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AMA: Obesity is a disease state
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The American Medical Association House of Delegates approved a resolution recognizing obesity as a disease state requiring treatment and prevention efforts. Obesity was previously recognized as a condition.
“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” AMA board member Patrice Harris, MD, said in a statement. “The AMA is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and type 2 diabetes, which are often linked to obesity.”
Obesity is defined as a BMI of 30 or higher. According to the American Heart Association, more than one-third of US adults and almost 17% of US children aged 2 to 19 years are obese. Obesity is the implicated cause of 111,900 to 365,000 deaths each year. Medical costs associated with adult obesity are estimated to range from $147 billion to nearly $210 billion annually.
Donna Arnett
The delegates’ resolution conflicts with a recent AMA Council on Science and Public Health report, citing the lack of “a single, clear, authoritative and widely accepted definition of disease” as one reason why it is difficult to determine conclusively whether obesity is a disease state. Further, the previous report stated, “a sensitive and clinically practical diagnostic indicator of obesity remains elusive” and that BMI, the current standard for defining obesity, has certain limitations.
The AHA issued a statement praising the AMA’s recognition of obesity as a disease, noting that the decision will generate further attention on obesity as an important risk factor for CVD, stroke and other conditions. “Even taking off a few pounds can provide you with cardiovascular benefits, so every step in the right direction is a step toward healthier living,” stated AHA president Donna Arnett, PhD.
Perspective
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Steven R. Smith, MD
I think there are three key points here. The first is that this has been a long time coming. A lot of other organizations have already made this statement and made it forcefully in the past. The second point is this will open the door for other events that will make it easier for endocrinologists to be reimbursed and supported when they treat their patients with obesity, diabetes, and other conditions that need weight management.
This is a nice first step in the right direction to get other organizations including the CMS and payers on board with the idea that obesity is a serious disease and needs to be treated seriously.
As we look to the horizon, I think this will be important for reimbursement, for making sure that we can treat obesity seriously and that we have the ammunition behind us to do that.
I think endocrinologists in general have not jumped on the obesity management bandwagon for a lot of different reasons and reimbursement is a major one. This really sets the stage for driving that conversation forward.
The last point I’d like to make, which is really true for all of us as a society as much as it is for physicians in this specific case, is that it gives clinicians permission to say that it is not a lifestyle choice, that it is not all about gluttony and slothfulness. That’s a real mindset I think we still have a big challenge to overcome. We often believe, and I think erroneously so, is the things that are good for prevention are going to be good for treatment. For example, in prevention we know healthy lifestyles, diet, and physical activity are all key components of prevention. They’re certainly a foundation for treatment but the things that work for prevention don’t always work for treatment and I think that’s an important consideration in why this is so important.
Calling obesity a disease, which I believe is the right thing to call it, allows us to use more of a medical model and less of a prevention model.
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W. Timothy Garvey, MD
I was a co-author on a position statement that was published by the American Association of Clinical Endocrinologists (AACE) last year, designating obesity as a disease.
As you can imagine, I’m very much in favor of this designation. Obviously, obesity is a disease with genetic behavioral and environmental determinants like any other chronic disease (i.e. diabetes, hypertension, and asthma). I really think this designation is going to accelerate the changes in societal attitudes already in progress, in that obesity is less viewed incorrectly as a lifestyle choice and more correctly as a disease. This will also help set health policies and health care coverage for obesity medical care. Overall, I think this is very positive.
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