Tuesday, June 18 was a very big day for those of us toiling in the world of obesity. On this day, the American Medical Association (AMA) voted to officially recognized obesity as a disease. Other medical associations had already done so including the American Association of Clinical Endocrinologists and the American College of Cardiology. The announcement was quickly endorsed and praised by the American Heart Association.
The AMA called obesity a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like Type 2 diabetes and cardiovascular disease. It also stated that obesity as a disease “requiring a range of medical interventions to advance obesity treatment and prevention.” Previously, the AMA had referred to obesity as an “urgent chronic condition,” a “major health concern” and a “complex disorder.”
Okay. So what does all this mean?
At the most basic level, the AMA is suggesting that 78 million Americans with a BMI over 30 have a disease state that requires treatment. That’s about three times as many people who are classified as diabetic. This would have included yours truly in 1999 right before he joined Weight Watchers.
The question on whether obesity is a disease is not a new debate, and considerable blood has been shed on the battlefield of those who have been duking it out on this issue. Interestingly, in voting for the resolution to classify obesity as a disease, the AMA members were voting against the recommendation of their own expert panel that had been evaluating this question over the past year.
It feels like a pretty complicated topic all the way around. For starters, most of us think of a disease the same way we think of the flu or a cold. However, more and more, the diseases that have the biggest impact on us are of the chronic variety including cancer, heart disease, pulmonary, diabetes, etc. Obesity in turn significantly raises risk for most of the aforementioned chronic diseases, particularly diabetes and heart disease. So does that make it a disease? Honestly, I have no idea and will happily leave the finer details of this debate to the clinicians and health experts that are much more heavily steeped in these designations than little old me.
The question I find more interesting is whether this new designation is (or can be) a good thing. I see the answer to this on three levels:
1) The healthcare level
We have seen from our own research at Weight Watchers that the urging of a doctor to address weight can have a profound impact on how seriously we take the issue. I have met countless members who have shared that it was their doctor that gave them the final push to get started on the road to changing their habits and lifestyle. I happen to be one of those members.
Unfortunately, many doctors don’t have this conversation with their patients, and if they do, it may be merely a passing comment. Worse, one study from Johns Hopkins indicated that doctors were 35% less likely to have an emotional rapport with their overweight patients. For many physicians, the conversation about weight with a patient can be at best uncomfortable. In some cases, they may worry that nagging a patient may cause the patient to seek care elsewhere. In other cases, the doctor may shy away for fear of coming across as judging how someone looks.
So, by far, the biggest benefit I see coming out of the AMA pronouncement is having more doctors having constructive conversations with their patients about obesity.
The second, likely longer-term benefit coming from announcements such as this will be greater support by health insurance companies to provide coverage for clinically proven treatments for obesity. For many/most of us, losing weight on our own has been a losing proposition (pardon the pun): it’s hard to just “lose the weight” and to simply “cut back”. For many of us, we need the help from proven treatments and help. Yes, I’m horribly biased here in that I see Weight Watchers as a leader in this area with roughly 85 publications over the past 15 years. Programs and support systems that have stood the test of time and have a track record for clinically demonstrated results should be covered under health plans just as hypertension medicine is covered under our health plans. If the healthcare industry starts seeing obesity as a disease, it would be odd for them not to consider covering the treatment of said disease state. It’s impossible for me to advocate for this without being self-serving, but I believe in it passionately nonetheless.
In general, I’m a big believer that the healthcare system has a strong role to play in addressing conditions such as obesity. We need to shift our health system from sick care to health care by helping to people avoid becoming diabetic rather than to kick into gear once it’s too late.
2) The human level
So, if you have a BMI greater than 30, you are now considered not only “obese” but also suffering from a “disease.” Have a nice day!
First things first… I’m not a fan of the word “obese”, particularly when applied to me. It’s hard to argue that it has any connotation that isn’t pretty harsh/negative. It conjures media images of exposed bellies underneath shirts. It’s symbolic of “what’s wrong with America” and all sorts of other states of judgmentalism. I frankly cannot think of a better word, but this one seems pretty bleak. That said, when the healthcare world talks about obesity, they are referencing it as it relates to health risk factors, not body image. That doesn’t make the medicine taste any better, but at least we can understand the intent.
Secondly, let’s just state right away that having a BMI greater than 30 does not mean you are currently sick. By the way, having a BMI less than 25 does not mean you are necessarily fit either. That said, there are very clear statistics that your RISK for related diseases (comorbidities) become greatly elevated once BMI travels north of 30. If you are also pre-diabetic (ask your doctor), have high cholesterol or high blood pressure, the risks are that much more clear. So, if you are not pre-diabetic, you’ve got the heart of a lion and low blood pressure, are you “sick” or “diseased” because your BMI is greater than 30? Your risk for becoming sick is still higher even if you are not currently symptomatic other than by weight. It’s one of the tricky parts of obesity: the diseases it causes often come later in life. Nonetheless, the word “disease” carries a lot of connotations, most of them not pleasant.
I wonder what my reaction would have been when I got my physical in 1999 were my doctor to have told me that I had obesity, which was a disease. Honestly, I don’t know. My guess is that my first reaction would have been to be pretty depressed and maybe a little freaked out. I hate being sick. That said, I also can’t rule out that I might have had an even greater sense of urgency to deal with it. I also think my doctor would have been that much more forceful in how she delivered the message.
3) The broader conversation level
It goes without saying that there is a tendency (understatement) to feel pretty badly about ourselves when we are told we are obese. Is there a way to turn this entire conversation on its head? What if we simply saw our weight problem as a health condition that requires treatment lest we get sick or get more sick? What if there was a way to have the obesity condition leave the world of body image, self-flagellation and bad feelings once at for all?
Ironically, just before this came out, I wrote a piece for the Huffington Post that tries to get at this very point.
Call me a ridiculous idealist, but I see the possibility for a better way and a much more empowered and constructive conversation with this new announcement by the AMA.