This article was written by Joanne Sauer, LCSW. She currently is taking graduate classes at Plymouth State University to further her knowledge and work to help patients diagnosed with Eating Disorders. She works as a Social Worker at the Albany NY VA Hospital. She also works part time for a managed care company as a Care Manager. Her interests include caring for her numerous animals, running, reading, kayaking and spending time with family and friends.
As widely reported on network television, the internet and in major newspapers such as the LA Times and the NY times, after much debate the AMA voted to declare obesity a disease with a primary goal of changing the way the medical community evaluates and treats up to 78 million American adults and 12 million children. The debate centers around whether this action would help people have better access to treatment or whether it would contribute to further stigmatize a condition that is not always easily defined.
There are no real legal ramifications with this vote. It is more of a declaration. It is hoped that physicians will communicate more with patients the health related concerns related to
obesity. Insurance companies will most likely be pressured to increase reimbursements for medical care said to be related to obesity including bariatric surgery, diabetes management, dietary counseling and weight-loss programs.
As cited by Holes-Lewis and Malcolm, there is research that indicates obesity to be associated with related conditions including heart disease, type 2 diabetes, sleep apnea, stroke and certain types of cancer. However, there is also research that shows that people who are considered overweight can be healthy. For example, a 2010 study found that middle-aged men who engage in regular exercise are less likely to suffer an early death independent of their Body Mass index. A recent study by the Journal of Clinical Endocrinology and Metabolism found that obese individuals are not more likely to suffer from cardiovascular disease or experience early death than normal weight individuals. 22,203 men and women from Scotland and England were followed for an average of 7 years.
Where does this lead in regards to the big business of weight loss, a massive industry where billions of dollars are spent every year? It can be speculated that companies will step up their marketing efforts for various diet books, foods, exercise equipment and other interventions. The media will probably add to their marketing campaigns something that attempts to convey the medical imperative importance of losing weight and avoiding obesity. The pharmacological industry will certainly benefit as weight loss drugs including the most recent additions to the weight loss arsenal: lorcaserin (Belviq) and phentermine-topiramate (Qsymia) are increasingly marketed and sold.
It would benefit us as Americans as we focus on healthy eating and lifestyle habits, to remember we are all unique and special. We can be healthy in all shapes and sizes. The debate still remains whether obesity is considered a disease. We know our standard measurement tool, the BMI, has flaws and incorrectly measures children, adolescents and the elderly. We look forward to the benefits that the AMA declaration will afford those who would benefit from medical treatment that will lead to a longer life. Positive interventions can include increase in physical activity and behavioral modification as cited by Eckel in his article Nonsurgical Management of Obesity in Adults. Will the AMA declaration also affect healthy, happy Americans who may have a higher BMI in a negative way? We need to be diligent to ensure people are not judged, stigmatized, directed towards treatment that isn’t needed or made to feel their body is imperfect.
Since the AMA readily admitted concern over the possibility of increased stigma over higher weight with their declaration, it would be to their benefit to include in their recommendations the need for less emphasis on BMI with more emphasis on education regarding healthy diet, lifestyle and choices which contribute to our physical, emotional and spiritual health.
Eckel, Robert H, MD; Nonsurgical Management of Obesity in Adults, The New England Journal of Medicine, 358:18, May 2008.
Hamer, Mark and Stamatakis, Emmanuel; Metabolically Healthy Obesity and Risk of all-cause and Cardiovascular Disease Mortality, Journal of Clinical Endocrinology and Metabolism, 97 (7): 2482, July 2012.
Holes-Lewis, KA and O’Neil, Malcom R; Pharmacotherapy of Obesity: Clinical Treatments and Considerations, American Journal Medicine Science, 345 (4): 284-8, April 2013