Three Steps for Dealing with Obesity

The endocrinologists have gotten religion about dealing with obesity as a chronic disease. In 2011, the American Association of Clinical Endocrinologists (AACE) adopted a position affirming that obesity is a complex, chronic disease. Ever since then, AACE has been showing up at every public forum that arises to affirm their support for addressing obesity as a health issue with every evidence-based method available.

This week, AACE and the American College of Endocrinology (ACE) sponsored a consensus conference to define a path for activating more healthcare resources to address obesity. The efforts culminated in a press conference yesterday in which AACE leadership presented three key findings: obesity is a chronic disease, it requires an integrated approach of medical management and preventive medicine, and we need compelling evidence for outcomes and the value of investing in obesity interventions.

All this ferment leads us to think that we have three steps in various stages of completion for successfully addressing obesity as the complex chronic disease that it is.

1. Accepting that it’s a problem. We’re well down the road on this part of the task. Few people with credibility on health issues deny that obesity is perhaps the greatest health challenge facing America for this century. The generally positive reception for First Lady Michelle Obama’s childhood obesity initiatives is evidence that the public broadly accepts this fact. The only resistance comes from people who mistakenly think that concern about obesity is some sort of attack on the normal diversity of body size. Given all the bias against people with obesity, this reaction is understandable. The solution is not to deny the health implications of obesity, but to work to make weight bias and shaming unacceptable.
    
2. Acknowledging that it’s a disease. Though we’re making progress on this front, the work is incomplete. Last summer’s resolution on the subject by the American Medical Association was a big help. But too many people — both health professionals and the general public — remain stuck on issues of body image, thinking of obesity is simply a condition of outward appearance and weight. Although Body Mass Index (BMI) is a good starting point, diagnosing obesity requires an assessment of metabolic health, physical function, and health-related quality of life.
    
3. Allocating resources to understand, treat, and prevent the disease. Resources for intensive research, effective treatment, and evidence-based prevention are very far from adequate. Policymakers who are naive about the complexity of obesity think we know enough to solve this problem, as if just exhorting people to eat less and move is all it will take. But we desperately need an adequate research investment to really understand the disease and equip us to find treatments that are truly effective. We need health plans that provide for evidence-based treatment of obesity. And we need to invest in prevention programs backed by evidence that they will really work, and not just make ourselves feel warm and fuzzy about the effort.

 
It’s great to see endocrinologists becoming vigorous advocates for dealing with obesity. The Obesity Society, the Obesity Action Coalition, the American Society for Metabolic and Bariatric Surgery, the Academy of Nutrition and Dietetics, and the American Society of Bariatric Physicians have been working on this for some time now — collaborating closely as the Obesity Care Continuum.

We have a lot of work to do.

Click here and here for more information on the AACE/ACE consensus conference and click here for a thoughtful essay on defining and targeting diseases.

Leaf Disease, photograph © Kathleen Franklin / flickr

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