Six Obstacles to Dealing with Obesity as a Disease
We are approaching the third anniversary of the American Medical Association finally recognizing that obesity is a complex, chronic disease. Some progress has come in addressing the disease, but it is frustratingly slow. Why?
Scott Kahan and Tracy Zvenyach have published a thoughtful new commentary in Current Obesity Reports and they identify six factors that are slowing the acceptance of obesity as a disease.
- Ambiguity. A close examination of how diseases are defined reveals some wiggle room in whether a condition is regarded as a disease. Randolph Nesse explained in a 2001 essay. He said, “Our social definition of disease will remain contentious, however, because values vary, and because the label ‘disease’ changes judgments about the moral status of people with various conditions, and their rights to medical and social resources.”
- Choice. Bias and misunderstanding of obesity lead some people to regard obesity as a matter of choice that can be reversed by choice.
- Undeserving Patients. Some arguments against regarding obesity as a disease requiring medical care are founded upon misguided thinking that people with obesity do not deserve medical care.
- Medicalization. A more academic form of resistance to providing medical care for obesity is the notion that medicalizing obesity will simply be an inefficient way to deal with a problem that some regard as preventable.
- Treatment Futility. Successful obesity treatment provides important improvements to health and quality of life, even with relatively modest weight loss that can be maintained. But some physicians and patients regard modest weight loss as disappointing and thus regard treatment as futile.
- Costs. Because obesity is so prevalent in the population, some people reject the notion of dealing with obesity as a disease because they assume it will be costly. However, the costs of obesity and its complications are already borne by health plans and our economy. Refusing to address the root problem does not eliminate the economic results.
Obesity is complex, so we are not surprised that the reactions to addressing are complex as well. Kahan and Zvenyach offer encouragement:
Though US obesity rates are high, there has been much progress in shaping healthcare policy to afford greater access to care and innovation. Still, more needs to be done.
Click here to read their analysis.
Obstacles, Portals, and Waves. Photograph © Justin Kern / flickr
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May 1, 2016
May 01, 2016 at 6:11 am, Al Lewis said:
Hey I know it’s not always about me but the ubiquity of workplace wellness programs isn’t helping. They spread the idea that it’s NOT a disease and can be cured by bribing or fining employees, and with biggest-loser contests, now called weight-loss “challenges.”
Then when a study showing this approach fails does come out in a major journal, like Health Affairs, the investigator says “incentives” only failed because they haven’t figured out the right ones. https://theysaidwhat.net/2016/03/04/does-the-new-york-times-now-support-corporate-fat-shaming/
May 01, 2016 at 7:32 am, Ted said:
Well, you’re right, Al. And the irony is that employers who’ve bought into bogus wellness plans often don’t cover evidence-based obesity care in their health plans.
May 01, 2016 at 6:15 am, gerry stanewick said:
you forgot a 7th…the fda
May 01, 2016 at 11:30 am, Stephen Phillips said:
The AMA classification of obesity as a disease is simply misguided.
Obesity is effectively defined as an excess of adipose tissue in relation to lean tissue…The blunt instrument we clinically use to diagnose obesity is the BMI
Obesity is a physical condition like being underweight that is sometimes, only.sometimes associated with diseases or risk for diseases.
Millions of people are unfairly being diagnosed with a disease they do not have and are in good health (see abstract link)
http://www.nature.com/ijo/journal/vaop/ncurrent/abs/ijo201617a.html
However the AMA classification of obesity being a disease may encourage insurance providers to underwrite the care and treatment of those with obesity that do have and co-morbid diseases
Stephen Phillips
American Association of Bariatric Counselors
May 02, 2016 at 4:44 am, Mary-Jo Overwater said:
I’m just so grateful that obesity is finally taken seriously! Too bad, getting to this point has come at such an increased prevalence and incidence. I still remember the days when doctors would aggressively treat co-morbidities, but seemingly ignore if a patient had obesity or state outright that it wasn’t important to address in the treatment plan as nothing could really be done about it anyway. However it’s classified — condition or disease — access to effective treatment has to happen — with insurance coverage assured. People do not choose obesity.
May 02, 2016 at 6:14 am, Ted said:
Well said, Mary-Jo. Thanks!
May 02, 2016 at 11:21 am, Allen Browne said:
Interesting comments to Kahan’s commentary. Much food for thought.