Debate erupts over labeling obesity as disease
Though fat activists demand that the AMA reverse its position, calling obesity a disease will open doors to better treatment and better reimbursements, said Dr. Steve Smith, president-elect of The Obesity Society.
ORLANDO, Fla. — When the American Medical Association (AMA) last week declared obesity a disease — instantly labeling one-third of Americans as sick — it launched a controversy not seen since alcoholism received the disease designation.
Hailed by some obesity experts as a long-overdue victory, the news from the nation’s largest medical group was denounced by others who say the move fuels the stigma against obese Americans.
Fat activists promptly started the #IAmNotADisease hashtag on Twitter, and a petition demanding that the AMA reverse its position.
Calling obesity a disease will open doors to better treatment and better reimbursements, said Dr. Steve Smith, president-elect of The Obesity Society, which has referred to obesity as a disease since 2008.
“It adds legitimacy to the problem, will help raise public awareness and will get doctors engaged in treating the condition,” said Smith, also scientific director for the Florida Hospital-Sanford Burnham Translational Research Institute for Metabolism and Diabetes, in Orlando.
The AMA’s decision “is a defining moment,” said Joe Nadglowski, president of the Obesity Action Coalition, a national nonprofit based in Tampa that helps those struggling with obesity. “It puts obesity on the same path as treatments for addictions to alcohol or tobacco, and mental-health problems, such as depression.”
A few decades ago, those conditions were also perceived as behavioral problems, said Nadglowski. “Once we realized they involved a disease process, that drove better coverage, better treatment, and real change.”
More than 35 percent of Americans are obese, according to the Centers for Disease Control and Prevention (CDC).
But that doesn’t necessarily mean they’re sick, many argue.
“We don’t see ourselves as diseased,” said Peggy Howell, spokeswoman for the National Association to Advance Fat Acceptance, a 44-year-old nonprofit that works to improve the quality of life for people of large size.
“To label a whole segment of society as diseased without any knowledge of their health is unacceptable,” she said. “It directly fuels discrimination. This is a step backward.”
Howell, 65, added: “I have been fat my entire life. If being fat were so horrific, why am I not wracked with problems? I have slightly high blood pressure, like a lot of thin people, but other than that, I perceive myself as a healthy woman, far healthier than a lot of people I know. But two days ago I was declared diseased.”
Linda Bacon, a nutritionist at University of California, Davis, said: “I’m appalled that the AMA chose to ignore science and name obesity a disease.”
Bacon, author of “Health at Every Size,” joins other critics in noting that the definition of obesity — basically how one’s weight and height ratio stacks up on a BMI chart — is imprecise and only defines size not health.
“The AMA just determined that some people are sick based on how they look,” said Bacon. “What’s next? Will they pronounce being black as a disease because there are higher rates of cardiovascular disease in black communities?”
Nadglowski of the Obesity Action Coalition believes the new designation will reduce the stigma regarding obesity.
The coalition has long referred to obesity as a disease based on the complexity of the issue, he said. “It’s not as simple as pushing away from the table and getting on the treadmill.”
Last year the American Association of Clinical Endocrinologists joined the coalition and The Obesity Society in calling obesity a disease.
One change Nadglowski expects to see as a result of the AMA’s position is obese patients feeling more comfortable discussing weight problems with their health-care providers. Now that their condition can be recognized as a legitimate disease, he said, they will feel less ashamed talking about it with their doctors.
He also hopes the new awareness will improve training in medical schools, where education on treating obesity is minimal.
Howell, however, believes the label will make those of large size even less likely to seek medical care.
“A high percentage of doctors still perceive obese patients as those who overconsume fast food and sugary sodas and have weak characters,” Howell said.
“The AMA decision won’t change those attitudes overnight,” she said.