Last week, the American Medical Association voted to classify obesity as a disease. In one day, 78 million American adults and 12 million American children were diagnosed with a medical condition that required treatment. The decision was controversial, to say the least.
We asked prevention consultants with specialties in alternative medicine, cardiology, diabetes, family medicine, fitness, nutrition, and women's health if they believe obesity is a disease, and here's what they said:
Tansneem Bhatia, MD, (also known as Dr. Taz), Medical Director and Founder of the Atlanta Center for Holistic and Integrative Medicine
Like alcoholism, depression and anxiety, obesity is a disease. There are clear medical patterns: hormonal imbalances, neurotransmitter deficiencies, and nutritional depletion that contribute to obesity. Many of my obese patients have underlying medical issues that need to be addressed.
I agree that there are behaviors that contribute to obesity, but these same behaviors are rooted in other biological factors. Stress, the standard American diet, and the industrialization of food have been responsible for the obesity epidemic. While all of these factors contribute to obesity, they also create critical biological imbalances that people either cannot overcome or lack the tools or knowledge to understand how to change.
Diet and exercise programs often fail simply because the underlying medical pathology has not been addressed. My approach is to perform a thorough evaluation of a patient, including family history, comprehensive hormone evaluation, nutritional status, and life inventory to understand where to begin treatment for this condition. There is no such thing as a quick weight loss for overweight people.
Osama Hamdy, MD, PhD, Medical Director, Obesity Clinical Program; Director, Inpatient Diabetes Management, Joslin Diabetes Center; and Assistant Professor of Medicine, Harvard Medical School
The obesity is an illness. But what can define it? Most of the definition is based on BMI, and BMI is really misleading. And using BMI to define obesity is a problem because someone like Arnold Schwarzenegger, for example, has a very high BMI and it's all muscle. Because the body mass index is calculated from height and weight. So it doesn't matter if the weight is muscle or fat. And at the same time there are people with a low body mass index who have a high percentage of body fat. Therefore, the true definition of obesity must be based on the amount of body fat in the body, or percentage of body fat. And we need to use another surrogate marker to define obesity as waistline, as intra-abdominal fat, as center visceral fat.
science is science. Obesity is definitely a problem. It's a disease. But now we have a wrong definition of obesity. That is the question. We have to define it much better.
David L. Katz, MD, MPH, Director, Center for Prevention Research; Associate Associate Professor of Public Health, Yale University School of Medicine
In a way, classifying obesity as a disease is a way of conferring legitimacy: it is a condition, not a weakness of the will; deserves medical attention; it is insurable. All this is positive.
But I never liked the idea of characterizing obesity as a disease, because disease occurs when the body doesn't work right. Converting excess calories into fat stores is not a malfunction; It's normal physiology. Calling obesity a disease implies that the body is not working properly, not the state of the body.
For example, we do not call drowning a disease. It is clearly a legitimate condition worthy of treatment and insurance coverage. But the fault lies with the situation, not with ourselves, in the sense that the human body is simply not adapted to spending a lot of time under water.
Obesity is the same. It is widespread in the modern world, not because of the changes in our bodies, but because of the changes in the modern world. The causes are all around us; we drown in them! We are drowning in excess calories and labor-saving technologies.
I prefer to categorize obesity as a form of drowning, in calories rather than water, because that would combine medical legitimacy with a proper focus on environmental causes. To assess the danger of calling it a disease, instead of focusing on fencing, lifeguards, and swimming lessons, consider trying to develop drugs to treat drowning.
Marianne J. Legato, MD, Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons
While reading the AMA news, I easily missed the announcement that obesity is now an official disease, because it's so hard to define what the term really means to a person, let alone figure out what causes and perpetuates it.
Obesity is a complex entity that can have many causes; Some are endocrine (eg, thyroid dysfunction or overactive adrenal glands due to Cushing's syndrome), but often the condition is caused by a combination of inactivity and overeating. For others, there are genetic factors that create a tendency to be overweight, even when they consume enough calories for most people.
There is, of course, an important emotional component to overeating; Patients often do this out of convenience, habit, boredom, or to combat anxiety. Some use obesity as a defense against rejection: "Just because I'm fat doesn't get me a promotion/I don't have a partner/I have few close friends." ingrained in his behavior. Many children receive inadequate food in very large portions.
Therefore, counseling patients about their weight becomes very complex, since identifying the causes of obesity and then helping patients manage lifestyle changes or correct diseases that may be causing their obesity is not easy for the practicing physician. Adding to the difficulties is that, believe it or not, family members make an investment to maintain the patient's excess weight: the husband, who worries about improving the appearance of his wife, for example. These family members can actually sabotage or neutralize the patient's efforts to control and correct weight. Society's perception of what height is acceptable could also be a factor - look at British TV - many of the actresses would be classified as obese by an American doctor!
It doesn't really matter how the AMA or any other organization characterizes “obesity” – clarifying the causes and tackling the incredibly complex task of moving a patient to a healthier and more functional state is not a trivial task. In short, it is a heterogeneous entity and often one of the most difficult to correct. Whether the causes are hormonal, genetic, or brain-based (your underlying reward system or circuitry, perceived portion sizes, food choices, etc.) they are often difficult to resolve.
Mary Jane Minkin, MD, Clinical Professor of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine
If healthcare professionals are compensated by the definition of a disease for the time they spend advising patients on proper diet, exercise, and healthy lifestyle habits, then I am all for it; I'd rather see money spent on prevention than therapy for all the negative consequences.
However, I do not see obesity as a condition imposed by God (as e.g.Lupus– there is nothing you can do to avoid itLupus(if you can do it, unfortunately you will). But everyone can prevent obesity: if you eat right and exercise right, you won't become obese.
So I have a mixed opinion about it. And I don't really care about the semantics: I have always counseled my patients on proper diet and exercise, and will continue to do so, no matter what people call obesity; I want to prevent
Pam M. Peeke, MD, MPH, President, Peeke Performance Center for Healthy Living; Clinical Assistant Professor of Medicine, University of Maryland
In general, the AMA's decision to designate obesity as a disease is progressive. Of course, using a BMI-based system has its drawbacks, but the myriad of positive benefits for obese people of all ages far outweigh this problem.
Does obesity fit the strict definition of a disease? According to Mosby's Dictionary of Medicine, Nursing and Health Professions, a disease is: 1. a condition of abnormal vital functions affecting any structure, part or system of an organism; 2. A specific disease or disorder characterized by a recognizable set of signs and symptoms attributable to heredity, infection, diet, or environment. Answer? It fits.
As a physician who, like my medical colleagues, has had to resort to creative diagnostic coding to work with people in the field of weight management, I hope that now, with disease labeling, those people can have insurance for delay some of the costs associated with obesity. This is especially true for those who, according to the article and the research, do not yet have metabolic syndrome but are clearly obese and seek help.
In addition, it is important that the medical community, as well as the public and insurers, abandon their stereotypical notions of the obese and elevate the status of obesity above that of other diseases, along with respect for those who suffer from it. Ultimately, I hope this is a wake-up call to policy makers and public and private funders that certain comprehensive prevention and treatment resources are available to all consumers.
Andrew Weil, MD, Director, Arizona Center for Integrative Medicine, University of Arizona
I don't see obesity as a disease. It is a condition that may be associated with an increased risk of certain diseases. It is possible to be obese and healthy as long as you eat a balanced diet, exercise regularly, take care of other aspects of your lifestyle that affect health, and get proper medical care.
Wayne Westcott, PhD, Director of Fitness Research, Quincy College
According to Merriam Webster's College Dictionary (10th Edition), the disease is defined asa condition of the living body of an animal or plant, or any part thereof, that affects its normal functioning. According to this definition, obesity can be considered a disease to the extent that it interferes with the normal functioning of the organism. Of course, obesity is a prerequisite for diabetes, heart disease, lowBack pain, some types of cancer and a variety of other diseases/disorders.
On the other hand, with more than a third of the US population currently classified as obese, it is clear that there are many causes for excessive fat accumulation (for example, genetic problems, lack of exercise/physical activity , overeating, poor diet). choice, eating while watching television, etc.). Obesity is in many cases the result of a certain lifestyle, which is usually (at least in the short term) replaced by another lifestyle (eg).
Carey Rossi is Senior News Editor for Prevention and Prevention.com. you can follow her@CareyRossi.