Now it’s a disease? Hmmm…

June 24, 2013 — 34 Comments

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.”

I was also trained as an engineer.  Double disease states it seems...

I was also trained as an engineer. Double disease states it seems…

 

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.

http://www.huffingtonpost.com/david-kirchhoff/health-as-a-measure-of-success_b_3398673.html

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.

Thoughts?

34 responses to Now it’s a disease? Hmmm…

  1. 

    I guess the scary thing about obesity being labelled as disease is people may feel that medical intervention such as surgery or medication is the solution, which we know it is not. It would be great if Doctors could convey the information to the patient with empathy and understanding empowering the patient to seek help (such as Weight Watchers) to learn how to live a healthier lifestyle over TIME. Give them the support they need as they move along.

    • 

      Agreed, and that is already out there. Some (SOME, not all) bariatric [and isn't it amusing that the spellchecker/thesaurus wants me to use the word "barbaric" in place of "bariatric"] surgeons tout stomach bypass or lap-band surgeries as the “only cure for diabetes.”

      There’s a danger with medicalizing things. And many people resent the medicalization of issues formerly considered personality traits. Look at how people react to emotional health issues and alcoholism. And….how do you feel when you see a morbidly obese person with a handicapped accesses parking tag — who buys pop and potato chips at the grocery store?

      On the other hand, calling it a “disease” may be what allows someone to address it — it’s no longer a personal failing, or a weakness. It’s a medical problem, and we are supposed to seek care for medical programs.

      As David points out, society’s view of obesity is grossly distorted. How big to you have to be to BE obese? Certainly, it was a shock for me to realize my BMI placed me squarely in the obese range — and I’m a health educator, so I should have known better. But I used that to talk to my students about image — I looked pretty normal. Yet I was clinically obese.

      We’ll have to wait and see what happens, but I suspect we can look at how society deals with alcoholism as a benchmark for what to expect.

    • 

      My thoughts exactly. :)

      • 

        All along my weight loss journey doctors have recommended I lose weight and weight watchers was mentioned by many of them. I do believe it is a disease and it does require a change in lifestyle, including psychological and medical assistance. Most of us were on some type of medication due to the obesity and the medical care is required to monitor our medications to the point where we may not be required to take them. The psychological assistance is needed because whether we realize it or not we have a mind set that has to change as our bodies change. It is all a process of a lifestyle change.

  2. 

    Interesting. As someone who was always overweight until Weight Watchers helped me achieve a healthy weight – and I have been at a healthy weight for 5.5 years now – one of my major “ah ha” moments was realizing that no matter how much I actually weigh, I will always have a weight problem that needs to be monitored. I will always need to track and watch and practice my routines. I draw a parallel to my husband, who is type 2 diabetic and will always need to monitor his sugar. Do I have a disease? I don’t know. But I have something – a disease, a condition, a syndrome – that I now have “in check”, thankfully. Thinking of it that way helps me accept this is a part of who I am and will always be.

  3. 
    Janet Rowland June 25, 2013 at 9:48 am

    Hmmm… is a good response and one I have as well. I enjoyed reading your article and this announcement is thought provoking for someone, like me, that now has a disease?! I’m 57 and weight has, like so many, always been an issue. I recently found a baby picture my mother sent my father who was in service that had written on the back,”do I look any fatter?” I guess we’ll just keep trudging along.

  4. 

    If this sparks doctors to have meaningful conversations with patients regarding weight and health, that would be great. In my case, my doctor just told be I needed to lose weight and gave me a web address. He never offered any real help for how to do it. He said he wouldn’t recommend me for bariatric surgery until I had lost some weight with another program. The fact that I didn’t want surgery and never asked for it, didn’t seem to matter. Needless to say I eventually ditched him although not without a whole bunch of suffering. I’m happy to said that over the last 2 years I’ve found real success after a lifetime of struggle. Hopefully this new designation will lead to legitimate medical counseling.

  5. 

    i am concerned about the new disease designation for obesity. yes, i agree that maybe it may encourage doctors to have a more considered conversation with their patients, but how does this designation help people understand that living with a healthy bmi requires a major lifestyle change? Very possibly a healthy bmi will require a societal change as we consider a healthy diet and healthy food. i have seen several members who have had major weight loss surgery who still struggle with day to day eating. some have gained major weight back after the surgery. unfortunately i believe that this new designation will only assist in more pharmaceutical and surgical interventions for people who are obese without changing more fundamental lifestyle and food issues.

  6. 

    From all of this, I do hope that the designation of disease makes doctors feel more comfortable approaching the subject of obesity with their patients. I have been at varying levels of obesity since childhood, and I have never had one doctor talk to me about my weight. I’m wondering if just one of them had confronted me about it in my early years, it may have changed the trajectory of my entire life. Maybe that person could have saved me some time and pointed me toward Weight Watchers before I found it myself at the age of 35. You are correct David: If nothing else, the AMA has started the conversation–and that’s the most important part.

  7. 

    I’m having trouble thinking of obesity as a disease – perhaps a syndrome as Dawn mentioned; a syndrome that requires constant monitoring. A disease connotes medical intervention & although the super obese may need psychiatric services, ALL obese persons must commit to major lifestyle revisions as Paula noted. Tearing apart our innards is NOT the answer. I feel MD’s can convey the seriousness of obesity w/o suggesting surgery & point their patients in a healthier direction towards WW along w/ counseling if needed.

  8. 

    We’re inclined as a culture, to compartmentalize – to put issues in boxes in order to better understand them. If Obesity is a Disease, then I can begin to understand it, I can give it general characteristics that more easily define it. It’s easier than having this “nebulous”, loosely defined term that is, what? a condition? a disease? a syndrome? as Dawn so aptly stated. Such a curious culture we have…

  9. 

    If obesity is a disease and it is caused by eating junk food, then shouldn’t the stores stop selling food that is making so many of us sick?

    • 

      Rachael, i think your point is really at the heart of much of this issue: Financial interests. the food that most of us are eating on a regular basis is making us sick and sicker. however the financial interests of big agriculture and big pharma are not told to stop making, selling, and advertizing addictive food that has empty calories, too much fat, too much salt, and too much sugar. instead we are lulled into thinking that being overweight is a matter of individual choice. individuals who attempt to legislate the amount of supersized sodas that can be served are ridiculed and maligned. and the disturbing statistics continue. take alook at the HBO mini series, The Weight of the Nation, for an alarming view of the state of our health and, a bigger issue, the state of our children’s health.

    • 

      that’s essentially what people like michael bloomberg and david kessler are advocating.

      • 

        I believe that our government needs to stay out of this. If we let them start on this, will they eventually make us buy certain things at the grocery store? Parents need to teach their children at a young age what is healthy and what is not. Then when they are teenagers they will have the knowledge to make good decisions and not super size their food. I was a single Mother with a daughter that learned good health habits, and has had a healthy bmi all of her 46 years. So just because I was not taught good health habits as a child (clean your plate & cookie if you hurt yourself),that was not the way she was raised.

  10. 

    I can only hope that more doctors will suggest weight watchers instead of surgery. It really bothers me to hear and see sevral advertisments for surgery as a weight loss!

  11. 

    Reblogged this on Larry Chalew's Blog and commented:
    “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”

  12. 

    Two things come to my mind after having several members mention this new designation of obesity as an disease. First, it MIGHT lead to more insurances helping pay for part or all of the treatment….it might not too…..however, it opens a little part of the door.

    Second, I have actually had two members use this as an “excuse” for their not following the plan…after all they are “sick and can’t help what they do!” Of course I discussed with them why they take medicine for a disease and if it were for a cure or put it under control, then following the plan can be what they need to handle obesity as a disease and control it. But, it will continue to be interesting to read what and how the reactions will be from the membership and the media.

    I applaud the quick reply by our president and am wondering how soon the news media will take this ruling and run with it, thus creating more questions in the meeting room or the line waiting to get weighed-in.
    Thanks for putting this in perspective for all of us!

  13. 

    I think Weight Watchers can use this to their advantage by giving us service providers literature that we can take to our own physicians promoting Weight Watchers to their patients by giving them some kind of incentive to get them through the door. :)

  14. 

    Well, here’s a NEED for printable receipts! With this ruling, a Weight Watchers membership should be allowed as a medical expense. That means that if you have a Flexible Spending Account, you could use that to pay for your membership. You need a RECEIPT to submit your claim though!

    This will help us getting and retaining members!

    • 
      Diary of an Aspiring Loser July 1, 2013 at 1:02 am

      Before Lifetime made my membership free I was able to be reimbursed from my FSA for WW meetings. All I had to do was get a note from my doctor’s office stating my doctor had recommended it, which she had.

  15. 

    Does weight watchers plan to use the word “disease” in either meeting room discussions or in printed collateral material? This can make for lengthy open-ended discussions that may stray from the lifestyle programs we teach our members.

  16. 
    Diary of an Aspiring Loser July 1, 2013 at 1:11 am

    I’ve been blogging about my weight loss (now maintenance) journey since I started over 6 years ago. I often tell people I crawled into my first WW meeting feeling hopeless, desperate and unmotivated. Anyway, http://diaryofanaspiringloser.blogspot.com if you want to know more about that.

    As I’m sure you know the American Heart Association came up with 7 criteria for ideal cardiovascular health. I’ve asked a number of friends to take a guess at what percentage of Americans meet all 7 criteria. They usually guess in the 10-25% range, some guess a bit lower, some higher. NONE guess that it’s below 1% as stated in HBO’s Weight of the Nation. Scary stuff and as a nation, we are in denial. Maybe this will help. I’m not sure I see obesity as a disease but I know when I was 95+ pounds overweight I wasn’t well.

    Also, a local public radio show, Forum with Michael Krasny, had an hour call in on this very topic a few weeks ago, thought you might find it as interesting as I have.
    http://www.kqed.org/a/forum/R201306250900

    • 
      Diary of an Aspiring Loser July 1, 2013 at 2:01 am

      I should add, the less than 1% was of middle aged Americans, not all Americans.

  17. 

    Thank you for the letter, there are many questions to be answered later by the AMA that obesity is a disease. As you said you went out to learn new habits so you could be healthier. Going to WW was your answer which has proven over the years to work as long as you keep your good habits as your lifestyle as our 360 program says.

  18. 

    Hum….could we get in trouble for practicing medicine without a licience….treating the disease obesity in our meetings, really!

    • 

      Why would someone who has struggled with weight all his/her life come to WW and endure the struggle of changing so much of what has been their former lifestyle when s/he can lose the weight by taking medication or having surgery for his/her disease?

      • 

        Morbidly obese people – those that are the sickest and have probably battled it their entire lives – go to WW because even if you take medicine or have surgery, that’s only a temporary fix. If you don’t change your lifestyle then you will just get fat again. As they say at my meeting, “Do what you’ve always done, get what you’ve always got” Furthermore, WW offers a hugh community to connect with others who have the same struggles. And, by teaching this as a lifestyle, not a diet, it takes the emphasis off of taking it off quickly, which is harmful and not lasting. I have over 100 pounds to lose. I am eligable for surgery. I have tried weightloss prescriptions. I am back at weight watchers because it is the only thing that actually changes me and makes me feel good.

      • 

        hi rachael and thanx abunch for your inspiring post. you are spot on with your reply to my post: motivation is the key. you are clearly very motivated and it is your vision of what you want for your life that will support you in being successful. i suggest that given the statistics on weight loss and weight maintenance people need to be very motivated to have a lifestyle change that actually results in long term weight loss and weight maintenance. i believe this is the reason for the national weight control registry project.

        ww360 is a program to establish habits that support people in automatically and habitually change their lifestyle that could very possibly result in weight loss and weight maintenance. but it takes alot of effort/change and since being overweight is not totally about the food we eat or the activity we do, sucess in weight loss may also require some more indepth personal work. many of us eat for emotional reasons that may be painful or difficult to face/change. the disease designation for obesity can release many of any responsibility for their condition and allow for a medicine to take the place of the lifestyle change. i have witnessed many diabetics take an insulin shot and then eat the piece of cake. how is that behavior helping them to be healthy?

  19. 

    I have two thoughts:

    Personally, I am concerned with the “disease” connotation. For an obese person who might not be motivated to change his or her lifestyle, the word “disease” may act as an excuse rather than an incentive. I remember when the AMA said alcoholism was a disease. That’s fine, but accepting the word “disease” needs to be seen as a beginning point; not an end point.

    But on the other hand, many healthcare practitioners including doctors and nurses are obese themselves, and therefore may skirt conversations with their patients about weight. So maybe labeling obesity as a disease will help practitioners talk about it from a striclty medical standpoint, which could be a good thing.

  20. 

    If obesity is really a disease, David’s statement seems so logical:

    “…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.”

    Ultimately though, each individual who takes control of her/his health learns skills and habits–and builds confidence–that are so important in defining quality of life. Sure, society as a whole benefits, but let’s look inside ourselves for the strength to learn and “grow” thinner and healthier.

  21. 

    I wouldn’t label this as a syndrome. A syndrome, by definition, is clinical symptoms that are recognizable by someone other than the patient. Multiple symptoms. For example, Down syndrome… Flat face, very friendly, spread eyes, intellectual disability, etc. I don’t believe obesity fits in this category because the only symptom is how someone looks and even then you can’t always be sure where someone lies on the BMI scale. I know this from personal experience being told that “there’s no way you are 196 lbs! You must be 140!”. It’s not always that easy to see.

  22. 

    This is great, but still leaves many folks, like me, who struggle to lose weight while burdened by other disabling disorders, no doubt worsened by obesity, floundering with little help because our disabilities have impoverished us.

    The cost of joining a program with a success record like Weight Watchers prevents us from getting the support we need to lose weight. Doing it alone just hasn’t worked for many of us.

    How about offering a free scholarship program for one deserving disabled person each month. It is a way for Weight Watchers to give back to the community.

    After all, according to Bloomberg Businessweek you personally have a compensation package worth $4,671,036/year, (http://investing.businessweek.com/research/stocks/people/person.asp?personId=8001817&ticker=WTW); and Weight Watchers had a reported profit of $48.8 million for its 1st Quarter in 2013.

    By contrast most obese disabled people living on Social Security Disability benefits only receive a monthly income of between $650 to $1,000/month. They have to pay for housing, food, transportation, insurance and out-of-pocket medical expenses on this. Do you think you could do that? AND still have anything left over to join and participate in a much needed program like Weight Watchers to help us lose weight?

    Poor people are actually more likely to be obese because they struggle to buy food and often make cheap choices high in calories and low in nutrition; and if they have to rely on food pantries (as most do) they are given mostly processed foods that are not only high in calories and low in nutrition, but contain tons of chemicals that probably contribute to their health problems that have disabled them in the first place.

    You could introduce a new charity program like this as part of an advertising campaign and hold a monthly essay competition for disabled people who want and need to lose weight and who cannot even dream of joining Weight Watchers because of our exceptionally low income.

    The essay subject could be about why they want to join Weight Watchers. Each month select one essay as the winner. The lucky person would be given a free membership of a duration that would allow them enough time to lose the weight they need to lose and learn how to start a lifetime change in their eating habits to continue the weight lose and/or maintain it.

    Weight Watchers can then feature before and after photos of these winners and/or allow them to be spoke persons for Weight Watchers success.

    Please care enough about us to include us in your program and help us regain our health….

  23. 

    Obesity is a chronic disease. Like any other chronic disease there are genetic, environmental, and behavioral factors that contribute to the problem. Like any other chronic disease it affects our health, our longevity, and our daily lives. Like any other chronic disease there are medications, procedures, and behavioral changes that can manage the problem and limit the complications of the disease. Like any other chronic disease the patient and healthcare provider need to balance the benefits and risks of treatment options, make a plan, monitor the effectiveness, and bill these visits and interventions to the insurance companies of the people who are lucky enough to have insurance.

    Does anyone remember when the government got involved in trying to reduce the number of smokers in this country? Public education beginning with our children in school was a great thing. I can remember going home and asking my parents to stop smoking. I can remember announcing that I would never smoke. I never did and none of my siblings ever did. I didn’t understand my parents’ addiction to nicotine until I was leaving work after a particularly difficult day at work. As I walked to the parking lot I didn’t see the person standing around the corner smoking and caught a lungful of his exhaled smoke. After years of secondhand smoke growing up, that whiff of cigarette smoke at a vulnerable time made me want to start smoking at the age of 45. For one moment, I felt such a sense of relief. I didn’t start smoking but I did realize what a powerful thing nicotine is.

    I also remember the shift in public thinking. Smoking became a disgusting habit rather than glamorous or social. Nicotine addiction became a treatable disease and it was discussed at annual physicals and sick visits. Did everyone stop smoking? Of course not but the numbers dropped in spite of the tobacco companies’ efforts to bring in as many new smokers as possible.

    It’s more than OK for the government to get involved in this public health issue. It’s one of the things they are there for. They can help make a difference.

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