Diabetes Blogs

Is Obesity Really a Disease?

This past week delegates of the American Medical Association voted to recognize obesity as a disease, despite the recommendation of a panel assigned to study the issue. The panel voted that way because they felt BMI was not a good measure of obesity.  But according to AMA board member Patrice Harris, the broader AMA physician community overruled the recommendation because “recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans.”    

Gauging by the reaction of opinion pieces and comments from readers, it would appear this action is quite controversial.

While I would vote "Yes" on the question, I am not sure the answer really matters.  The decision by the AMA to name obesity a disease is already accomplishing its goal: sparking greater awareness and action around the impact of obesity on America and Americans.

Having spent the last week reading a surprising amount of negative responses from both experts and everyday Americans, it seems like we are missing the broader point.

The responses seem to fall into two categories:

  1. Obese people are lazy. Therefore calling this a disease absolves them from any personal responsibility 
  2. This decision will promote the "medicalization" of obesity

The first characterization belies a lack of understanding about obesity, its causes, and implications for this country, while the second is a cynical response to the AMA's attempt to address what is a global pandemic - whether technically accurate or not.

First let's look at some of the facts: (source CDC.gov)

 

The number of states with obesity rates greater than 30% (the darkest color) increased by 33% in one year! And it is not slowing down.  Most statistics indicate by next year one out of every three Americans will be obese.  According to the American Heart Association, obesity costs this country $254 billion and is on the way to $850 billion over the next 15 years.  We are literally drowning under the weight of this epidemic.

More alarming, according the the American Academy of Pediatrics, 1 out of every 3 new cases of type 2 diabetes, lifestyle related diabetes, are children.  Yes, children.  If you think our healthcare cost challenge is a problem now, just wait.  In fact, we are finding that the incidence of complications is higher in children with type 2 diabetes than adults, so the velocity of the problem will increase over time.

We need to change the way we think about this problem.

Which brings me back to the backlash against the AMA's decision to label obesity a disease.

Here are some quotes I found from the comment section of reputable news sites that wrote about this story:

  • "What's next? It takes the responsibility of pushing away from the table and going for a walk away from some fat arses. "But I've got a disease!", he says as he finishes his second quart of ice cream that day."
  • "How do you force people into having Will-Power?"
  • "It’s a self-serving ruling by the AMA, period. More money for physicians, more Dr. visits, more specialists, more testing etc. etc. "
  • "For some people I can see it as a disease, emphasis on SOME. But for most people, they're just plain lazy, eat all the wrong foods, and NEVER exercise. If those huge, obese people on the "biggest loser" can lose weight, then anyone of that size can lose weight. It just takes the heart, dedication and eating healthy to do so."
  • "The only disease related to obesity is hand to mouth disease and that inflicts 100% of the obese population. If people stop eating so much, you wont be as fat."
  • "Diabetes is a result of being obese, not the other way around. Thyroid conditions are a very, very small percentage of the problem."
  • "next week's news headline- "Extra, Extra, No One Has Personal Responsibility For Anything Now!" Of course physicians WANTED this to be disease! Insurance co.'s pay for more tests, more Dr. visits, more crap..... it's not a choice when fat people shove Twinkies in and sit rather than exercise & eat healthy.... please!"
  • "And the cost of medical insurance rises, yet again."

Even the editorial pages of many major papers and websites echoed variations of these two arguments, admittedly with more care than the commenters above.

Once you get past the emotion and hyperbole, you realize that the AMA's action, regardless of the merit of the decision, accomplished exactly what we needed.  It started a national dialog about obesity and its impact on society. Regardless of cause, the effect of obesity harms all of us in the form of a greater percentage of GDP going to treat chronic lifestyle disease. 

Slamming physicians, the pharma industry and entrepreneurs for seeking cost-effective solutions to the problem is NOT the answer.  Screaming about personal responsibility will not get us out of this mess.  We need to embrace a variety of behavioral, psychological, pharmacological and surgical interventions in combination to have an impact.  It will cost money, but the costs of intervening now are significantly lower than the costs of treating the complications of obesity tomorrow.

I could care less if you call it a disease or an addiction, but I am 100% behind the AMA's decision to do so because its an important first step in a national solution to a national problem.

For a more in depth look at both sides of this issue, Travis Saunders at Obesity Panacea has a great post and video debate

Do you agree with the AMA's decision to define obesity as a disease?


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