A recent decision by the AMA may
have a dangerous ripple effect.
Last week, the House of Delegates of the American Medical Association (AMA) voted to classify obesity as a disease. While the AMA has no legal authority, as one of largest organizations for conventional medicine, it has tremendous sway over public policy makers, insurance companies, and the public.
One of the main reasons doctors have been reluctant to prescribe obesity drugs is that obesity drugs are currently not covered by Medicare, and most insurance companies take their coverage cues from Medicare. Since the AMA has such sway with the government, its classification of obesity as a disease may well end up influencing what Medicare will cover (which also benefits the AMA, since they establish the billing codes in line with what Medicare will cover). Labeling obesity as a disease gives doctors a much larger market base for their lucrative obesity treatments: one-third of Americans are obese, meaning there is a potential market of 104 million people.
The problem, of course, is that obesity is a lifestyle condition, not a disease in and of itself. Studies show that most medical schools fail to supply even a meager 25 hours of instruction in diet and nutrition, so doctors will inevitably turn to the treatments they know best: drugs and surgery.
This effort to “medicalize” lifestyle conditions comes at a time when two new dangerous and largely ineffective weight loss drugs—with horrific side effects—have been approved by FDA: Qsymia and Belviq. Qsymia has not sold well, in part because of concerns that the drug may cause birth defects, but also because of the lack of Medicare reimbursement. This, of course, may change if the trend to label obesity as a disease continues.
Lap-band surgery, which is very profitable and increasingly popular, will benefit as well. The American Association of Clinical Endocrinologists, the Obesity Society, and the American Society for Metabolic and Bariatric Surgery have all broadened their recommendations on who qualifies for bariatric surgery. The AMA’s new label will only increase the surgery’s popularity.
Even worse, categorizing obesity as a disease could threaten integrative approaches to obesity treatment:
- Supplements that say they assist with weight loss would now be considered to be making “disease claims,” which is strictly forbidden. If this happens, weight loss supplements could be banned. GlaxoSmithKline has already petitioned the FDA to remove weight loss supplements from the market so it can sell its weight loss drugs without competition. If you haven’t done so already, please be sure to send your message to the FDA and tell them to reject GSK’s petition and keep weight loss supplements safe!
- At worst, we would lose access to such important weight loss supplements as garcinia cambogia. At best, supplements may remain on the market but the public will be ignorant of their benefits as manufacturers won’t be able to say what conditions the supplements can affect.
- Labeling lifestyle conditions as a disease may dissuade people from making lifestyle changes to reverse their condition. For example, people may feel powerless and say, “It’s my biology” or “It’s in my genes,” with the implication that the condition is unchangeable outside of aggressive pharmaceutical or surgical treatment.
Mainstream medicine, and the AMA is no exception, bases a determination of obesity on one’s body mass index, or BMI. Developed in 1830, it’s a simple ratio of your weight to your height. If your BMI is 30 or above, you’re obese.
Unfortunately, BMI as a measurement has serious limitations because it doesn’t account for body composition (how much is muscle versus fat); some thin or inactive people with low BMIs may be nutrient deficient or have an unbalanced fat ratio; and it doesn’t account for ethnic differences or age-related requirements.
Other measurements are more accurate gauges of health. In a twenty-year study, Oxford Brookes University found that death rates are more accurately predicted by the waist-to-height ratio than by BMI. Keeping your waist circumference to less than half your height can greatly reduce your risk for stroke, heart disease, and diabetes. Waist-to-height accounts for how much fat has accumulated around one’s central organs, a factor that has been definitively linked to stroke and heart disease.
The AMA’s Council on Science and Public Health did its own year-long study on BMI and obesity as a disease, and recommended against classifying obesity as a disease. It found that to a great extent, there is no accurate and clinically practical way to diagnose for obesity. Sadly, the AMA’s House of Delegates chose to ignore its own committee’s study and its recommendation!
Most classifications of disease in the US stem from the World Health Organization’s “Classification of Diseases and Related Health Problems,” usually called the ICD-10. While the ICD-10 makes references to obesity, it is unclear whether obesity is considered a disease or a “related health problem.”
Many analysts—particularly adherents of integrative medicine—believe that obesity is more of a risk factor for disease than a disease in and of itself. The symptom (fat) is also the defining feature (being fat): there are no other clinical or subclinical signs. Many people, especially those at the lower end of the range, suffer no obvious impairment because they are overweight, or no impairment that is unrelated to other disease factors like diabetes or heart conditions, other than failing to meet certain (somewhat arbitrary) standards of physical fitness, which some non-obese but sedentary people might also fail. Being obese is merely one manifestation among many of a body that is out of balance.
Unfortunately, mainstream medicine is trending in the opposite direction:
- In 2008 the Obesity Society officially supported classifying obesity as a disease.
- The IRS has ruled that obesity treatments quality for tax deductions—if you itemize, you can deduct your weight loss program under medical expenses.
- Medicare removed language from its coverage manual saying obesity was not a disease—though Medicare Part D does not cover weight loss drugs. Yet.
An integrative approach recognizes that obesity fits into a bigger picture—that being fat is a symptom for larger conditions. Treatment includes nutritional approaches focused on getting good fats, tailored supplementation, and the right kinds of exercise. Other protocols are often recommended as well: acupuncture can help reduce hunger, break food addictions, and address chronically imbalanced systems; metabolic typing can help determine the diet best suited for each individual. Environment may also play a part: the body’s toxic burden can affect metabolic systems, and now studies show that BPA may lead to obesity.
We heartily welcome more awareness that obesity is a risk factor for other disease, and we believe people should be more proactive in managing lifestyle and other factors that contribute to being overweight. Designating obesity as a disease, however, simply means that dangerous drugs will become more available and risky surgeries will be more frequently recommended—even though they just don’t work very well.
Copyright © 2013 Alliance for Natural Health USA (ANH-USA)