More Than Half of Physicians and Nurses Say Obesity Is a Disease

Marcia Frellick

October 18, 2018

Sixty-four percent of physicians and 54% of nurses and advanced practice registered nurses (APRNs) who responded to a recent Medscape poll say obesity is a disease.

However, there was a substantial amount of uncertainty. Among physicians, 20% said it is not a disease and 16% were unsure, and among nurses/APRNs, 24% said it isn't a disease and 22% were unsure.

Opinions on whether obesity is a disease differed by specialty. For example, 82% of specialists in diabetes/endocrinology agree that obesity is a disease compared with 63% of primary care physicians, including family medicine, internal medicine, and general practice.

Table. Opinions on Whether Obesity Is a Disease by Specialty

Response Cardiology Diabetes/Endocrinolog Primary Care* Pediatrics
Yes, % 77 82 63 70
No, % 8 9 17 9
Unsure, % 15 9 19 21
*Family medicine, internal medicine, general practice
 

The poll responses include 1484 physicians and 2802 nurses/APRNs.

AMA Declared Obesity a Disease in 2013

The poll comes 5 years after the American Medical Association (AMA) declared in 2013 that obesity is a disease that requires interventions to advance treatment and prevention. 

Lee Kaplan, MD, PhD, director of the Obesity, Metabolism, and Nutrition Institute (OMNI) at Massachusetts General Hospital in Boston, recently told delegates at the Pediatric Academic Societies 2018 meeting in Toronto that patient success is dependent on a shift in the way healthcare professionals think about obesity; otherwise, patients are destined for failure.

The topic remains divisive and opinions were varied in the 122 comments logged since the poll questions were posted this summer.

An internist wrote, "Obesity is a behavioral problem that leads to disease."

A cancer surgeon wrote: "Obesity is not a disease but a condition where, either by genetics or endocrine issues (people are predisposed to it)."

An internist wrote, "We know the lifestyle choices that lead to obesity: bad diet, overeating, low activity level, and also know that it's pretty rare for obesity to be due to heredity or illness alone. So using the car rather than walking is a disease. Eating thousands of calories more per day than you need is a disease. Refusing to delay gratification or to avoid laziness is a disease."

Some blamed economic barriers such as food prices. "Why does it cost more to eat 'clean' than 'dirty'?!” one provider asked. A family physician noted that "in many vending machines it's cheaper to buy a coke than water. Our priorities are skewed."

A commenter identified as "other healthcare provider" said progress will take a combination of approaches and wrote that "the solution requires changes in society AND people employing the critical thinking and reasoning abilities of the human brain to counter the lust to eat and eat and eat."

What's at the Root of Obesity?

When asked how often lifestyle choices are the underlying cause of obesity, 80% of physicians and 68% of nurses/APRNs answered that they were always and often the underlying cause.

The intervention most recommended to address obesity was diet across all providers, followed closely by exercise. Physicians were more than twice as likely as nurses/APRNs to recommend surgery (32% vs 14%). Physicians were also more than twice as likely as nurses/APRNs to recommend prescription medications (24% vs 11%).

The poll asked providers how often their patients with obesity succeeded at long-term weight management and numbers were low.

Physicians reported that their patients succeed always or often only 12% of the time and nurses/APRNs put the percentage at 5%. Physicians reported their patients rarely or never succeed 39% of the time and nurses/APRNs put the percentage at 41%.

In a separate commentary on the poll published by Medscape, Akshay B. Jain, MD, an endocrinologist at Wockhardt Hospital and Fraser River Endocrinology in Vancouver, British Columbia, Canada, writes, "In the interest of definitively addressing a situation that is attaining pandemic proportions, it is high time that we recognize obesity as a disease. As long as we as medical professionals do not take obesity seriously, we will be ineffective in dealing with the subsequent biopsychosocial and economic ramifications of what arises in its aftermath. Calling out obesity as a disease is the first step toward objectively assessing the factors that lead to it and working toward its prevention and treatment."

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