Fat Equals Sick: Is This About the Money?

Bradley P. Fox, MD; Robert W. Morrow, MD; Charles P. Vega, MD; Mark E. Williams, MD

Disclosures

July 15, 2013

In This Article

Follow the Money

Bradley P. Fox, MD (Family Physician)

Last month, the American Medical Association (AMA) decided to label obesity as a disease.[1] When I first sat down to write about this topic, I looked up the online definition of "disease." I need to quote the first definition here: "A disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment." I have a difficult time fitting obesity into this definition -- especially when you look at nutritional deficiency as one of the possible causes.

The second definition had to do with diseases in plants. I then looked at the third definition: "any harmful, depraved, or morbid condition, as of the mind or society: His fascination with executions is a disease." I am not buying that either.

OK, so why did the AMA decide to declare that obesity is a disease? I figured it had to do with research or the recommendation of a subcommittee, but according to Geoffrey Kabat,[2] this is not the case either. In fact, he writes, it was a decision that went against the recommendation of the Council of Science and Public Health.[3] Really? Then why?

The reason: Make doctors more readily recognize and address obesity, hopefully to aid in reimbursement from insurance companies for the treatment of obesity -- and, to take it a step further, to promote payment for the 2 new obesity drugs that it just so happens recently came to market. Follow the money, folks.

I am sorry, but it is not hard for primary care physicians to recognize obesity. We see it every day. We don't ignore it. We attack it head on.

That said, obesity comes in different shapes and sizes. The strict definition of obesity being a BMI greater than 30 kg/m2 does not always define the actual patient. I have several athletes who have BMIs of 30 kg/m2 or more who are in fabulous shape and health. I would not consider them diseased (and I have a hard time labeling them as obese). I do not think that calling it a disease is going to make the average doctor change the way they look at the patient in front of them.

It comes down to money. Obesitologists (does this specialty exist yet?) must have lobbied the AMA for the statement. Well, make that the bariatric surgeons. Talk about a specialty explosion. The hospital I work for has a "bariatric product line," and I am sure that they are applauding this label change.

And then there are the new drugs. Industry policy does not allow us to take pens or note pads or T-shirts or golf balls from any pharmaceutical reps. With the Sunshine Law, we need to declare every bottle of water or bag of chips a rep gives us for lunch. Despite this, I find it too coincidental that Qsymia® and Belviq® were both released shortly before this change in how the AMA looks at obesity. Follow the money.

Do I agree with the change? Do I think that obesity should be considered a disease? Not really. I don't think that smoking is a disease. I don't think that laziness is a disease. I don't think that poor hygiene is a disease, so I need to be consistent and say that obesity is not a disease.

Honestly, I don't think that it really matters. I do not think that it will change how doctors look at obese persons. I don't think that it will motivate doctors to treat more aggressively (or take better care of themselves, for that matter), and I do not think that insurance companies will be any more likely to pay more when they are looking for ways to pay us less. It will, however create a lot of material for Jay Leno and other late-night comics for their monologues and for us to debate in Roundtables.

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