Fat chance

Wednesday June 26, 2013

With a nod to the media and a declaration to Americans, obesity is now a disease. Based on a news story last week, the American Medical Association has now determined that obesity is a disease. Does this mean the world has changed?

The pompous AMA might want us to believe it is so, based on a story that appeared in the New York Times as well as the Medscape web site. One sentence on the Medscape web site by Marcia Frellick on June 19 says it all: "This decision could have implications for provider reimbursement, public policy, patient stigma, and International Classification of Diseases coding."

As far as I am concerned, this new diagnosis is about money. That is the real story. Once obesity becomes a "recognized" disease it means that health care providers might be able to bill insurance companies for services connected to the treatment of this disease.

It is not a bad thing, because a great deal of time in providers' offices is spent dealing with problems related to obesity. It can be a side issue when dealing with "real" diseases such as diabetes, hypertension, hypercholesterolemia, joint disease and depression to name a few.

In the Medscape story, Melvyn Sterling, MD, said this brings to mind the debate over whether hypertension is a disease.

"I'm a general internist, among other things, and I treat the complications of this disease. It's interesting to look back in history at a time when hypertension was not thought to be a disease," said Dr. Sterling, who is from the AMA Organized Medical Staff Section, but was speaking for himself. "Obesity is a disease. It's very, very, very clear that even though not every hypertensive gets a stroke and not every obese person suffers the complications, that does not change the fact that this is a disease."

Of course, it was not that long ago when homosexuality was considered a disease by the medical establishment. When it comes to understanding extremely powerful political organizations such as the AMA, one has to consider motive and suspiciously look for the back story.

Many people may benefit from the recognition of the disease "obesity" by insurance companies. It may mean that there will be greater coverage for dietary counseling and bariatric surgery and ultimately, as we all well know, the scope of medical care is not determined by providers but by insurers in the American free-market heath care system.

Within the AMA there is not unanimity over this new disease classification.

Russell Kridel, MD, incoming chair of the AMA Council on Science and Public Health, told Medscape Medical News that there is no debate about the importance and urgency of addressing the problem, but he doesn't believe it qualifies as a disease.

"It's more like smoking. Smoking isn't a disease. Smoking can cause disease such as lung cancer and emphysema in the same way that obesity can lead to diabetes and hypertension," he explained. "We're really talking nomenclature here, not philosophy."

In the end, will it really matter if obesity is called a disease? Publicity about obesity may be the best result of this new public declaration when one considers that "According to the Centers for Disease Control and Prevention, 35.7 percent of Americans are obese. Obesity-related conditions, including heart disease, stroke, type 2 diabetes, and certain cancers, are some of the leading causes of preventable death."

Keep in mind that the AMA is not a benevolent organization and the pill of political power is their most common prescription. The world will not change and people will not suddenly lose weight because the AMA might be able to treat obesity as a reimbursable disease.

This story should remind all of us that, individually, we have a lot more power than the AMA when it comes to losing weight. We don't need a doctor telling us we have a disease in order for us to do the right thing.

Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at rbdav@comcast.net.


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