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Obesity as a Disease: What Does the AMA Decision Mean?

On June 18, 2013, at the annual meeting of the American Medical Association, members voted to recognize obesity as a disease. The announcement has met with mixed reactions from those within the medical community and from those considered obese. Here are some of the things you should know about obesity and the AMA decision.

Council on Science and Public Health Against the Decision

The decision to declare obesity a disease was far from unanimous. The AMA’s own Council on Science and Public Health had advised against the move, stating that it was unlikely to improve health, and the means of determining obesity is inaccurate and inherently flawed. Others opposed to the decision argue that the rise in obesity is largely related to increased sugar intake and lower activity rates, which are lifestyle choices. (Critics argue this is equivalent to saying lung cancer is not a disease because it was based on the lifestyle choice of smoking tobacco.) On the other hand, American Association of Clinical Endocrinologists and the American Academy of Family Physicians support the new definition, arguing that obesity is a metabolic disease. Lexington dietitian, Jennifer Kraschnewski supports the decision saying, “I think obesity is a disease, because it’s something that is diagnosed and can also be treated or cured.”

Problems with Measuring Obesity

So how is obesity measured? The Body Mass Index (BMI) measures body fat based upon a person’s height and weight. Kraschnewski says, “BMI is a widely used diagnosis tool. Every dietitian I know uses BMI as indicator for categorizing body composition. However, there are downfalls of using BMI.” A BMI of 30 or higher categorizes you as obese. There are several problems with this. First, the BMI does not take into account muscle mass, ethnicity, or body structure. Thus, most professional athletes would be considered obese, simply because their muscle mass adds to their weight. Many at your local gym whom you aspire to look like are no doubt in the obese category because of this arbitrary measurement. Furthermore, BMI is no indicator of overall health. Being overweight or fat does not automatically mean you are unhealthy, just as having a “normal” BMI does not guarantee perfect health. So why is BMI used? According to Kraschnewski, “Until there’s an efficient and cheap way to use those body composition machines (DEXA and BOD POD for example), BMI is the best and quickest solution for now.”

Does the AMA Decision Have Any Real Power?

Since the AMA is not a legal body, the move to label obesity as a disease is mostly symbolic. However, the hope is that doing so will encourage insurance companies to increase their coverage of “treatments” such as lap band surgery and weight loss pills.

Therein lies the rub – many skeptics say that the announcement was motivated by money and heavily influenced by pharmaceutical companies (especially since two new diet drugs have recently been approved).

So Does It Really Change Anything?

Whether obesity is a disease or not – does it really change anything? Will it motivate some people to lose weight? Will it encourage doctors to help their patients? Jonathan Piercy, a Hazard-based professor of family medicine does not expect to see many changes: “People who think there’s nothing complicated about losing weight and that fat people are just lazy will roll their eyes and not change their opinion. People who do have a weight problem already understand. And there still isn’t much doctors can do about it, except for weight loss surgery in some cases and treating complications.” Louisville nurse Sarah Martin agrees: “It’s a label, plain and simple. There are so many negative connotations of obesity that it automatically shuts down the discussion.”

Whether we choose to consider obesity a disease or not, the truth is that America has a weight problem. Perhaps the best advice comes from Lexington resident and writer, Doris Settles. She says, “The reality is that Americans eat S.A.D. (standard American diet) with high gluten wheat content, grain-fed meat and cheese, and way too much sugar. Then because they feel bad they don’t move. There are real physical issues that cause obesity, but for many diet and exercise is the issue. Obesity as a “disease” is ludicrous. Let’s stop rationalizing our behavior and stand up to take responsibility for it.”

By Fiona Young-Brown

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