Up until now, the medical establishment has described obesity as “a major public health problem.”
That’s a soothingly impersonal way to put it. Collectively, too many obese people constitute a problem. But people don’t normally wake up in the morning and think, “Hey, I am part of a major health problem.”
Now the ground has shifted. The American Medical Association this week officially recognized obesity as a disease. That strikes a lot closer to home. One could conceivably look in the mirror and say, “I have an illness.”
Would that help or harm?
Obesity is a scourge. It drains the economy of $200 billion a year and raises health care costs for everyone — by $1,723 per person annually, according to a recent report. A young person I care deeply about is verging on obesity, and it is painful to see what excessive weight does to someone’s health, career and happiness prospects.
But are we ready to say that the nearly one-third of Americans who are obese are ill?
I propose that the right answer to that question is: Whatever works.
Health professionals, public officials and others have been trying unsuccessfully for years to reverse the alarming increase in obesity rates. Rates keep rising and some researchers have predicted 42 percent of Americans will be obese by 2030. That is just an appalling prospect.
Physicians who support the change think it will lead to earlier and better treatment of obesity itself, which is a healthier and more cost-effective approach than waiting to treat the results of obesity, like diabetes, heart disease and cancer.
If obesity is looked at as a disease, medical students might spend more time learning how to help patients prevent it. Insurers might pay for nutritional counseling, or follow-up visits with a primary care doctor to discuss a weight loss regimen. They likely would be more willing to pay for obesity drugs and surgeries.
“If this is an illness it would be more difficult to justify not having insurance coverage for a disease,” said Dr. John Price, medical director of surgical weight loss for the Kansas City-based St. Luke’s Health System. Price performs bariatric surgeries, which only about half of the insurance companies serving this region cover.
“Increased attention to obesity as a disease helps us move away from what is sometimes viewed as a behavioral or choice issue,” said Dr. Sarah Hampl, medical director of weight management services at Children’s Mercy Hospitals in Kansas City. “There is a very complex interplay of genetics and environment that we’re just now starting to understand.”
But to really make a difference, the new definition of obesity must resonate beyond the doctor’s office or surgical suite.
If obesity is a disease, we should be doing more to prevent it. We have laws mandating clean air and water to prevent lung disease and various cancers. So why is it so controversial to contemplate laws limiting the size of sugary drinks, a leading cause of obesity? Why is the food industry able to market sugary cereals and salty snacks to kids, getting them hooked on addictive, disease-causing foods at an early age? Why do planners bisect communities with highways and unwalkable stretches?
It’s true, as the personal responsibility crowd points out, that nobody forces anybody to eat a bag of potato chips in front of the TV, or start the morning with a glazed doughnut. It’s also true that junk food is often more accessible than fresh fruits and veggies. And entire families have no experience or tradition of healthy eating.
It’s very strange to think of one-third of Americans as being sick, and the AMA’s definition is bound to receive push back. But Americans have always been able to rally in favor of healing. Defining obesity as a disease should not be looked at as a cop-out but as a call for action.