A few years ago, while I was teaching in the hospital, a medical student presented the case of a man with coronary artery disease, diabetes, hypertension, and hyperlipidemia. When we entered the man's room I was surprised that the student had omitted a certain fact from his presentation: the man weighed well over 400 pounds.
No one argues that diabetes and blocked coronary arteries are diseases. And nobody argues that obesity, at least in part, causes these diseases--or that losing weight helps improve or even reverse them. But the question of whether obesity itself is a disease has been controversial.
The American Medical Association, the nation's leading organization of physicians, has just announced its stand on the question: obesity is a disease.
Some might wonder why this announcement is news, why the issue is controversial at all. I think it has to do with our ambivalence about conditions that have a behavioral component. In the last few years the question of whether certain behaviors are diseases or disorders--drug use and alcoholism, as well as hoarding, gambling, and Internet overuse (which the American Psychiatric Association now lists as disorders or potential disorders)--has come up repeatedly.
We tend to like to think we can control our behaviors, and everyone knows someone who--by sheer effort and willpower--has given up certain self-destructive behaviors. No doubt, many will see the AMA's designation of obesity as a disease as an encouragement of "victim mentality"--an absolving of personal responsibility.
But the causes of obesity are complex, and include genetics, stress, the food supply, medications, and other factors. One could argue that if self-discipline alone cured obesity, people like Oprah Winfrey, Gov. Chris Christie, and millions of the rest of us who exhibit this quality in so many other aspects of our lives wouldn't have a problem with weight. I can't count how many patients I've seen who hold down two jobs, volunteer, and take care of their parents and kids and tell me they can't lose weight because they're "lazy."
Another objection to classifying obesity as a disease will be that it's so common. Do one-third of adults and one-fifth of children in America have a disease? By 2020, when, as is projected, 75% percent or more of us are obese, will most of us be "sick?" Does the word "disease" have any meaning if it affects a majority of people? If it's the new normal?
The AMA has no specific authority to designate obesity as a disease, but it's decided to use its considerable influence to effect a cultural shift. The hope is, that if obesity is thought of as a disease, insurance companies will be more supportive of obese people, researchers will pursue the problem more aggressively, public health efforts to curb obesity will be strengthened, and individual clinicians--like that medical student I mentioned above--will be better trained to address obesity with their patients.
A study last year showed that only about half of primary care doctors felt competent to deal with their patients' obesity. Among doctors who were obese themselves, the percentage was much lower.
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