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AMA: Obesity is a disease state
The American Medical Association House of Delegates recently approved a resolution recognizing obesity as a disease state requiring treatment and prevention efforts, according to a press release.
A number of organizations and medical societies, including the American Association of Clinical Endocrinologists, sponsored the resolution and now applaud the AMA’s decision. Other advocates include The Endocrine Society, the American College of Cardiology, the American College of Surgeons, the American Urological Association and the Texas State Delegation, among others.
“A paradigm shift is needed to reverse the course of this epidemic that now afflicts more than 60 million Americans,” Jeffrey I. Mechanick, MD, president of AACE, said in the release. “The action by the AMA House of Delegates represents a major step in addressing obesity head-on and helping patients to get appropriate interventions and treatment they need.”
Obesity is defined as a BMI of 30 or higher. According to a statement from the American Heart Association, more than one-third of US adults and almost 17% of US children aged 2 to 19 years are obese. Overweight and obesity increases the risk for many health conditions and disease, such as breast cancer, coronary heart disease, type 2 diabetes, gall bladder disease, hypertension and stroke. Medical costs associated with adult obesity are estimated to range from $147 billion to nearly $210 billion per year. Further, obesity is the estimated cause of 111,909 to 365,000 deaths each year.
In its statement, AACE said mounting scientific evidence indicates that obesity is a disease that must be addressed using a medical model for treatment and prevention that includes lifestyle modifications, medications and surgery together with interventions targeted to public education, behavioral change and the built environment.
The AHA also issued a statement praising the AMA’s decision to approve the resolution, noting that it will bring attention to obesity as an important risk factor for heart disease and stroke.
Donna Arnett
“Obesity is mainly caused by taking in more calories than are used up in physical activity and daily life, but other factors may also contribute to obesity including genetics, limited access to healthy foods or unsafe environment for physical activity,” Donna Arnett, PhD, president of the American Heart Association, said in the statement. “When people eat too many calories, or too much saturated fat, trans fat and cholesterol, their blood cholesterol levels often rise. But 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.”
The resolution conflicts with a report recently released by the AMA. In the report, the association cited a 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 report states, “a sensitive and clinically practical diagnostic indicator of obesity remains elusive,” noting that BMI, the current standard for defining obesity, has certain limitations.
Perspective
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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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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.