Boom! Science in action. (P.S. I have sooooo totally done this. And the group crouch. I don’t know why. )
Ever felt that there’s got to be more to gaining and losing weight than just calories in/calories out? Well, it turns out the American Medical Association agrees with you. In a surprising and controversial decision – they actually went against the recommendation of their own board set up to study this issue for the past year – the AMA announced last Tuesday that they are now officially classifying obesity as a “disease” in its own right rather than just a contributing factor to other diseases like diabetes and heart disease. The semantics are important as this implies that there’s a medical dysfunction involved in weight gain and is not just a product of “eating too much and exercising too little.”
When I first read about the decision, my initial reaction – like so many of my glitchy first impressions – was a not-well-thought-out but very assured “Well about time!” But then Shape asked me to cover it and I realized I probably needed to think about it a little deeper. My original stance stems mainly from the fact that the more science discovers about the physics of weight gain in humans (and mice and monkeys), the more factors we discover are involved – things like pollution, viruses (oh yes), altitude (check out this super interesting map!), your mother’s diet while pregnant, processed foods designed to be addictive, and even estrogenic compounds in the plastic liners of your “healthy” organic beans affect people’s ability to put on weight or take it off. Then there’s the stuff we already knew about like genetics. And of course, there’s also the recent findings that thinner is not always better, health wise and that it turns out it is possible to be “overweight” and quite healthy. So when there’s so much going on – and how much more don’t we know? – then it seems insultingly reductionist to tell people “Well if you just tried harder you could lose all that weight!”
And yet what are the implications of labeling over 1/3 of the American population “ill” – as opposed to having a “condition” or “disorder” as obesity was previously defined? Will people begin to think of themselves as victims and stop trying to make healthy lifestyle changes? Does this mean that people can no longer be obese and considered healthy despite the growing body of research showing that some obese people are just as healthy or healthier than their skinny counterparts?
And how do you even define what constitutes obesity as a disease anyhow, especially when the main diagnostic criterion – the BMI or body mass index – is widely considered flawed by most medical professionals, including the AMA themselves?
When I posted about the decision (which, by the way, is not legally binding in any way – it’s just the AMA’s single, but very influential, opinion) on Facebook, I was surprised to find most of my friends were very much against calling obesity a disease.
Anna responded by pointing out that “but you can overcome those obstacles [and lose weight] if you put the work in…” And she’s right. In spite of everything, some people do manage to successfully lose weight and keep it off.
“I’m afraid that will lead to more demonizing of fat people in general, and it misses (again) the point that one can be fat/obese AND be healthy.”
Lizzie pointed out the ambiguity, saying, ” Nonsense. Very slippery slope…”
Lesley disagreed with the AMA on corporate grounds rather than personal ones:
“Most weight gain is a product of the wrong habits including so called ‘health foods’ – this change absolves processed ‘food’ manufacturers etc of any responsibility. I do agree with the addictive nature of these products & I believe manufacturers need to be held accountable rather than reaping their massive profits.”
Annabel pointed out the financial benefits of the decision:
“AMA defined obesity as a disease against the wishes of the scientific advisory board. why? because creating a disease is profitable. this will only further stigmatize fat people and continue to perpetuate the fallacious, though well-conditioned, belief that fat=unhealthy”
While these worries are valid says Dr. Patrice Harris, M.D. and a board member of the AMA, she adds that the distinction is important because “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans. The AMA is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and type 2 diabetes, which are often linked to obesity.”
Reading through the AMA literature and early commentary by experts, I gleaned some potential positives of the decision:
– Reduced stigma. By classifying obesity as a disease, it takes away some of the stigma from the individual. Despite much evidence to the contrary, obese people are often (unfairly) considered lazy, unmotivated or deluded. This could help both doctors and patients work together to treat it seriously rather than simply shame and blame.
– Greater access to medical benefits. Currently many treatments for obesity are not covered by most health insurers, a problem that will likely be remedied by this declaration. This opens the door for more people to be covered for things like bariatric surgery and weight loss pills but perhaps also for things like gym memberships and nutritionists.
– Research and drug funding. While the AMA’s decision has no legal authority, the “official” stamp opens it up to increased money and resources dedicated to finding a cure.
My friends saw some other benefits as well:
Melissa thought it sounded good because it might increase access to gym memberships and personal training if they were deemed “medically necessary by health insurers.
Grant pointed out this might change doctors’ attitudes towards obesity and perhaps change the way they interact with obese patients:
” Looks like it might improve the coverage for medical nutrition therapy with a registered dietitian. If I remember the research right, doctors are not very likely to ask how physically active you are on intake forms or other assessments. Hopefully this will help improve it. It has been a little while since I reviewed this http://exerciseismedicine.org/“
Sonia made an excellent point, writing,
“Also could lead to protection against employment discrimination, which isn’t there now.”
Janet, a teacher, backed up her positive reaction with actual science lesson:
“if an agent causes a disease, you can transplant the disease agent from a sick individual to a healthy individual, and cause the disease. Lab researchers can induce obesity in mice by transplanting feces from obese mice to healthy mice, suggesting that obesity is caused by whatever is in the feces.”
But I have to admit that it was Jeremy’s comment about how all eating disorders are just different sides of the same coin (or dice? I need a throwable object with more than two sides!) that made me really think the most:
“There are reasons why some people tend towards obesity just as there are reasons why other people tend toward malnourishment. Why should bulimia or anorexia be classified as diseases but obesity should not? Why are skinny people allowed to assign a name to their disorder in order to justify their lack of self control but fat people can’t do the same thing? The same types of insecurities drive some people toward malnourishment and others toward obesity. Obesity is the end result of some other underlying problem, just as malnourishment is the end result of things like bulimia and anorexia. I apologize if this sounds unkind but reading all of these comments many of which I’m sure are coming from “gym addicts”, I’m seeing a lot of hypocrisy. Bulimia and anorexia and every other eating disorder are the result of bad habits. Making yourself puke is a bad habit. Not eating enough nourishing foods is a bad habit. Eating too much junk food is also a bad habit. So, what is it that makes all of you skinny people feel justified in putting a name to your disorder but denying that same thing to the overweight? I think more thought should be put into analyzing the different causes of obesity and classifying each of those causes as diseases/disorders rather than lumping it all together into the term “obesity”, but this is no less justified than the other end of the weight scale.”
In the end, I think I still do agree with the AMA’s decision, albeit much less assuredly. Mostly I hope that this will lead to more understanding and less stigmatizing of not only obese people but of all of us who have struggled so much with our weight because something major needs to change in the way we talk about all of this. But maybe that’s too much to hope for from one tiny word change?
What’s your opinion on the AMA’s decision? Should obesity be defined as a “disease”? Were you as surprised as I was at how many random things contribute to what we weigh??