It’s not a new question, but the American Medical Association’s decision Tuesday to recognize obesity as a disease is new – and controversial.
So, how should we think about this?
What is a disease, as opposed to a condition or illness?
That's a tough question. Most medical experts would agree that a disease is a more-than-temporary (So, the flu is an illness, not a disease.) condition that causes some kind of disturbance of the body’s organs, tissues, hormones, or metabolic functioning (So, those little sun-damage spots on your face and arms are a condition, not a disease; but if they turn cancerous, they are a disease.) most often associated with some signs and symptoms, abnormal things you experience.
Does obesity fit the definition of disease?
Often, but not always. There are clearly a subset of people who are overweight and may even satisfy the definition of obesity, however, no disturbance of the body’s functioning can be detected. There are some individuals, like me, who technically meet the definition of obesity, but demonstrate a very high level of fitness. I would tend to think of myself having a condition that may predispose me to risks, rather than a current disease.
On the other hand, it is often possible to demonstrate various metabolic, hormonal, and inflammatory measures of dysfunction in people who are obese, even before they develop the complications associated with obesity such as hypertension, hyperlipidemia, diabetes, heart disease, strokes, musculoskeletal problems, and cancer. For a fascinating guest blog piece from St. Luke's own Dr. Dan Zuckerman about the obesity-cancer connection, go to http://drpate.stlukesblogs.org/2013/04/15/the-obesity-cancer-connection-and-what-can-be-done-about-it/.
What qualifies as obesity?
The most commonly used measure is the body mass index (BMI). BMI is calculated from dividing your weight in kilograms by the square of your height in meters.
A healthy weight is considered 18.5 to 25. Overweight is classified as 25 to 30. Greater than 30 is considered obese.
But the BMI is notoriously imperfect. First of all, the ranges are for adults. A determination of obesity in children should be made with the child’s pediatrician and using a growth chart, considering the child’s age, and comparisons to similar children.
Another problem is that the BMI will be high in very muscular individuals and not represent true overweight or obesity.
Why is this anything more than an academic question?
Classification as a disease might result in insurance coverage for counseling, coaching, classes, and other education, weight loss programs, medications, and even greater coverage for surgical options.
The other consequence of classifying something as a disease is the epidemiologic surveillance and reporting of disease prevalence across the world according to standardized definitions. Once classified as a disease, more accurate counts of obesity will be obtained from healthcare providers than other self-reporting or other indirect measures that previously have been used.
What is the harm of calling it a disease?
All of a sudden, 35.7 percent of adults in the United States would have a disease or a new disease added to their health problem list. And there are concerns that some people will not address the need for healthy behaviors because they will justify that they have a disease.
I don’t find this argument very convincing. Most overweight and obese people I know don’t want to be, and would be willing to participate in efforts if they felt encouraged and supported.
Others will be worried about the stigma. Again, I am not persuaded, because the stigma exists whether we choose to call this a disease or not.
What do I think?
Blog readers know that I believe the only hope we have to get healthcare costs down for the long-term is to improve health. And I have said repeatedly that while we certainly have a healthcare crisis, it pales in comparison to the healthcare crisis coming our way as a consequence of an epidemic of childhood obesity.
We also are already starting to see, and will continue to see even more over the next decades, a growing rate of serious and very costly complications in adults than we have ever seen before, and at a younger age than we have seen previously. In my mind, increasing the focus and funding to address this problem is the right thing to do, whether or not obesity is ultimately classified as a disease.
Here are local news reports about the decision:
KBOI Channel 2: http://www.kboi2.com/news/local/obesity_disease-212234831.html
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.