On June 18, 2013, the American Medical Association voted to classify obesity as a disease. They thought it was a good idea.
This decision was made against recommendations from a subcommittee that had evaluated the pros and cons.
The pros must’ve won out. After all, calling it a disease could open up all kinds of money available for anti-obesity treatments like medications and gastric bypass surgery. It may also increase the likelihood that an insurance company will actually pay for treatment of obesity. Although, with the insurance companies’ just-short-of-lemming-like action to move insureds to high deductible plans, this aspect may not really help anyone.
Not that the financial benefits of drug companies would have had anything to do with the decision of the AMA in this matter, nor would the AMA ever do anything for purely financial gains. Nope. All on the up and up.
So. Obesity is now classified as a disease. No real downside, right?
Well, there wouldn’t be one if the American public didn’t think like the American public. I remember quite a few years back when a patient of mine who was rather large decided to look into bariatric surgery. In order for insurance to cover the procedure, he had to go to the required “weight loss program” put on by the bariatric clinic prior to undergoing surgery. The overall gist of the “weight loss program” was that weight was genetic and there really isn’t anything you can do about it so bariatric surgery is your best option.
This is just what everyone wants to hear deep down inside. It’s a disease. There is something wrong with you that you need external help to control.
Just in case you think I’m being dramatic, I present this particular study. In it, researchers looked at the attitudes of a group of obese study participants’ attitudes following the labeling of obesity as a disease. Here’s what they found:
- Labeling obesity as a disease weakened the importance of health-focused dieting.
- Obesity as a disease reduced concerns about weight among obese individuals.
- With this reduced concern about weight there was a greater likelihood that participants would choose higher-calorie foods.
- The disease message lowered body-image dissatisfaction (possibly a good thing in the right context), but this attitude also led to higher-calorie food choices.
While on the surface it may seem like a good idea to reclassify obesity as a disease rather than a symptom or as a risk factor for other diseases, in reality it seems to remove the incentive for obese people to make the right decisions. Worse, they seem to be more comfortable in their current weight instead of focusing on making changes.
None of this is saying that obesity is not a challenging situation and that there are not ideal candidates for bariatric surgery. However, we need to understand that getting back to an ideal body weight is a very long term process. I just saw a patient this evening who is 7 pounds away from her 100 pound weight loss goal. This process has taken almost 3 years and she sounded a little disappointed by how long it has taken.
Holy cow! Even if it took her 10 years to lose 100 pounds it is a move in the right direction. Most would not have the patience to wait 3 years for the outcome. I think it is fantastic and illustrates wonderfully the dedication it takes to turn health around.
The biggest challenge is getting started.