Early Morning Disagreement

Cheers and Jeers for the AMA Vote on Obesity

When the AMA vote on obesity overruled a report of their Council on Science and Public Health and declared that obesity is a disease, who would have guessed we would still be talking about it a week later? Reactions have ranged from cheers to jeers to shoulder shrugs.

“Take the stigma away so insurers will pay!” said Leslie Bonci, director of sports nutrition at the University of Pittsburgh Medical Center, in an article in the Pittsburgh Post-Gazette. But according to the same article, insurers are more cautious. They almost never cover behavioral interventions for obesity and very inconsistently cover prescription drugs or bariatric surgery.

“I think the standards are not going to change for right now,” said Dr. Carey Vinson, Vice President of Quality and Medical Performance Management at Highmark. That will take “conclusive medical research, gathered and disseminated over time.” Dr. Stephen Perkins, Senior Medical Director for UPMC Health Plan, agrees. The AMA decision “doesn’t automatically change our benefit structure.”

An editorial in Time was even more dour. While admitting that defining obesity as a disease is likely to reduce the stigma associated with it, the author of the piece was quick to point out that after alcoholism was labeled a disease in 1956, the amount of pessimism people with alcoholism felt about being able to overcome their condition actually increased. The author also argues that medicalizing alcoholism also led to a more extreme treatment regimen in which only total abstinence combined with professional help and/or treatment in an AA-type program would work, an event he’s afraid will happen with obesity, making people who could help themselves without intervention end up relying on more intensive — and expensive — treatments.

Martin Binks offers a thoughtful analysis of the situation, saying:

As a psychologist who has devoted his entire career to obesity treatment and research I am thrilled that obesity has finally begun to be legitimized by the AMA. I am hopeful it will lead to great things in our battle for improved public health. However, I am somewhat concerned by the overall impression in the media firestorm that we have somehow achieved a solution.

Public reaction, at least measured in online comments, seemed to be divided between those expressing relief — that the problem they or a loved one struggles with has finally gotten recognition in the medical world — and those upset with the AMA’s decision.

Someone who posted a comment as Meshell on the Time editorial, gave voice to the angry crowd: “Whatever happened to a person taking responsibility for the consequences of  his or her own actions, i.e., lifestyle? Whatever happened to an adult practicing some self control?”

Clearly, facts and reason are not going to get in the way. As Meshell says in his post sign-off, “Those are my thoughts, and I’m sticking to them, right, wrong, or indifferent.”

Thank goodness for the abundance of grace.

Click here to read the editorial in Time, click here to read the Post-Gazette article, and click here to read the analysis by Binks.

Early Morning Disagreement, photograph © Piers Nye / flickr

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