If you’ve been paying much attention to the news the last week or so, you have probably heard something about the American Medical Association (AMA) officially terming obesity as a disease. There are arguments both for and against this notion, and both sides of this argument were present at the AMA meeting in Chicago. In fact, the committee that studied this matter recommended that Obesity not be defined as a disease, but this motion was outvoted.
The argument goes back several years. In 2008, a study published in the Obesity Journal used several approaches to review the literature and found that, yes, the benefits of classifying obesity as a disease would far outweigh the drawbacks (1). In 2004, Medicare removed all references to Obesity as not a disease, though they continue to not cover weight-loss medications on the Part D prescription plan.
I don’t know about you, but this sounds like an awful lot of mixed messages to me. So let’s start at the beginning – What is obesity?
Traditionally, Obesity is classified using weight as a function of height. It has a medical code, which means that paperwork documenting this can be submitted to insurance for reimbursement by your healthcare providers. The formula typically used is BMI, which is calculated by dividing your weight by your height (squared) – kg/m2. Anyone with a BMI >30 is considered “Obese” by this calculation.
The theory is that if you are X height, and you weigh more, you are likely carrying a disproportionate amount of body fat, and you are therefore more likely to have certain medical complications as a result – elevated blood lipids, high blood pressure, diabetes, to name a few. However, this calculation does NOT take into account actual body fat. This means that if you have a high proportion of body fat, and are therefore at risk for these complications, but your BMI happens to be in a healthy range (generally considered to be right around 22), then you are not obese, even if you have the aforementioned metabolic complications. BMI may be a useful tool, but it is only one of many when evaluating a patient for certain risks, and this finding is the primary reason the AMA committee did not recommend classifying Obesity as a disease.
Further, there is plenty of research to show that healthy lifestyle (including proper nutrition and regular physical activity) independent of body weight are better predictors of risk than weight alone. Meaning, if you are technically overweight or obese, but you exercise and have a balanced diet, you are more likely to be healthy than if you are of a “normal weight” but do not include balanced meals and exercise in your everyday.
So, why then, are we bothering with this question at all? As it happens, the AMA does have some amount of clout. If this group of physicians makes a declaration, insurance companies are likely to follow suit, which means they will begin to cover and reimburse programs (and medications) aimed at promoting healthy weight and resolving the Obesity issue. Reimbursement by insurance is a pretty good incentive to create and market medications and treatments, and so pharmaceutical companies are more likely to begin developing medications to help achieve and/or maintain a healthy weight.
Is there a lesson here? Maybe, maybe not. Like so many things in life, there’s no clear right or wrong in this situation, it simply is. Maybe the best we can do for now is to promote a healthy lifestyle, loaded with balanced meals and regular physical activity. After all, research has shown us time and again, that’s the easiest way to ensure you achieve metabolic balance – regardless of the number on the scale.
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- Les, MS RD LD
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