Obesity is now a disease: What are the implications?

Obesity is now a disease: What are the implications?

The American Medical Association (AMA) has voted to formally recognize obesity as a disease. In the shadow of this recognition is the untimely and tragic passing of a great actor, James Gandolfini, who, known for throwing his weight and clout around onscreen as Tony Soprano, is suspected to have died from a heart attack at the early age of 51.

What is the implication of the AMA’s vote?

Those in favor of the ruling argue that in calling obesity a disease, it forces physicians, be it subconsciously or outright, to more readily address the issue with patients, and to be more proactive in tackling the problem. Perhaps it will enable us to avoid skirting around the issue as to not offend or place blame, but instead to have an open and honest discussion with patients about how this disease is so well-intertwined with others, namely heart disease, the number one killer of U.S. adults in this country.

And the kids, the kids! As cheesy as it may sound when the late Whitney Houston so beautifully belted out “I believe the children are our future,” she hit the nail on the head. They are the silent sufferers of this disease. By labeling obesity a disease, perhaps campaigns like “Let’s Move,” with FLOTUS leading the way, won’t be viewed by some skeptics as just a project to keep herself busy, but as a necessity, given the startling statistic that 1 out of every 3 American children are overweight or obese. In support of this declaration of obesity as a disease is that insurance companies will be compelled to reimburse for obesity counseling, and the medical and surgical treatments of obesity, without all the red tape.

With all the supporters, however, there is of course opposition to the ruling; many warn that labeling obesity as a disease supports the medicalization of a majority of Americans’ everyday lives and behaviors.  They say that the vote serves to scrutinize people’s every decision about what they choose to put in their mouth or how much time they choose to spend on the couch instead of jazzercising, prancercising, or however creative method used to stay fit.

Those who have not struggled with obesity firsthand see it as a choice, and not a disease, plain and simple. Some argue that it allows overweight or obese patients to justify particular unhealthy lifestyle or dietary practices if obesity is now recognized as a disease. Some pooh-pooh the ruling as a matter of semantics that in the larger picture, changes little for the better in the struggle against the obesity epidemic. And some even propose that this will lead to the domino effect of having cheeseburgers, fries, and large sodas laden with labels warning that these foodstuffs are hazardous to your health, akin to those labels on cigarette cartons.

Data in plain sight on the Center for Disease Control’s website reports that 68.9% of Americans were overweight or obese in 2010. That is a deafening and dangerous number. Many argue that they are sick and tired of hearing about the obesity epidemic. Soon enough, however, we all just may be sick from the obesity epidemic. Though obesity does discriminate, with our nation’s ethnic minorities disproportionately suffering from obesity in higher proportions, the disease plagues all of us, whether we are obese or not. Healthcare expenditures, sick leave for comorbidities associated with being overweight or obese, and the like are ongoing issues that will not rectify themselves.

If a beloved, talented, and obese actor like James Gandolfini brings the terrible and beyond unfortunate consequences that accompany obesity to the forefront of people’s minds, we must recognize that now is the time to use all of our available resources to help combat this disease. And if the AMA’s voting in support of officially classifying obesity as a disease with the hope that such a ruling will propel the fight against obesity forward and work as a positive agent of change in doing so, so be it.

Sophie M. Balzora is a gastroenterologist and can be reached on Twitter @SophieBalzoraMD.

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  • Guest

    Before you use James Gandolfini as your poster child for your “LOOK OUT FAT PEOPLE — OBESITY KILLS!” campaign, might you care to provide us with some medical evidence that his heart attack was directly attributable to his weight?

    Or is correlation a good enough substitute for causation in today’s sensationalistic MedBlog world?

    • Sophie Balzora, MD

      It’s true – the intimate details of Mr. Gandolfini’s medical records are not public knowledge. But the medical literature we do have about obesity, particularly when distributed in midsection, and heart disease are certainly linked.

      Whether purposefully or without intent, public figures do bring attention to certain medical diseases. Though we cannot say that Mr. Gandolfini’s untimely death was directly or indirectly due in part from obesity, it serves to raise public awareness about the link between many heart diseases and obesity. It brings an important conversation to the table, be it with other family members potentially at risk, or between doctor and patient.

    • Dana

      “Never Let A Celebrity Death Go To Waste.” If it’s good enough for WHO Weekly, it’s good enough for KevinMD.

  • PollyPocket

    There are those of us who put very little stock into AMA proclamations. So this is unlikely to change the attitudes of a great many US physicians.

    Furthermore, obesity has long been codified by the ICD. So this opinion comes a little late if the goal is to somehow change reimbursement for a diagnosis of “overweight,” or “obese.”

    Attitudes will not change, treatment options will not change, and reimbursement will not change.

    But congrats to the AMA for trying to stay relevant!

    • Sara Stein MD

      Code 278.01 Morbid Obesity has NOT been reimbursable by any insurer even with the minor change in Medicare counseling provided by primary care.

      • DevonTexas

        Thank you for that!

  • Guest

    “The American Medical Association (AMA) has voted to formally recognize obesity as a disease.”

    Wow, isn’t the AMA on the cutting edge? How long has this “obesity” thing been a problem?

    /sarc/

  • Chiked

    Everyone is missing the REAL reason the AMA declared the obvious. It is so big Pharma can market a pill that has been “shown” to help people with this disease.

    These days, big pharma is in the business of looking for diseases then finding a pill that can help (not cure). You never want to cure a condition. There is more money is just helping it along.

    • DevonTexas

      Considering the benefits of “Big Pharma”? I agree that a cure for maladies is preferred but having a treatment in the meantime is also a benefit. For example, Type-2 Diabetes may have causes but, thanks to “big Pharma”, we have treatment for it. I really can’t think of any condition that “Big Pharma” is treating without benefit. Your claim that they are “looking for diseases then finding a pill that can help (not cure)” is unfounded.

      • Chiked

        Sure it is a benefit but like you said it is not a cure. Can you remember the last time big Pharma actually cured anything? I don’t. They don’t want to because there is more money in keeping the disease but providing benefits.

        Obesity can be CURED with a simple change in diet and exercise but I guarantee that big Pharma will find a pill that provides benefits.

        • DevonTexas

          Yes, obesity can be cured… in some cases… with diet and exercise. But if it was that simple, it wouldn’t be a problem, would it? There was a time that blood-letting cured the vapors, too. It was that simple. Let’s use the “obesity is a disease” model for a bit and see how that works. The “simple solution” of diet and exercise isn’t working. While we’re awaiting a cure for those who don’t respond using your simple solution, let’s try some other methods, okay?

          • Chiked

            The “obesity is a disease” model is what we have done with just about every problem and all we have gotten in return are lousy pills. You have high cholesterol, here is a pill. You have diabetes, here is another pill. The other day we tried to limit soda sizes and all of a sudden it became a political discussion on big government. The one group enjoying and fueling this charade is big pharma.

            Like I said before, big pharma is bereft of ideas. They can’t cure anything. They need the disease mentality to stay alive.

  • Dana

    “And the kids, the kids! They are the silent sufferers of this disease.”

    We Are All Victims Now. All Hail The Victim-Industrial Complex.

  • Dr. Pamela Peeke, MD

    There is another aspect of the AMA announcement that has been largely ignored: this May, the American Psychiatric Association published the the diagnostic handbook, the DSM-V, in which Binge Eating, a very loosely defined disorder, is now considered a separate eating disorder and can be billed as such.

    Is the AMA merely catching up? If insurers do as well, we may be able to cap the costs of obesity by treating it rather than its side affects (type 2 diabetes, hypertension, cholesterol, etc.). This will curtail not only the side affects as presented but those which have not yet manifested, saving the health industry millions of dollars.

    Also missing from the AMA panel were neuroscientists, who have shed startling light on obesity, finding that compulsive eating mimics the exact pathology of excess drinking or cocaine addiction.

    Substance abuse researchers say that the brain adaptions
    that result from regularly eating so-called hyperpalatable foods – foods that layer salt, fat, and sweet flavors, proven to increase consumption – are likely to be more difficult to change than those from cocaine or alcohol because they involve many more neural pathways. Almost 90 percent of the dopamine receptors in the reward center of the brain are activated in response to food cues.

    The evidence mounts higher every day that obesity involves, in many many incidents, addiction.

    We have to stop treating people like science fair projects
    when it comes to food and “dieting”. Science now shows through new tools like PET and MRI brain scans the addiction-related organic changes that take place in the reward system and the prefrontal cortex, which is involved in creating goals, cognition, personality expression, decision making (i.e., will power) and social behavior. This occurs across all additions, from drugs and alcohol to the newly
    discovered food addiction. This new pioneering research is also helping us to appreciate a holistic and integrative approach to addiction. I was first senior research fellow in the
    NIH Office of Complementary Medicine. Using food addiction as template, THE HUNGER FIX addiction plan integrates personal empowerment, spirituality, along with whole food nutrition and restorative physical activity. Shame, blame and guilt must be neutralized with compassion, empathy and then the tools of self-empowerment must be taught and implemented.

    • Dorothygreen

      This is the best comment I have read in going through a number of comments on this issue here and elsewhere. I would like to add a couple of points.

      Cigarette smoking was never considered a disease but rather the highest RISK factor for chronic preventable diseases. The tobacco model – the tax, decreasing tobacco subsidies, messages on cigarette packages and massive education reduced our smoking rate from more than 60% of the adult population to about 18% as well as a reduction in health care costs of those diseases and related health problems attributable to smoking.. It doesn’t take much of a physician’s time to say “you need to quit smoking” and show a picture of good lungs compared to diseased lungs. Nor, should it take much of a physican’s to say ” you are at a high risk of your arteries, heart, brain, joints becoming irrevesibly damaged if you continue to current high calorie, poor nutrient diet and don’t exercise. The bulk of education will be done as a public health issue as was smoking – lots of programs, assistance with places to exercise – no tax on exercise shoes, basic bicycles, helmets. etc – ads etc,

      The binge eating is not of “food” but rather the high amounts of sugar (refined grains include), unnatural fats (corn fed animals included) and excess sodium. Folks have to be educated about inflammation, glycation and oxidation. Folks need to know that bulk of our health care costs are for chronic preventable diseases. That everyone’s income tax health insurance premium’s are being used to pay for these diseases.

      So, it is the tobacco model (change to RISK model to give it an appropriate name) that is needed. There must be some Dr. Koop like physicians who would support this and push it as critical to not only save lives but to truly reform health care.

      Preliminary calculations show that a RISK tax at $.003/ Gram of sugar and unnatural fats (trans, vegetable oils with high amounts of Omega 6, corn fed animal fats, and $.003/100 mg added sodium would provide at least $100 billion/annum for public health education, policy changes to make vegetables and low glycemic fruits cost less and be more accessible than donuts, pastries, cookies, chips, soda, ice cream etc, 2) to offset middle income tax payer premiums and contributions to to health care (over 50% of all costs are for chronic preventable diseases. 3) to change the farm bill from a profit bill to “healthy affordable and accessible food for all” bill.

  • hostess

    Let’s not forget that at one time, despite its psychosocial and medical implications, alcoholism too was once viewed as just a behavioral problem, and not a disease. Obesity is a complex issue, and calling it a disease is one of many ways it will be viewed as a legitimate condition that requires the attention it deserves.

  • LBENT

    Ridiculous. It’s an addiction like tobacco brought to us by the food industry. Eat less and exercise. My housekeeper at age 71 lost 100 pounds by doing just that. No surgery, no pills, just changed the way she ate and behaved.

  • querywoman

    Homosexuality was once viewed as a disease.

  • Sophie Balzora, MD

    In classifying obesity as a disease, the hope is that there will also be a greater emphasis on prevention, especially during childhood. Also, this may lead to big changes in medical education curricula. The CDC estimates that by 2030, over 40% of Americans will be obese. Medical schools will be more apt to incorporate topics like nutrition, the complicated short- and long-term consequences of obesity on the body, and how to manage a disease from which so many patients will be suffering.

  • DevonTexas

    To answer the question, “What is the implication…?” The Health Insurance Companies will have to pay for treatment. Thus far, they have hid their heads in the sand about reimbursement for treatment of obesity (many refusing to pay for bariatric surgery, for example) and, instead, have had to pay for the associated conditions that arise from it. My funniest recollection was the insurance company paying to treat back pain that was caused by an increasing expanding belly. They will pay for a pacemaker due to heart disease but not for the obesity that led to the condition. It’s time to address the disease of obesity and save the long-term costs!

  • Suzi Q 38

    I liked my PCP’s solution to getting me to lose weight.
    After a decade of “Please watch your weight or lose some by the next visit, Mrs. L.,” He threw the lab report and my medical file down and said “YOU are WAAAY too FAT. You are going to get diabetes. You DON”T want this disease…” He looked like he was really frustrated. He was angry and sweating. In the 10 years that I have had him as my PCP, I had never seen him like this before.

    I started exercising ( a bit too much) and being careful with what I ate.
    Within a year, I lost 40 pounds. My a1c is lower, my cholesterol is pretty much the same, I no longer need my inhaler, and my BP is 20 points lower.

    I am doing better. Unfortunately, after my surgery I couldn’t exercise, which left more time to be depressed and eat more.
    I regained 8 pounds, and have recently lost 3-4 again.

    I am fighting back, but it isn’t easy. It is a daily struggle for me.

    • Sophie Balzora, MD

      Suzi Q – Thanks for sharing your story! I’m sure it will resonate with many. Getting healthy by losing the excess weight can be quite difficult, and keeping it off is even more challenging. It’s not just about willpower and discipline – the physiology of the body changes dramatically in the setting of obesity, which is in large part the reason why keeping off lost weight can be quite a struggle for patients. Knowing more about the disease and preventing it is essential.

      • Suzi Q 38

        You are welcome.
        I hate reading that losing weight is impossible or “an addiction” that can’t be beat.

        I agree, eating good food is so pleasant.
        Last night I ate a Costco “prime” ribeye steak.
        Our son ate one that was about 16 oz. My steak was 3 oz.
        He ate a baked potato with it, and I ate a small kale and cabbage salad. He is only 27, and at 6’4″ and 150 pounds, he can afford the calories, LOL.

        If need be, I can control my weight with just limiting my food choices. For me and many others, 80% of weight loss is what we choose to eat and drink. Yes, drink.
        I don’t put a moral judgement on drinking, but it is costly and has a substantial amount of calories.
        Beer, wine, mixed alcoholic drinks, lemonade, and sodas all have extra calories. I would rather eat food.

        The other 20% is activity and exercise. My heavy friends think that their bones can not take the exercise and that is why they are fat. Yes and no. The main reason is that they eat way too much and don’t do anything with their spare time.
        They sit home and watch TV or a movie or are on the internet, alone. They get bored and hungry and start eating again.

        I have a set of neighbors that will walk with me. all I have to do is text one. If one can’t go, another one will. This takes a little effort.

  • querywoman

    I only take the AMA seriously when it tries to protect its member income.

  • Nikki

    Actually, labeling obesity a disease stirs up a need for evaluation of causes. Much like tobacco, there is a personal component, but also a corporate component. Obesity has root causes in environment, personal responsibility as well as our food sources, i.e. antibiotics, growth hormones, poor nutrition of animals and live stock. This is especially important for obese children, who are not responsible for food decisions, but also for access to food. Better food standards, organic and sustainable food, not just an option.

  • Lisa

    I hope classifying obesity as a disease is helpful. This issue is so complex. As an obese female, I resent the over-simplification by doctors that the problem is easily resolved by better food choices and exercise. Well, duh. Personal responsibility is critical to resolving the problem, of course. But when I go to my doctors for help, my ailments are aligned to specialties and not looked at collectively–which is a part of the problem. I’ve successfully lost oodles of weight on my own, only to gain it back (& more) because I need help identifying and managing what the root cause is. Additionally, insurance won’t help pay for weight loss programs and they put obstacles in the path to being able to have surgery. If I were anorexic, no one would tell me to just go eat more and both insurance and my doctors would treat me immediately–no waiting periods, no hoops to jump through. We are biologically predispositioned to recognize obesity as out of step with nature, I get that. But I, personally, would really appreciate feeling like the medical community was a part of a team empowering my weight loss journey rather than the often judgmental attitudes, disappointed looks and obstacles I encounter. I know doctors are frustrated, too, as patients often want them to fix it, to give them a miracle pill or instant solution. Again, perhaps this new labeling obesity as a disease will help turn the tide so we can individually and collectively improve our health.

    • Sandra_Raup

      Lisa, Have you tried Overeaters Anonymous? I’m just curious – I spoke with someone who was advocating its use because it had worked for her, and I was wondering how many people have used it (successfully or unsuccessfully) or have even considered it. She made a compelling case that it could be helpful in some cases.

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