doc
Winter 2014 • Kentucky
Does the AMA Decision
Have Any Real Power?
Since the AMA is not a legal body, the
move to label obesity as a disease is mostly
symbolic. However, the hope is that doing
so will encourage insurance companies to
increase their coverage of “treatments” such
as lap band surgery and weight loss pills.
Therein lies the rub – many skeptics say that
the announcement was motivated by money
and heavily influenced by pharmaceutical
companies (especially since two new diet
drugs have recently been approved).
So Does It Really Change
Anything?
Obesity as a Disease:
What Does the AMA Decision Mean?
By Fiona Young-Brown
On June 18, 2013, at
the annual meeting of
the American Medical
Association, members voted
to recognize obesity as a
disease. The announcement has met with
mixed reactions from those within the medical community and from those considered
obese. Here are some of the things you
should know about obesity and the AMA
decision.
Council on Science and
Public Health Against the
Decision
The decision to declare obesity a disease
was far from unanimous. The AMA’s own
Council on Science and Public Health
had advised against the move, stating that
it was unlikely to improve health, and the
means of determining obesity is inaccurate
and inherently flawed. Others opposed to
the decision argue that the rise in obesity
is largely related to increased sugar intake
and lower activity rates, which are lifestyle
choices. (Critics argue this is equivalent to
saying lung cancer is not a disease because
it was based on the lifestyle choice of smoking tobacco.) On the other hand, American
Association of Clinical Endocrinologists and
the American Academy of Family Physicians
support the new definition, arguing that
obesity is a metabolic disease. Lexington
dietitian, Jennifer Kraschnewski supports
the decision saying, “I think obesity is a
disease, because it’s something that is diagnosed and can also be treated or cured.”
Problems with
Measuring Obesity
So how is obesity measured? The Body
Mass Index (BMI) measures body fat
based upon a person’s height and weight.
Kraschnewski says, “BMI is a widely used
diagnosis tool. Every dietitian I know uses
BMI as indicator for categorizing body
composition. However, there are downfalls of using BMI.” A BMI of 30 or higher
categorizes you as obese. There are several
problems with this. First, the BMI does not
take into account muscle mass, ethnicity,
or body structure. Thus, most professional
athletes would be considered obese, simply
because their muscle mass adds to their
weight. Many at your local gym whom you
aspire to look like are no doubt in the obese
category because of this arbitrary measurement. Furthermore, BMI is no indicator of
overall health. Being overweight or fat does
not automatically mean you are unhealthy,
just as having a “normal” BMI does not
guarantee perfect health. So why is BMI
used? According to Kraschnewski, “Until
there’s an efficient and cheap way to use
those body composition machines (DEXA
and BOD POD for example), BMI is the
best and quickest solution for now.”
Whether obesity is a disease or not – does
it really change anything? Will it motivate
some people to lose weight? Will it encourage doctors to help their patients? Jonathan
Piercy, a Hazard-based professor of family medicine does not expect to see many
changes: “People who think there’s nothing
complicated about losing weight and that fat
people are just lazy will roll their eyes and
not change their opinion. People who do
have a weight problem already understand.
And there still isn’t much doctors can do
about it, except for weight loss surgery in
some cases and treating complications.”
Louisville nurse Sarah Martin agrees: “It’s a
label, plain and simple. There are so many
negative connotations of obesity that it
automatically shuts down the discussion.”
Whether we choose to consider obesity a
disease or not, the truth is that America has
a weight problem. Perhaps the best advice
comes from Lexington resident and writer,
Doris Settles. She says, “The reality is that
Americans eat S.A.D. (standard American
diet) with high gluten wheat content, grainfed meat and cheese, and way too much
sugar. Then because they feel bad they don’t
move. There are real physical issues that
cause obesity, but for many diet and exercise
is the issue. Obesity as