Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Call obesity what it is: a disease

Albert Do, MD, MPH
Conditions
November 24, 2018
Share
Tweet
Share

In 2013, the American Medical Association (AMA) announced its decision to classify obesity as a disease, moving against the recommendation at the time of a group studying obesity. Yet there are still those who believe that obesity is not a disease but rather a “condition,” and this has downstream ramifications for health policy, health care provider reimbursement, and, ultimately, societal health and well-being. But this is incorrect — the common arguments against obesity as a disease are insufficient. Some may argue that if obesity were a disease:

1. “… it will lead to excessive focus on medications and surgery to treat obesity”: We have seen trends since the 1980s showing a gradual increase in obesity rates, and numerous societal factors have been known to contribute. Despite ongoing policy based in behavioral interventions, prevalence rates of obesity continue to increase. At this point, aggressive interventions are warranted. To this effect, a label of disease would imply a personal and societal responsibility to develop and provide treatment. A comparable disease is colon cancer, where dietary factors (low fiber, high red-meat diets) clearly
contribute to it
, but patients receive screening, surveillance tests, and surgery or chemoradiation therapy as needed. We simply to do not fault patients for developing cancer, yet do so for patients with obesity.

2. “… it will result in over a third of the United States population having a disease”: There are many complications of obesity across all body system, and many of those with excess weight likely already suffer some sort of issue related to adiposity. Additionally, other diseases are also markedly common in society. There is no question of their disease status, such as hypertension, dyslipidemia, diabetes, and heart disease, yet we still treat those diseases as such. Why not obesity?

3. “… obesity is only a risk factor for other diseases”: complications of obesity can be due to metabolic changes or from mechanical complications of excess adiposity. For someone with tibial bowing or knee osteoarthritis from excess weight, would one not desire to treat obesity to prevent these musculoskeletal complications from occurring, rather than waiting for these complications to manifest and then labeling those as diseases?

4. “… then it will adversely affect how doctors and society view patients with obesity”: There is robust data on the discrimination against individuals with obesity (weight bias/discrimination) in the context of health care and beyond. Some examples include one
study
finding that 24 percent of nurses were “repulsed” by persons with obesity, and other effects in hiring prejudice and wage disparities. People already discriminate against individuals with obesity, and so as a disease there will likely be little detriment and potentially positive effect as health care providers recognize that obesity is a disease to be treated. It is unfair to attribute obesity solely to individual behavior and vague concepts such as “willpower” when societal forces such as developments in food refinements and additives, corn subsidies and the rise of high-fructose corn syrup, food marketing, mass media and fast food also entice.

Obesity and excess adiposity, like other diseases, leads to shortened life expectancy, decreased quality-of-life and increased health care expenditures. Splitting hairs about whether obesity itself represents a disordered or dysfunctional organ system (i.e., disease) is missing the forest from the trees. If obesity is the root of numerous other diseases, then obesity treatment to prevent complications is the best approach, instead of waiting for more issues to develop before starting treatment. This represents a myopic and delayed approach to treating disease. Thus, irrespective of the semantics regarding the definition of disease, when obesity is classified as a disease, clinically meaningful and beneficial outcomes result:

1. Recognition of a problem. Societal acknowledgment that obesity is the result of both environmental and genetic contributors, rather than being simply the result of maladaptive choices related to excess nutrition is essential. Hormonal, metabolic, psychological, behavioral, historical and societal factors have contributed to the current obesity epidemic. It would emphasize that obesity is something that we as a population need to address, rather than placing ownership on the individual. In affixing the label of “disease” to obesity, it will be made unequivocally clear that it is something to be eliminated if at all possible. Besides the controversial concept of metabolically healthy obesity, a large majority of people with obesity already have some complication, or it is only a matter of time.

2. More treatment. Doctors will likely be less apt to ignore obesity if it were a disease. Thus, patients with obesity would be more likely to receive treatment during the course of their doctor’s visit. By calling it a “condition” or some other precursor to disease, physicians who are already time-pressured may provide brief anticipatory guidance but would otherwise not allocate significant time just to address obesity as a problem.

3. More reimbursement. If more doctors treat obesity, there needs to be a more concrete reimbursement system to incentivize the time spent on obesity-related care. Obesity as a disease will facilitate the development of appropriate diagnostic codes and payment mechanisms for frontline providers providing obesity care. With the need for anticipatory guidance, behavioral counseling, and lifestyle-based treatments, it can be hard for physicians to provide comprehensive care and as a result, patients are referred to ancillary providers who may be ill-equipped to treat obesity. Thus, applying a disease label will lead to further efforts to develop payment pipelines for physicians, leading to increased management of obesity in the clinic.

4. More research. The emotional valence of the disease label will spur legislators to promote measures to treat and prevent obesity. This would likely take the form of increased funding allocation towards the development of more behavioral, medical and surgical treatment modalities.

Obesity has reached pandemic proportions. We already classify obesity as a public health crisis, implicit in this designation are the harmful effects it has on our society. We have to treat it as it underlies so many other complications throughout our bodies. The least that we could do is to call obesity what it is: a disease.

Albert Do is a gastroenterologist.

Image credit: Shutterstock.com

ADVERTISEMENT

Prev

Medicine: noble profession or big business?

November 24, 2018 Kevin 14
…
Next

Don’t wait to take action on gun control

November 25, 2018 Kevin 27
…

Tagged as: Obesity, Primary Care

Post navigation

< Previous Post
Medicine: noble profession or big business?
Next Post >
Don’t wait to take action on gun control

ADVERTISEMENT

More by Albert Do, MD, MPH

  • How can we really stop obesity?

    Albert Do, MD, MPH

Related Posts

  • Health care workers should not be targets

    Lori E. Johnson
  • Who’s really to blame for the obesity epidemic?

    Peter Ubel, MD
  • Should only infectious disease specialists be allowed to prescribe antibiotics?

    Craig Bowron, MD
  • My first patient to be diagnosed with cancer

    Ton La, Jr., MD, JD
  • The culture of perfection in medicine is a disease

    Andy Cruz, MD
  • Why do we think obesity is caused by lack of exercise and not junk food?

    Martha Rosenberg

More in Conditions

  • Coconut oil’s role in Alzheimer’s and depression

    Marc Arginteanu, MD
  • Ancient health secrets for modern life

    Larry Kaskel, MD
  • How the internet broke the doctor-parent trust

    Wendy L. Hunter, MD
  • Mpox isn’t over: A silent epidemic is growing

    Melvin Sanicas, MD
  • How your family system secretly shapes your health

    Su Yeong Kim, PhD
  • The human case for preserving the nipple after mastectomy

    Thomas Amburn, MD
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

      Adwait Chafale | Meds
    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

      Adwait Chafale | Meds
    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Call obesity what it is: a disease
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...