AMA Wonders: Is Obesity a Disease?

News comes from the American Medical Association’s annual meeting in Chicago that the House of Delegates is deliberating on whether it’s time to declare that obesity is really a disease. At last year’s meeting, a resolution to do so from the Illinois delegation was referred for study to AMA’s Council on Science and Public Health. They’ve studied it, written a report, and decided that they’re not sure if it’s a disease, but it sure is a problem.

On the surface, this seems to be a relatively simple question to answer. Morgan Downey, a veteran of these discussions, points out that for the most part, this ship has already sailed. Consider the following:

  • NIH declared in its 1998 clinical guidelines, “Obesity is a chronic disease, and both the patient and the practitioner need to understand that successful treatment requires a life-long effort.”
  • The Social Security Administration recognized obesity as a disease in 1999.
  • The Centers for Medicare and Medicaid Services began treating obesity as a disease in 2004 and removed language to the contrary from their coverage manual.
  • The IRS decided in 2004 that costs for treating obesity were deductible medical costs.
  • The Obesity Society published a position paper affirming obesity as a disease in 2008.
  • The American Association for Clinical Endocrinology recognized obesity as a disease in 2012.

In the detractors’ camp, some believe that calling obesity a disease might lead to “medicalizing” obesity and relying excessively on treatment. This, the council report says, might lead to a diminished focus on health behaviors and prevention.

Pardon us for saying so, but this rationalization is a bit tortured. Prevention and treatment go hand in hand, not in opposition. There’s no lack of focus on health behaviors. And we only wish we needed to worry about excessive treatment of obesity. The literature is full of evidence that treatment is happening all too rarely in an evidence-based medical setting. We need more, not less of that.

Perhaps clearer reasoning will prevail. This report was referred to a reference committee that recommended AMA “recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention.”

Stay tuned for the final vote.

Click here to read more from the Downey Obesity Report, here to read more from Forbes, and here to read the AMA Council on Scientific Affairs report.

The Sick Woman, photograph © Dani Sardà i Lizaran / flickr

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