Obesity Declared a Disease, Now What?

Warning Pregnant Woman

Last month, the American Medical Association (AMA) declared obesity a disease. According to Melissa Healy and Anna Gorman, LA Times, this is “a move that effectively defines 78 million American adults and 12 million children as having a medical condition requiring treatment.”

Recognizing obesity as a disease, the medical community contends, will change the way it approaches this vast issue, making it an obligation of the medical professional. Obesity treatments such as bariatric surgery and treatment of conditions associated with obesity, such as diabetes, is uneven among the insurers nationally, often varying state by state. Some programs, including the federally funded Medicare ones, do cover those services.

However, some health care professionals question, according to the article, “whether the action would do more to help affected patients get useful treatment or would further stigmatize a condition with many causes and few easy fixes.”

Healy and Gorman write:

Studies have found that more than half of obese patients have never been told by a medical professional they need to lose weight — a result not only of some doctors’ reluctance to offend but of their unwillingness to open a lengthy consultation for which they might not be reimbursed.

Not only do doctors shy away from “that conversation” with their patients, but some also apparently have been turning the obese patients away. Bob LaMendola reported for Sun Sentinel back in May 2011:

Fifteen obstetrics-gynecology practices [in South Florida] out of 105 polled by the Sun Sentinel said they have set weight cut-offs for new patients starting at 200 pounds or based on measures of obesity — and turn down women who are heavier.

Some of the doctors said the main reason was their exam tables or other equipment can’t handle people over a certain weight. But at least six said they were trying to avoid obese patients because they have a higher risk of complications. […]

[T]he policy worried leaders of physician groups, medical ethics experts and advocates for the obese, all of whom said it violates the spirit of the medical profession.

Apparently, ob-gyns have turned overweight pregnant patients away for years, but refusing to treat overweight women who are not pregnant is a relatively new practice. It’s not illegal, per AMA, to turn away patients and refer to the specialists instead (or drop them, citing, say, a personality incompatibility), unless it’s discriminatory, of course.

The good doctors have spoken: Some do indeed feel underqualified to give counseling to overweight patients. Here are the results of a study by researchers at the Johns Hopkins Bloomberg School of Public Health:

Researchers examined primary care physician perspectives on the causes of and solutions to obesity care and identified differences in these perspectives by number of years since completion of medical school. They found that only 44 percent of primary care physicians reported success in helping obese patients lose weight and that primary care physicians identified nutritionists and dietitians as the most qualified providers to care for obese patients.

The John Hopkins press release announcing the results of the study quotes Sara Bleich, Ph.D., lead author of the study and an assistant professor with the Bloomberg School’s Department of Health Policy and Management:

With respect to training and practice-based changes, primary care physicians would like to see implemented, 93 percent reported that including body mass index (BMI) as a fifth vital sign would be helpful; 89 percent reported that including diet and exercise tips in patients’ charts would be helpful; 85 percent reported that having scales that calculate BMI would be helpful and 69 percent reported that adding BMI to patients’ charts would be helpful.

Bleich continues, and perhaps this is the key finding:

There are few differences in primary care physician perspectives about the causes of obesity or solutions to improve care, regardless of when they completed medical school, suggesting that obesity-related medical education has changed little over time.

AMA hopes to change that, one step at a time, and, apparently, after much deliberation. Even if the doctors can’t “cure” obesity necessarily, at least they can view it as more than a behavioral problem, and approach it as a serious health risk, and the expensive and complicated issue that it is.

The LA Times article notes:

The new designation follows a steep 30-year climb in Americans’ weight — and growing public concern over the resulting tidal wave of expensive health problems. Treatment of such obesity-related illnesses as cardiovascular disease, Type 2 diabetes and certain cancers drives up the nation’s medical bill by more than $150 billion a year, according to the Centers for Disease Control and Prevention.

Source: “AMA declares obesity a disease,” LA Times, 06/18/13
Source: “Some ob-gyns in South Florida turn away overweight women,” Sun Sentinel, 05/16/11
Source: “Physicians Admit Feeling Under Qualified and Lacking Necessary Education to Treat Obesity,” JHSPH.edu, 12/20/12
Image by raebrune.

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