The newest disease may affect 35.7% of Americans, but good luck calling into work with “obesity”, which was recently classified as a disease by physicians at the American Medical Association (AMA) 2013 Annual Meeting.
Although the vote passed by an overwhelming majority, physicians and health officials held an impassioned debate in the hours before the vote. Nearly all health officials were in agreement about spreading awareness and the importance of personal responsibility in combating obesity, but many clashed over the idea of classifying it as a disease.
The Case For Obesity as a Disease
Even though obesity may be more preventable than some diseases like viruses or cancers, many physicians argued that it should still earn the designation of “disease”.
“Obesity is a pathophysiologic disease,” said Jonathan Leffert, MD. “There is a treatment for this disease; it involves behavioral modifications, medications, and surgeons. Obesity affects minorities disproportionately. The scientific evidence is overwhelming.”
Other physicians, like Melvyn Sterling, MD, said he agrees with the new classification, and he cited the history of high blood pressure as a disease to support his argument.
“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 (high blood pressure) was not thought to be a disease,” said Dr. Sterling. “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.”
The Case Against Obesity as a Disease
Despite being in the minority, other physicians were not convinced that obesity met the criteria to be classified as a disease. Dr. Russell Kridel, the incoming chair of the AMA Council on Science and Public, compared obesity to other health-adverse lifestyle choices, like smoking a cigarette.
“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,” Dr. Kridel said. “We’re really talking nomenclature here, not philosophy.”
Kridel added that nothing has changed over the past 30 years to suggest obesity should be classified as a disease. The only thing that has changed, he said, was our diets.
“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.”
Dr. Robert Gilchick echoed Kridel’s sentiments, saying that just because obesity should be treated does not mean it is 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,” Dr. Gilchick explained. “But that does not alone make it a distinct medical disease state.”
Dr. Silverman Chimes In
The American Medical Association is misdirected in their most recent vote.
The latest theories of diabetes point to obesity as a means to accommodate for the excess carbohydrates such as sugars and grains in diet. These raise insulin levels, which in turn cause fat storage. Some people get diabetes and aren’t fat and some get very fat and do not have diabetes.
It seems that adipose (fat) tissue is created to allow people to store the excess glucose energy. If insulin resistance develops and cells become less responsive to insulin then they can’t store the glucose and they get diabetes.
Treating something that is a normal adaptation as a disease is silly and bound to fail.
Related source: Medscape, American Medical Association