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Every time a political problem gains national attention certain segments of the public cry out for politicians to “do something” — even if the prudent thing to do is to sit back and break the problem down into manageable pieces. Today, the AMA decided to use the “do something” approach to obesity, defining it as a “disease” — even though that isn’t true.
The Los Angeles Times reports:
The American Medical Assn. voted Tuesday to declare obesity a disease, a move that effectively defines 78 million American adults and 12 million children as having a medical condition requiring treatment.
The nation’s leading physicians organization took the vote after debating whether the action would do more to help affected patients get useful treatment or would further stigmatize a condition with many causes and few easy fixes. …
Got that? Many causes. It could be that person x has a thyroid condition, or it could be that person x sits on the couch all day playing video games while eating potato chips and drinking cans of soda. It could be that person y has natural joint pain that prevents them from exercising, or it could be that person y has joint pain because they were lazy for decades and the excess weight is straining their knees.
I was once getting examined by a military doctor for what ended up being a slightly fractured collar bone and the guy next to me said, “I have knee problems.” The doctor’s response: “You don’t have knee problems — you have a fat problem. Lose some f***king weight and your knees will feel better.” That’s the kind of honesty that the AMA fears.
“As things stand now, primary care physicians tend to look at obesity as a behavior problem,” said Dr. Rexford Ahima of University of Pennsylvania’s Institute for Diabetes, Obesity and Metabolism. “This will force primary care physicians to address it, even if we don’t have a cure for it.” …
Perhaps doctors look at obesity as a “behavioral problem” because in the vast majority of cases it is. It’s called “not paying attention to the things you shove down your throat and not exercising regularly.”
In laying out the case for and against the redefinition of obesity, the AMA’s Council on Science and Public Health argued that more widespread recognition of obesity as a disease “could result in greater investments by government and the private sector to develop and reimburse obesity treatments.”
The Food and Drug Administration, which has approved just two new prescription weight-loss medications since 1999, would probably face increased pressure to approve new obesity drugs, spurring new drug development and more widespread prescribing by physicians, the council noted. …
[The Council also warned that its decision could] shift the nation’s focus too much toward expensive drug and surgical treatments and away from measures to encourage healthy diets and regular exercise, the council wrote in a background memo for AMA members.
Are you ready for more Drugs! Drugs! Drugs!? That’s exactly what’s going to happen because we live in a society that looks for any opportunity to cut corners. It wants to have its cake and eat it, too. And the sad thing is, the AMA knows exactly what’s going to happen.
I talked to a good friend of mine in the medical field today about this issue and feel as though I should share her response:
It’s a complicated issue. I’m pissed that people who are obese now get to eat up another chunk of my monthly insurance premiums, but I am also happy that doctors will have incentive to counsel patients on the very same issue.
Here’s where I’m torn: People in the U.S. are fat. Despite what science has been warning them of for years and years, they keep putting fat in their mouths and keep putting a burden on medical costs.
Heart disease has become a major killer and the number of diabetics is increasing exponentially. Also, each person who has a metabolic disease won’t have just one issue. They have hypertension, coronary artery disease, foot ulcers, breathing problems — you name it. The lifestyle that brought on diabetes and obesity probably involved drinking (liver disease) and smoking (COPD, lung cancer) and generally living it up. The fat lazy patients who live their entire lives doing what they want to then use the lion’s share of healthcare premium costs. It’s ludicrous.
The other half of me, the doctor half, is relieved. It’s about time that primary care doctors got paid for counseling weight loss. Or for those who don’t currently do it because it doesn’t pay, maybe this will be more incentive to start. I know some doctors don’t even touch on the subject with their patients and it’s not necessarily because they don’t want to call them fat. It’s because they don’t want to spend precious time out of the 15 min they have with the patient when the guy has a list of medical problems a mile long and the doctors don’t even get paid to counsel on obesity.
I envision visits purely dedicated to a “weight loss” talk where the physician goes through diet, exercise, and physiologic impact with the patient — one-on-one. Granted, it won’t be a magic pill but it’s bound to help some people and as a first step, it’s not too shabby.
Anyway sorry for the long rant. The AMA and insurance companies each have their own agenda too and that’s a whole other conversation.
Between the AMA deciding that obesity is a disease and the American Psychiatric Association’s new DSM-V essentially seeing to it that we’re all classified as having some sort of mental disorder, is it any wonder that no one takes responsibility for their actions? “Fat? Pssst! I have a disease. It’s not my fault. And my psychiatrist says I eat because I suffer from a new version of PTSD caused by elementary school bullying. Stop giving me a hard time and pass the Cheetos.”
At what point in time will J Crew start selling designer muumuus? I’ll have my Extra Small in lightweight chambray sunset check, please.
Douglas Ernst Blog 
Wow, despite the seriousness of that military doctor’s statement, I couldn’t help but crack a smile. One of your last statements about “bullying post-traumatic stress-disorder” also had me laughing.
One my uncles who is overweight had open-heart surgery recently because his arteries were clogged, and he swore he would start eating healthier and exercising. Now he’s going back on his promises because he can take drugs that will control his weight. He’s a good guy, but I’m disappointed in him; his mindset simply wants to “cut corners,” as you’ve stated. New drugs like these will almost always have unforeseen side affects and issues as well. America will undoubtedly see many of these cases soon.
On a side note, this new “disease” that obese people can use as an excuse for their condition reminds me of lazy and aloof people who won’t study or work and attribute it to the fact that they have ADHD.
I think the U.S. is too fast to give someone a drug every time they have a problem. I do admit that sometimes they’re necessary, but the knee-jerk reaction always seems to be: “Here! Try this newpillwonderdrugcureswhatailsya!” (one word).
Everyone wants to think all their problems will be gone if they just pop a pill. Well, many times, the pill simply masks an underlying problem. And, like you said, they often have weird side effects. Who hasn’t seen pharmaceutical commercials that would be hilarious if they weren’t real pitches for serious medical problems (e.g., “Take this drug for your high blood pressure, but be aware that you might have explosive diarrhea and sudden onset hotdog fingers.”
Your comment on ADHD dovetails nicely with my reference to the DSM-V. The “professionals” have conveniently found a way to make sure each and every one of us has some sort of “disorder” that they can treat with drugs.
A few years ago I had a highly stressful job and I was getting heart palpitations, among many other strange things. People very close to me all recommended doctors who would give me drugs to “deal” with the problem. They were convinced I needed anti-anxiety pills. So…I quit. I found a job more in tune with where I wanted to be, personally and professionally. Almost overnight, my sleep returned, my heart palpitations stopped and I was no longer a nervous wreck. What would I be like today if I listened to my friends (who really did mean well at the time)? I’d rather not think about it.
Scary
“Take this drug for your high blood pressure, but be aware that you might have explosive diarrhea and sudden onset hotdog fingers.”
LOL! So true. A lot of people have this view that medicine and pills and surgery = instant magical solutions to their problems. They’re apparently unfazed by the side effects/complications and all that. It’s funny you should mention ADHD (one of the most misdiagnosed “diseases” today), because there was a lady who wrote in today to my local paper complaining about a Ritalin shortage and that her kid would “suffer” as a result. She was completely ignorant of the fact that Ritalin has been linked to depression, passive-aggressive behavior and suicide. Then again, she just wants an easy solution to her kid’s problems.
From a personal standpoint, in late 2004 my grandpa (who was 83 at the time) had a pacemaker put in him. My dad told my aunts that he felt that Grandpa wasn’t strong enough for a pacemaker, but they rebuffed him by saying, “you’d be surprised at how strong he really is.” My dad’s warnings turned out to be prophetic, as my grandpa’s health went downhill after that and he died in 2006, nearly two years later. My aunts then took credit for what my dad said, which opened up a whole Pandora’s Box of problems.
And my grandma had back surgery a few years ago, because she’s always had this view that surgery is magic. Well, as a result of that back surgery, she can no longer walk and uses a wheelchair. The surgery was completely unnecessary.
Point is, people just want easy solutions to their problems via things like pills and the like. They don’t want to actually take responsibility for their own actions.
This is a tough subject, because most of the time when you start talking about it people try and peg you as against all drugs, surgery, etc. I’m not. I just think that people are way too quick to look for a pill to pop. When I hurt my back I took Advil, but I also put in hours of stretching and used a heating pad at night. I brought a foam roller to work and used it up against a wall a few times a day. I drank a ton of water and eat healthy meals. The point it, with all sorts of physical ailments there comes hard work on the part of the afflicted if they expect recovery. Most people try and avoid that hard work and look to a doctor to magically heal them.
I also believe that our mental state plays a huge role in how our body heals … but that’s a conversation perhaps for another time.
I weighed myself earlier this year and found myself to weigh 262 pounds. I am 6ft 2in tall. I am currently dieting and exercising and am down to 233 pounds and according to the BMI chart I am no longer clinically obese.
I am eating better foods and watching what I am eating. It isn’t that hard to live a healthier lifestyle and I feel like I have worked hard to lose the weight.
It doesn’t bother me that people use these drugs. The only problem is that if they don’t change their lifestyle it would be very easy to just put the weight back on should the drug not be available anymore.
Congrats, James! I’m super proud of you, man. Your lifestyle becomes you, so if you’re eating healthy and exercising your body will reward you for it. As you become more fit, be careful of the calculations used to determine what is and isn’t obese. When people simply use a height/weight ratio it doesn’t always take into consideration things like muscle mass. Years ago I was lifting some pretty heavy weights and got up to around 180 pounds. Most of it was muscle, but according to the government I was obese! I couldn’t help but laugh. These days I’m back down to about 155 lbs. at 5’8.
On a case-by-case basis, I would never begrudge anyone for the choice they make (I can’t get inside their head), but I do think as a whole we have a culture that turns to a little pill to solve its problems … without really taking into account the ramifications.
Again, congrats on the lifestyle change!
You’re right about how that when you start talking about Americans being way too quick to look for a pill to pop, people always try to lump you in with the anti-vaccine crowd (such as Jenny McCarthy and that quack from the UK who claimed there was a “connection” between autism and vaccines) and claim that “you must be a wacko if you reject meds.” That’s happened to me on a few occasions.
Ridiculous.
I’ve lost 15 to 20 pounds recently. I’ve no desire to be a muscle-bound Adonis but I didn’t want to, as I’ve mentioned before, be one of those people who was lifted out of their houses by a crane. Didn’t need the AMA to help me.
Great news, Carl! Glad to hear that you’re making progress on your health goals. I’m not sure what your strategy was, but I’m glad it’s working. If you ever have any fitness questions, then feel free to ping me.