June 24, 2013

The American Medical Association voted last week to declare obesity a disease. But what exactly does that mean?

“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, said in a statement. She suggested the new definition would help in the fight against Type 2 diabetes and heart disease, which are linked to obesity.

To some extent, the question of whether obesity is a disease or not is a semantic one, since there is not even a universally agreed upon definition of what constitutes a disease. And the A.M.A.’s decision has no legal authority.

Still, some doctors and obesity advocates said that having the nation’s largest physician group make the declaration would focus more attention on obesity. And it could help improve reimbursement for obesity drugs, surgery and counseling.

I admit that I'm still unsure as to the ramifications of this paradigm shift. There's no argument that the rising rate of obesity in this country has a consequent rise in obesity-related diseases like diabetes and heart disease.

But obesity is not a one-size-fits-all issue and I'm not a big proponent of drugs and surgery to 'cure' obesity without treating the underlying issues that caused a person to gain weight in the first place. Not every person with weight issues is eating processed foods or not exercising. And there are a wide variety of factors that could be contributing.

That said, there's also little doubt that the staggering consumption of sugary sodas (even diet sodas affect blood glucose levels even if they have less calories) and processed foods heavily laden with sugar, salt and simple carbs have played a part in contributing to nutritionally poor diets and weight gain.

If we move away from pathologizing individuals' weight issues under the umbrella of a disease, how then do we look to these contributers?

Can we now start treating sugar as a drug, to be regulated by the FDA? Do we start regulating soft drink ads, restricting when they can be aired, like we do alcohol? Can we make the use of cuddly mascots like Froot Loops' Toucan Sam a thing of the past like Joe Camel? Can we mandate "Fresh Produce Zones" near schools? Include community gardens as part of any multi-unit development? Should bags of potato chips come with a Surgeon General's warning?

It sounds absurd, but we have looked at other public health issues (smoking, alcohol) and made these choices. Is that what classifying obesity as a disease will result in?

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