More than half of obese patients have never been told by their doctors, or a medical professional, that they should lose weight. Last week, the board of the American Medical Association announced that obesity is, in fact, a disease in the hopes that it would inspire the medical community to bear arms and actively engage in combat. Whether or not we agree with "medicalizing" obesity, one thing is for certain: The AMA's decision is controversial.
We live in a culture where high-calorie, high-fat and high-cholesterol foods are readily available and affordable. Finding healthy options can be like a scavenger hunt and is not "light" on our pockets. But, similar to smoking, eating poorly is a choice, albeit one that is supported and made convenient by the culture we live in. However, by calling obesity a disease, we are telling the public that they are powerless to prevent or treat it by eating healthier and exercising. No one expects someone with breast cancer to have prevented their disease or treat it by altering their lifestyle choices.
Then there's the problem of how to diagnose the disease of obesity. A physician looks at signs and symptoms, performs a physical examination and orders laboratory and other studies as needed to make a disease diagnosis. Take Lyme disease, for example. Patients typically present with a characteristic rash as well as fever, headaches and fatigue. The diagnosis can also be confirmed with a blood test. Although obesity is an abnormal state that can affect the body, it lacks specific signs and symptoms, and there are no studies or labs that can confirm the diagnosis.
Being overweight is a risk factor for disease states such as diabetes, cardiovascular disease and osteoarthritis. However, there are a number of obese people who live healthy lives and do not suffer from these diseases. Similar to smoking, obesity can significantly increase the risk for certain diseases but does not guarantee it.
Although the AMA's announcement does not carry legal weight, it has the potential for affecting policy and having far-reaching consequences.
If obesity is considered a disease, insurance companies and employers may be required to cover pharmaceutical and surgical obesity treatments for their employees. A growing number of people will start swallowing pills to suppress their appetite or decrease absorption of calories and fat. Let us not forget what a gulp of bitter medicine Fen-Phen was in terms of heart and lung damage and lives it claimed.
Even if we do find a safer option, unless lifestyle changes are made, the moment we stop taking a pill, we will resume weight gain. This could lead to a lifetime of pill therapy. Additionally, more people will turn to surgery and its accompanying risks (including infection, bleeding, organ damage, pain and death) to prevent overeating when they could have made the decision to eat less and healthier.
Given the current trend in reining in health-care costs and the development of accountable care organizations, medical obesity treatments would overwhelm the system.
This could also divert money and resources away from patients with cancer or children with birth defects. Furthermore, the slippery-slope argument can be made when it comes to disability status and payments. Given that two out of three Americans are considered overweight, this has the potential to paralyze our workforce and drain funds from people with other disabilities.
Obesity is not a problem because it prevents someone from being Sports Illustrated swimsuit models. It is a problem because it has downstream consequences that can affect the quality of life and increase premature deaths.
The board of the AMA could have been more effective by calling for multifaceted changes, as has been done with smoking. Smoking ads are restricted near schools, and it is rare to see an actor or actress smoking on television or movies. Finding a public place to light up is also a challenge. Hefty taxes on cigarettes have made smoking cost-prohibitive, in particular for teenagers with limited means. And while the rate of smoking is not zero, it has continued to decrease with creative and persistent public-policy interventions. The rate of smoking is half of what it was in the 1960s.
But while the AMA's decision to call obesity a disease is controversial, we can all agree that obesity is a colossal problem, and it would be reasonable to call it a public-health crisis.
Dr. Nina Radcliff, of Galloway Township, is an anesthesiologist and a member of the American Medical Association.