AMA classifies obesity as disease

The American Medical Association designated obesity as a disease June 18 at its annual meeting in Chicago despite opposition from a council that assessed the issue.

In the U.S., one in three adults and almost one in five children were obese in 2010, according the Centers for Disease Control and Prevention, increasing their risk for coronary heart disease, type 2 diabetes, stroke, cancer and other conditions.   

“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” said AMA board member Patrice Harris, MD, in a statement.

The AMA reasoned that designating obesity as a disease would raise its profile with government, the public and payers and ensure payment to physicians for obesity-related services and procedures. In late 2011, Medicare began covering counseling and intensive behavioral therapy for beneficiaries with a body mass index of 30 or greater, for instance.  

A report by the Council on Science and Public Health called for better clinical and public health strategies to help obese patients modify behaviors. But council members also voiced concerns over the use of BMI as a measure of obesity; screening challenges; labeling some healthy patients with an illness; and the potential to promote pharmaceutical and surgical interventions rather than diet and exercise.

“It’s a very serious condition … a pandemic, a significant risk factor for many other diseases,” said Robert A. Gilchick, MD, MPH, a member of the council and director of the Child and Adolescent Health Maternal, Child and Adolescent Health Programs in Los Angeles. “But that does not alone mean it is a distinct medical disease state.”

Ethan Lazarus, MD, speaking for the American Society of Bariatric Physicians, argued in favor of the designation saying that obesity “affects patients psychologically, functionally, physically and medically.” He is a physician at the Clinical Nutrition Center in Denver.

Diana Ramos, MD, MPH, medical director for reproductive health in the Los Angeles Public Health Department, also supported the classification. “We should not be afraid to call (obesity) what it is,” she said.

In adopting the policy, AMA delegates said “a range of interventions” were needed to advance treatment and prevention of the disease.

Other policies voted in at the meeting include:

• Providing physicians with resources to effectively use computers and EHRs in patient-physician interactions and incorporating questions and feedback on the use of computers and EHRs in patient-satisfaction surveys;
• Opposing discrimination based on an individual’s genetic information;
• Supporting public access to genetic data, including information on the clinical significance of genetic variants, using a secure system;
• Making traditional compounding pharmacies subject to state board of pharmacy oversight;
• Banning the marketing and sale of energy drinks to children;
• Opposing the FDA’s current lifetime ban on blood donations from sexually active gay men;
• Supporting HIV/AIDS programs to raise physician awareness of early and preventive treatments;
• Recognizing potential risks of prolonged sitting, particularly at places of work; and
• Permitting sunscreen in schools by exempting sunscreen from over-the-counter medication possession bans in schools.

The July/August issue of Cardiovascular Business will explore the implications of obesity in cardiovascular care. To sign up for the free publication, click here.