Should Obesity Be Defined as a Disease? The AMA Thinks So

Some doctors are asking if the controversial designation will help the problem.

Is obesity a disease? Even if someone is overweight with no health problems? (Photo: Matt Cardy/Getty Images)

Jun 27, 2013· 2 MIN READ
Clare Leschin-Hoar's stories on seafood and food politics have appeared in Scientific American, Eating Well and elsewhere.

Will classifying obesity as an official disease do anything to impact American’s weight problem? The American Medical Association thinks so, and on Tuesday voted in favor of recognizing obesity as a disease that requires medical treatment.

The move, according to the Los Angeles Times, “makes diagnosis and treatment of obesity a physician’s professional obligation.” Something the newspaper says doesn’t currently happen. “Studies have found that more than half of obese patients have never been told by a medical professional they need to lose weight—a result not only of some doctors’ reluctance to offend but of their unwillingness to open a lengthy consultation for which they might not be reimbursed.”

Declaring obesity a disease is controversial, in part, because it went against recommendations of the AMA’s own Council on Science and Public Health, which issued the report cited by the Times. The council’s reluctance stems over increasing the stigma associated with obesity, and concerns that it will push patients towards surgical treatment or expensive pharmaceuticals.

“The council, which wrote the report and heard debate on the obesity-as-disease recommendation, opposed the resolution and urged the AMA against endorsing obesity as a disease,” writes Bruce Jaspen for Forbes.

So why did physician members vote to define obesity as a disease? In part, because they believe the endorsement will put pressure on insurance companies to cover the diagnosis and reimburse them for treating obese patients. That treatment, they say, could eventually lead to better outcomes. But not everyone agrees.

Dr. Robert Lustig, professor of clinical pediatrics at the University of California, San Francisco, tells TakePart that for many reasons, the disease designation is not the solution.

“The AMA is late to the party. In 2004 Health and Human Services declared obesity a disease and it didn’t change anything,” he says. “It’s not one problem, it’s many diseases. The reason for Cushing’s syndrome obesity is not the same for Down syndrome obesity, or muscular dystrophy obesity, or for 60 other different obesity diagnoses. The [disease] designation puts doctors on the hook. The only thing they have to tell patients is to eat less, exercise more, which doesn’t work.”

He’s got a point. Obesity rates have been growing for years. In the U.S., over 78 million adults and 12 million children are considered obese, and by 2030, more than half (!) of us could meet the criteria. (That criteria, by the way, is a body-mass index of 30.)

And reaching that point doesn’t necessarily mean someone will be doomed with type 2 diabetes or heart disease.

“For the 20 percent of obese people who are completely metabolically normal and don’t cost the taxpayer anything, do they have a disease?” asks Lustig. “They didn’t before, but they do now. And at the same time, 40 percent of the normal weight population have the same diseases.”

Abigail Saguy, author of What’s Wrong With Fat? writes in Time, “Obesity is a poor predictor of health. Some hope that designating obesity as a disease will remove the stigma associated with it, and obese people will no longer be blamed for their condition. Yet already it is being called the “fork to mouth” disease, and the disease categorization may reinforce blame by raising the stakes.”

Lustig agrees physicians should be reimbursed for treating obesity, and says that under Obamacare, that reimbursement is likely coming anyways.

“I believe obesity is a major public health crisis. It needs to be tackled, but the AMA calling it a disease doesn’t remotely move that ball forward,” he says.