Should Obesity Be Classified As a Disease?

The American Medical Association now recognizes obesity as a disease.

Posted Jun 19, 2013

On June 18, 2013 the American Medical Association voted to recognize obesity as a disease. This decision means that 78 million American adults and 12 million children are now officially recognized by the largest association of physicians in America as having a medical condition that requires medical interventions for treatment and prevention. "Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately 1 in 3 Americans," said Dr. Patrice Harris, an AMA board member.

Until now the AMA has referred to obesity as an "urgent chronic condition," or a "major health concern" and a "complex disorder." "As things stand now, primary care physicians tend to look at obesity as a behavior problem," said Dr. Rexford Ahima of University of Pennsylvania's Institute for Diabetes, Obesity and Metabolism. "This will force primary care physicians to address it, even if we don't have a cure for it."

The AMA's decision makes the diagnosis and treatment of obesity a professional obligation for physicians. Studies have found that more than half of obese patients have never been told by a medical professional they need to lose weight. This could be a result of doctors not wanting to offend a patient combined with a reluctance to hemorrhage time and money by opening themselves to ongoing weight-loss consultations for which they may not be reimbursed.

Recognizing obesity as a disease is an attempt to reverse the epidemic rise of obesity in the past three decades. There is growing concern about the skyrocketing costs of treating the health problems associated with obesity.

Treatment of such obesity-related illnesses as cardiovascular disease, Type 2 diabetes and certain cancers costs more than $150 billion a year, according to the Centers for Disease Control and Prevention. Projected increases in the obesity rate could boost that figure by an additional $550 billion over the next 20 years, a recent Duke University study concluded. If obesity continues to grow, about 42% of Americans may end up obese by 2030, according to a projection from researchers with RTI International, a non-profit organization.

The Dual-Edged Sword of Calling Obesity a “Disease”

Classifying obesity as a disease is a dual-edged sword. The decision to classify “obesity-as-disease” could backfire. Some doctors worry that patients considered obese by various measures such as BMI (Body Mass Index) may “otherwise be fit and healthy” and not require aggressive weight loss treatment. BMI is a simple height-to-weight formula that doesn’t accurately represent percentages and distribution of body fat.

The delegates at the AMA rejected the conclusion of a special council and voted instead in favor of a resolution pushed by the American Association of Clinical Endocrinologists, the American College of Cardiology and some other organizations. This resolution argued that obesity was a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like Type 2 diabetes and cardiovascular disease. “The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes,” the resolution said.

One reason in favor of the new classification is that it could reduce the stigma of obesity that stems from the widespread perception that obesity is simply the result of eating too much or not exercising enough. Many medical professionals believe that people do not have full control over their weight. Supporters of the disease classification believe that obesity fits the medical criteria of a disease because it impairs body function. People arguing against the disease classification believe that obesity creates higher risk factors for other diseases but that obesity itself not a ‘disease.’

Drug companies are eager to make money providing pharmaceuticals for weight loss. The obesity-as-disease classification could subconsciously take the onus off individuals to make lifestyle changes to maintain a healthy weight. A number of obesity drugs have entered the market in the last year. “Medicalizing” obesity by declaring it a disease means that one-third of Americans are technically "ill," when in fact many may be perfectly healthy. Again, this could lead to more reliance on costly drugs and surgery rather than making an effort to make lifestyle changes.

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Will recognizing obesity as a disease based on BMI backfire?

Categorizing obesity as a disease based on BMI could lead to overtreatment by physicians. When BMI is above a certain benchmark people will be tossed into the ‘obesity bin’ and labeled as being "sick," even though they may be in perfect health. Being labeled as obese can lead to a host of psychological detriments including: body dysmporphia, lowered self-esteem, and rejection sensitivity.

The medical establishment commonly uses BMI to categorize obesity. The vote of the AMA House of Delegates went against the conclusions reached by association’s Council on Science and Public Health, which had studied the issue over the last year. The council concluded that obesity should not be considered a disease primarily because BMI is simplistic and flawed. That said, there is no denying that obesity is an epidemic. The statistics confirming the obesity epidemic are undeniable and alarming.

The current value settings for BMI are as follows: a BMI of 18.5 to 25 may indicate optimal weight; a BMI lower than 18.5 suggests the person is underweight while a number above 25 may indicate the person is overweight; a person may have a BMI below 18.5 due to disease; a number above 30 suggests the person is obese (over 40, morbidly obese).

“BMI is a very imperfect measure,” said Dr. Robert Gilchick, an AMA delegate who is also director of Child and Adolescent Health Program and Policy with the Los Angeles County Department of Public Health and chaired the AMA’s Council on Science and Public Health, which issued a 14-page report for the AMA delegates to consider.  

Many people with a BMI above the level that usually defines obesity are perfectly healthy while others below it can have dangerous levels of body fat and metabolic problems associated with obesity. “Given the existing limitations of BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes,” the council wrote.

Conclusion: Obesity Is a Complex Disorder

To some extent, the question of whether obesity is a disease or not is a semantic one since there isn’t even a definition of what constitutes a disease that is universally acknowledged. Also, the AMA doesn’t have any legal authority to influence insurers or policy makers. However, the nation’s largest physician group has clout and this categorization will undoubtedly focus more attention on obesity. Plus, the decision will probably make it easier to get reimbursement for obesity drugs, surgery, and counseling.

Morgan Downey, an advocate for obese people and publisher of the online Downey Obesity Report, concludes,” I think you will probably see from this physicians taking obesity more seriously, counseling their patients about it. Companies marketing the products will be able to take this to physicians and point to it and say, ‘Look, the mother ship has now recognized obesity as a disease.’ ”

“We understand obesity as a condition and a risk factor for other diseases,” said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, which includes the nation’s largest health plans, UnitedHealth Group, Aetna, Cigna, Humana and many Blue Cross plans. “The important thing is to get programs and supports in place to address it, as health plans have done and are doing,” Pisano added. "The most important aspect of the AMA decision is that the AMA is a respected representative of American medicine. Their opinion can influence policy makers who are in a position to do more to support interventions and research to prevent and treat obesity."

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