Labeling obesity a disease a start to finding solution
July 5, 2013
When I heard the recent news that the American Medical Association decided to label obesity as a disease, my initial thought was — what took so long?
This decision seems a little curious because we are 10-plus years into the well-established epidemic. A third of us are obese, and another third are overweight, so the horse has definitely left the barn.
At this point, I imagine it was probably a spirited AMA debate whether to proclaim obesity a disease or just the new normal.
The elevation of obesity to disease-hood is an open admission that our approach to the problem has largely been a failure. Roughly 45 million people diet each year. They use one of dozens of popular diet plans, all promising to deliver a transformation that results in effective long-term weight loss.
Obesity is a medical problem that we are only just barely starting to figure out.
When these are evaluated for effectiveness, the only consistent result is dieting is a great predictor of long-term weight gain.
The experience is a remarkably constant: 5-10 pound weight loss in the first six months, followed by gaining those pounds back and adding more over the next two to five years.
A medical truism is, if a disease has many treatments, it means no one treatment is very effective. If any single treatment worked really well, we would all use that one.
And so it goes with weight loss. There are hundreds of different diets, medications, and surgeries, weight-loss coaches, foods and supplements. One can go to the gym, a doctor or have specially prepared diet foods delivered right to their doorstep.
The results are predictable – temporary weight loss, then gain it back and then some. For the record, see saw weight loss is worse than just maintaining the same overweight status.
The AMA is not the first medical group that has decided obesity is a disease. Medicare did the same in 2004, which did nothing to slow the progress of obesity in the last decade.
Now another medical organization put their weight behind calling obesity a disease. But the question lingers – will anything change?
Despite evidence to the contrary, obesity is seen naively as a character defect. "Why don't you just stop eating?" That's what most people think when they see an obese fellow traveler on our planetary voyage. That is, unless they have spent some time being overweight themselves.
The same could be asked of the alcoholic or habitual cigarette smoker. Just don't drink; just don't smoke! Do so only at risk of being told where to go, or getting a more direct and physical response, which ironically may require a bag of frozen peas.
Obesity is a medical problem that we are only just barely starting to figure out. This is somewhat surprising to most because we have been eating and putting clothes on all our life.
It doesn't take a Ph.D. to tell us that some people can pretty much eat whatever they want and stay pretty trim. Obesity is partly genetic. Now that we have sequenced the entire human genome (DNA), we may soon have a better understanding of how to help.
On the opposite field of psychiatry, obesity has psychological aspects in both cause and effect. That, too, is actively being researched.
The endocrinologists are also busy. Gone is the simple idea that fat cells are just inert storage tanks for excess calories, perfectly happy to shrink away to nothing with a little dieting effort. These cells are surprisingly hormonally active, and that, too, is an area of active research.
Society at large has also been looked at with a critical eye. The dramatic rise in obesity has occurred parallel with the steady rise of countless fast food restaurants and advertising. Unemployed cigarette company scientists would tell us it's simply a coincidence, but we wonder.
The AMA proclaiming obesity a disease is both everything and nothing. The sun will come up tomorrow and the majority of Americans will still be overweight.
But this does bring the whole obesity, weight loss problem into some healthy sunlight. A few of the biggest weight loss charlatans will slink away. More money will be invested in bigger ideas.
And the best news of all – we just might learn something that is helpful.
Donald Bucklin, M.D., is a regional medical director for U.S. HealthWorks.