TORONTO –In a contentious move aimed at fighting the obesity epidemic, the American Medical Association recognized obesity as a disease at its annual meeting.
The Tuesday night ruling is a controversial one: the AMA is the U.S.’s largest physician group and its declaration adds pressure on health officials around the world to rethink the way obesity is approached and treated.
Traditionally, obesity has been seen simply as a “risk factor” for a string of health concerns – diabetes, high blood pressure, high cholesterol or heart failure, for example. Canadian experts suggest its official disease status could thrust the condition into the focus of doctors, from family physicians to scientists.
“The reason nutrition experts and obesity experts want to label it as a disease is because it highlights the fact that obesity is not just a problem because it’s a risk factor for other diseases,” Dr. Anna Reid said.
Reid is the president of the Canadian Medical Association, a national organization which represents more than 76,000 doctors.
“Obesity experts and now the AMA are saying we need to reframe our thinking around this condition and we need to look at it holistically,” she told Global News.
“Sometimes, frankly, some of the advice given is not the best or most helpful. Telling someone that obesity means to simply eat less and move more is like telling someone with depression that they need to cheer up. It doesn’t go to the root of the problem, the actual reasons for overeating,” Sharma said.
Sharma is also a medicine professor and chair of obesity research at the University of Alberta.
Some people dealing with obesity could be in unhelpful environments, under stress, relying on medications, losing sleep or facing mood disorders, Sharma says, as examples.
“It is such a complicated issue and you have to take the time to try to figure out what is going on and address the drivers of obesity,” Sharma said.
Obesity and social stigma
There’s strong stigma around obesity as well, the doctors say. While the AMA voted in favour of medicalizing the condition, critics claim that the decision labels one-third of Americans as being sick. Some of these people could be treated simply for having a high BMI, while they may be healthy.
Ultimately, they argue that the decision removes the responsibility of personal health from the patient, who may use the disease as an excuse.
(To that, the AMA offered this response in its resolution: “The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.”)
Reid says obesity leads to mental health issues, such as depression, isolation and discrimination.
While the AMA’s decision doesn’t hold any legal weight, in the U.S., it could turn the diagnosis and treatment of obesity into a doctor’s professional obligation.
That’s important, too. Sharma’s Obesity Network launched its own tool kit for primary care doctors. It touches on helping doctors navigate obesity with their patients – what Sharma says can be an awkward situation for both physicians and patients.
Doctors can encourage and educate patients about exercise and healthy eating, along with medicine, as they would with diabetes or those who had just suffered a heart attack.
Obesity in Canada and worldwide
The ruling comes at a critical time: in its latest update, Health Canada warned that over one in four Canadian adults are obese. About nine per cent of kids across the country are obese as well.
Meanwhile, in the U.S., that number swells to one-third of the adult population. The World Health Organization says that globally, obesity rates have doubled since 1980. As of 2008, more than 1.4 billion adults were considered overweight.
The AMA’s decision contradicted a committee’s recommendation after it studied the issue. The AMA said it hoped its ruling would usher in new policies to target obesity, and in turn, fight chronic illnesses like heart disease or diabetes.
Sharma, who is in favour of the label, agrees. He suggests that attacking obesity is a proactive measure, instead of responding to the repercussions of the condition.
“In Canada, we need to think about how we will treat the disease and provide the resources to treat the disease. If you look at the money we are spending on the effects of obesity – joint replacements, hip replacements, sleep apnea, medications – these are all directly related to diabetes,” he explained.
“We could spend some of that money on treating obesity so that we don’t have to treat the complications,” he said.
The Public Health Agency of Canada pegged the economic costs of obesity at $4.6 billion in 2008 – that figure is based on the eight chronic diseases most commonly linked to obesity.
For now, the CMA doesn’t have a stance on obesity. Its members bring forth motions that are then debated before a policy is outlined, Reid said.