Treating the obesity problem

July 10, 2013 

Is obesity a disease? The American Medical Association thinks so.

The AMA voted June 18 to declare obesity a disease, a move that now defines 78 million American adults and 12 million children as having a medical condition requiring treatment. Past AMA documents have called obesity an “urgent chronic condition,” a “major health concern” and a “complex disorder,” but stopped short of labeling it a disease.

This effectively makes diagnosis and treatment of obesity a physician’s professional obligation. Primary doctors had been free to discuss weight with patients before — or ignore the issue as they saw fit — but now they are professionally compelled to offer treatment to those with body mass indexes, or BMIs, that are 30 or more, the threshold for obesity.

In the past, obesity has been regarded as the result of a lack of willpower. When people eat too much — especially too much of the wrong foods — they get fat.

Researchers and nutritionists now are learning that maintaining a healthy weight is not entirely a matter of willpower.

A variety of factors, including genetic makeup and how different people’s bodies respond to various foods, can have a significant influence on who becomes obese and who doesn’t.

That has prompted research into which diets are the most effective at reducing weight. It also has generated more interest in developing safe diet pills and in the use of surgery such as bariatric stomach reductions as a remedy.

New Jersey Gov. Chris Christie, who has been chronically overweight for much of his adult life, recently underwent bariatric surgery.

Obesity clearly is a problem, perhaps even a national epidemic. It has been linked to other related diseases, including cardiovascular disease, type 2 diabetes and certain cancers.

But officially labeling obesity a disease could have far-reaching ramifications. Pressure will mount for public and private insurers to expand coverage of obesity treatments.

That could be a boon for physicians. Some bariatric surgeries can cost up to $40,000.

At a time when the nation is seeking ways to reduce medical costs, obesity treatments could significantly increase them.

At the same time, however, obesity-related conditions already are a significant factor in raising overall medical costs. According to the Centers for Disease Control and Prevention, obesity drives up the nation’s medical bills by more than $150 billion a year, and projected increases in the obesity rate could boost that figure by an additional $550 billion during the next 20 years.

Yet the spiraling obesity rate is a relatively recent problem. For much of human history, obesity was far less prevalent.

If the causes of the spike in obesity rates are largely environmental — sugary drinks, eating on the run, too little exercise — perhaps the problem can be curbed by behavioral modification rather than direct medical intervention.

Nonetheless, with the AMA’s declaration that obesity is a disease, doctors are sure to become more involved in the issue of their patients’ weight than they were before.

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