Amid heated debate, AMA declares obesity a disease

Marcia Frellick

June 20, 2013

June 20, 2013

Chicago, IL - Physicians voted overwhelmingly to label obesity as a disease that requires a range of interventions to advance treatment and prevention [1].

However, there was impassioned debate in the hours before the vote here at the American Medical Association (AMA) 2013 Annual Meeting.

Although policies adopted by the house of delegates have no legal standing, decisions are often referenced in influencing governmental bodies. This decision could have implications for provider reimbursement, public policy, patient stigma, and International Classification of Diseases coding.

"Obesity is a pathophysiologic disease. There is a treatment for this disease; it involves behavioral modifications, medications, and surgeons. Obesity affects minorities disproportionately," said Dr Jonathan Leffert (Texas Health Presbyterian Hospital, Dallas), alternate delegate for Endocrinology, Diabetes, and Metabolism. "The scientific evidence is overwhelming."

Dr Melvyn Sterling (St Joseph Hospital, Orange, CA) said this brings to mind to 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 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."

Some not convinced

Others testified that the measure for determining obesity is imperfect and although it is an epidemic, obesity does not meet the criteria for disease.

Dr Russell Kridel (University of Texas Medical School at Houston, TX), incoming chair of the AMA Council on Science and Public Health (CSPH), said in an interview 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."

He noted that behavior and dietary choices play a part in obesity. "Thirty years ago, we did not have the obesity problem we have now. If you look scientifically at what has changed, our diet has changed. There's been no change in our genetic structure in the past 30 years."

Kridel said he would like to see more attention focused on prevention and personal responsibility. The CSPH issued a 14-page report opposing the classification of obesity as a disease.

"We did not think the evidence rose to the level where obesity could be recognized as its own distinct medical disease state. Obesity is a very serious condition. It's a scourge on our nation. It's an epidemic. It's a significant risk factor for many other diseases," said Dr Robert Gilchick (Los Angeles County Department of Public Health, CA), speaking on behalf of the CSPH. "But that does not alone make it a distinct medical disease state."

He explained that because body-mass index, an imperfect measure, is used to determine obesity, people who are otherwise healthy are being diagnosed as obese.

"Why should one-third of Americans be diagnosed as having a disease if they aren't necessarily sick?" he asked.

One-third of Americans

According to the Centers for Disease Control and Prevention, 35.7% 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.

Immediately following the AMA's announcement, the American Heart Association issued a press release essentially restating the AMA's action but neither applauding nor rejecting the "disease" definition [2].

"The American Heart Association believes the additional focus is needed on this important risk factor for heart disease and stroke. We work with individuals, industry, healthcare professionals, and national, state, and local governments to recognize the severity of the issue and the need for more coordinated and comprehensive solutions."

The AMA also adopted a policy that supports banning the marketing and sale of high-energy drinks to anyone younger than 18 years.

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