity is an enormous public health issue in the US and globally. According to the CDC, about one-third of Americans are considered to be obese, which can increase the risk for other diseases such as type 2 diabetes, cardiovascular diseases and some types of cancer, all of which can also be classified as conditions with preventable risk factors. It seems that this declaration has spurred a lot of attention and some believe this may be an AMA positive move, while others dissent. Let's review why some support or “LIKE” the AMA's decision and others may not.
According to the AMA the following guidelines were used to define a disease “1) an impairment of the normal functioning of some aspect of the body; 2) characteristic signs or symptoms; and 3)harm or morbidity.” Using these criteria it seems reasonable that obesity should be considered a disease. Some physicians are optimistic that they will be able to provide treatment such as counseling, medication or surgery to more patients. As a nutritionist, I am hopeful that insurance companies will allow nutrition counseling for obesity to be reimbursed. Currently, dietitians/nutritionists can only be reimbursed for nutrition counseling if the patient has another “disease” such as diabetes or cardiovascular diseases, which indicates that a patient must have more life-threatening conditions in order to receive this type of intervention. I am hoping that efforts that improve obesity screening will be expanded by this action as well, which can prevent so many other chronic conditions currently plaguing our society. The AMA decision may contribute to greater funding by government and the private sector for obesity-related policy, research, changes in the obesogenic environment and obesity treatment options. It certainly has put obesity in the spot light and brought a lot of attention to this current public health epidemic, which many anticipate that it can lead to engagement from all sides to tackle this problem.
Critics of AMA's decision have also voiced their concerns and have stated valid points. Obesity is defined using the Body Mass Index (BMI), which provides a ratio of body weight to height (weight in kg/height in m2), with a cut-off of greater than 30 kg/m2. Opponents of the AMA decision argue that this tool has many limitations, since it does not directly measure fat mass. There is a chance that patients may be diagnosed as overweight or obese based on BMI, who may actually be healthy. As a nutritionist, I am concerned that some will think that obesity can simply be treated with medication or surgery, and that diet, exercise and lifestyle changes are not important. Patients may think that they do not have control over their disease, are considered ill, therefore, they have no personal responsibility and behavioral changes are unimportant. Some health professionals feel that obesity is a “complex disorder” or a risk factor for other chronic diseases, and not a disease condition.
It seems there are plenty of questions and concerns as to what the future holds for this debate. Time will tell whether the obesity epidemic will be ameliorated by naming it a “disease.” As an optimist, I “LIKE” that all this attention brought by the AMA's decision may have a positive impact on prevention efforts for obesity, and that it will make treatment of obesity an essential component in an individual's healthcare. Real prevention efforts will require commitment from all entities of our society in order to effectively combat this disease, obesity.
1. American Medical Association (AMA). AMA Adopts New Policies on Second Day of Voting at Annual Meeting.
2. Centers for Disease Control and Prevention (CDC). Overweight and Obesity: Adult Obesity Facts.
3. American Medical Association (AMA). Business of the American Medical Association House of Delegates 2013 Annual Meeting. Annotated reference committee reports. Reference Committee D.
A Name by Any Other? AMA Declares Obesity a Disease
By Lindsey Smith, MPH
In June 2013, the American Medical Association (AMA) officially recognized obesity as a medical disease. Most public health and obesity experts agree that this shift is a positive one, since recognition by the largest medical organization in the US could increase awareness of the condition and improve insurance reimbursement for obesity-related treatment.
Yet, the picture is more complicated than first meets the eye.
One key question is how this new designation will change the perception of obesity. Despite the prevalence of obesity amongst US adult (over one third have BMIs in the obese range), obesity has long been stigmatized. Researchers at the Rudd Center point out that as a society, we tend to believe that individuals “get what they deserve,” and that obesity is the result of individual moral failure rather than emblematic of an obesogenic environment.
One potential benefit of officially labeling obesity as an illness is that, much like alcoholism or other additions, it neutralizes the term and re-orients it as an objective condition which can then be diagnosed and treated. Perhaps as the general public becomes more aware of obesity as a medical disease and stigma declines, obese individuals will be more likely to actively seek out treatment. Yet, paradoxically, the medicalization of obesity could also damage these same individual's likelihood of effective treatment. What gives?
As one Time Magazine article explains, such labeling can also promote pessimism about weight loss as people begin to view their disease as the inevitable result of biology and genetics rather than a modifiable condition. A second concern is that patients might rely too heavily on surgery and drugs as treatment for obesity rather than seeking to change unhealthy lifestyle patterns. Given that obesity is associated with increased risk for a host of chronic diseases, including type 2 diabetes, cardiovascular disease, and hypertension, healthier lifestyles including improved diets and physical exercise are essential to prevention.
In fact, the AMA Council on Public Health counseled that obesity should not be classified as a disease at all, precisely because of its association with chronic conditions: they argue that it is more of a risk factor for disease rather than a disease itself. Right now, the state of the science is inconclusive. Experts are unsure about how much morbidity and mortality is attributable to obesity in and of itself, or whether the association between obesity and health operates entirely through lifestyle factors or other diseases.
Clearly, one of the primary issues is how medicalization of obesity impacts promotion of and compliance with diet and physical activity recommendations. Yet, if done correctly, labeling obesity as a disease could actually improve the effectiveness of these recommendations: one key benefit of labeling is that it provides something tangible for people to grasp onto. People feel comfortable with the process of going to the doctor, being diagnosed, and provided with a clear-cut treatment option. Similarly, rather than isolating obesity as a “disease” apart from its associated lifestyle factors, an obesity diagnosis should carry with it clearly identified and easily operationalized goals and strategies for improved diet and exercise.
One compelling example of this approach comes from New York City, which recently launched a program to combat obesity: a prescription for fruits and vegetables. The clinic-based program, which aims to boost produce intake, offers coupons to high risk, low-income participants to spend at local farmers markets. The novelty of this program is that it harnesses the authority of the traditional medical system to define and treat obesity (diagnosis and prescription), while incorporating clearly defined behavioral goals (improved diet) and providing a tangible treatment option (coupons). Even better, the program seeks to improve diet behaviors which could benefit the participant's family, regardless of their weight status.
At this point, it's unclear how much this new designation will impact our perception, prevention, and treatment of obesity. In the meantime, researchers and practitioners alike would do well to remember that, disease or not, behind each case of obesity lies a complex story about genetics, environment, biology, and behavior.