Concerns emerge over calling obesity a disease

Many doctors are praising the decision to recognize obesity as a disease, but some say it could lead to higher health care costs and other problems.

The American Medical Association's decision this week to recognize obesity as a disease has many physicians and obese patients enthusiastic about increased attention to the condition and new treatment options, but others are concerned about the potential consequences this change could bring.

CLASSIFYING ALL OBESE PEOPLE AS SICK

The AMA's delegates made this decision despite opposition from the Council on Science and Public Health, an AMA advisory body. The board expressed concern over using body mass index (BMI) as an obesity gauge, noting that it can be an imprecise measurement.  Some people with a higher BMI are in good health, while others not considered obese by this standard can still have high levels of body fat and metabolic issues. 

POTENTIAL FOR INCREASES IN INSURANCE AND HEALTH CARE COSTS

Opinion is also divided on how this change will impact health care costs. The hope is that over time, a focus on preventive treatment will lower the enormous health care costs associated with the obesity epidemic.

According to the CDC, obesity cost Americans $147 billion in 2008, and spending for obese people was 42 percent higher than spending for those at normal weights.

Dr. Lou Aronne, an obesity expert at New York Presbyterian Hospital, said coverage for prevention and treatment programs "sounds like it's a bargain" compared to the costs of treating obesity-related diseases such as diabetes and heart disease.

But some doctors worry that calling obesity a disease will actually result in higher insurance premiums and drug costs.

"In theory, the coverage of preventive services will lead to lower overall costs, but in practice it will not work this way," said Dr. Charlie Seltzer, who specializes in weight loss.

"This will now validate driving up insurance rates for all to pay for ineffective drugs when less expensive dietary measures can be the solution," said Dr. Richard Hammer, an associate professor at the University of Missouri School of Medicine.

Unfortunately, this may be a lose-lose situation.

"The costs are going to go up whether obesity is classified as a disease or not," said Michael Wood, a health management consultant for Towers Watson.

Classifying obesity as a disease could possibly open the door for individuals to use the diagnosis as a partial basis for a disability claim.

Mira Calton, a Florida-based nutritionist, says the AMA's move means more people could wind up on disability, though eligibility takes more than an obesity diagnosis. As it stands, an applicant cannot get disability based on obesity alone; it is often tied to another condition listed on the Social Security Administration's list of impairments.

Dr. Patrice Harris, an AMA board member said the issue of disability was not a focus of the policy.

Related: Gene research may help stop baby's obesity risk

PATIENTS MIGHT CHOOSE DRUGS OR SURGERY OVER POSITIVE LIFESTYLE CHANGES

Dr. Nikhil Dhurandhar, vice president of The Obesity Society, believes more patients will feel that their condition has been validated as a metabolic disease and not just an eating issue and will seek treatment. He also predicted that pharmaceutical companies will develop more weight-loss drugs, expanding medication options.

New treatment advances would be a positive development, but the flip side of the argument is that obese people could start turning to medication instead of adopting an integrated plan with nutritional and fitness counseling.

Dr. Aronne, of Columbia, also said the change "very well may" result in an increase in weight-loss surgeries such as gastric bypass.

OBESE PEOPLE MAY GIVE UP

Some experts worry the AMA's decision will cause obese people to seek quick interventions or discourage them from making lifestyle changes.

"Labeling it a disease removes accountability, and without that key personality characteristic, change is not possible," said Michigan-based psychotherapist Harper West.

Still, many experts are hopeful that this change will have positive results.

Kenneth Thorpe, Ph.D., a professor at the Rollins School of Public Health at Emory University and executive director of the Partnership to Fight Chronic Disease, said the success of the Diabetes Prevention Program to lower the disease by 58 percent in trials indicates that the AMA's decision could have similar results for obesity.

"We could have an enormous impact on cutting costs and improving quality in care," Thorpe said. "This is sort of the first step. It changes the mindset for how physicians and [insurance] plans deal with preventive services."

Related: Obesity gets a new diagnosis: It's a disease

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