Obesity is a problem. It can lead to heart problems, diabetes and musculoskeletal issues, and it can be socially challenging. Some medical professionals now want to officially designate it as a disease. Why? Follow the money trail of health insurance.
Last week, as reported on MedPageToday.com, the House of Delegates-the policy-making body of the American Medical Association (AMA)-voted in a 60% majority to consider obesity a disease instead of a condition.
The significance of calling obesity a disease instead of a condition is twofold: It can change the way practitioners-mainly primary care/family doctors-treat overweight patients because insurance coverage of obesity treatment will improve.
Because many insurance plans don’t cover, or have limited coverage of, weight-loss programs or surgery, many doctors don’t spend their limited treatment minutes discussing things like diet and exercise with their overweight patients. But they do get reimbursed by insurance, however, when treating the disorders obesity can cause or at least contribute to.
Even under the Affordable Care Act, which becomes fully implemented in January, obesity treatment is not required in many of the plans sold on the state insurance exchanges where underinsured and uninsured people can shop for coverage.
The AMA delegates’ vote was controversial because it wasn’t the recommendation of the AMA’s Council on Science and Public Health, whose own report (see page 19) said that calling obesity a disease would present problems of its own.
Specifically, the council said that because obesity lacks a clear definition and is difficult to measure, calling it a disease could affect patient care negatively. Some people who are of “increased weight,” said one council member, have no other impaired function, so they don’t fit any definition of “disease.”
Council members pointed out that even if a person’s body-mass index makes them “obese” by commonly accepted standards, they might not be unhealthy. “Why should a third of Americans be diagnosed with a disease if they’re not necessarily sick?” one member asked
Still, the delegates’ resolution was supported by representatives from the American Academy of Pediatrics, the American Academy of Family Physicians, the American Association of Clinical Endocrinologists (among other disorders, they treat diabetes) and the American Society of Bariatric Physicians (gastric bypass and other weight-loss surgery).
The 60-percenters believe that calling obesity a disease sends a message not just to the public, but to the medical community that it must be made a priority for their attention.
Clinical guidelines for diagnoses and treatments are seldom defined from clear science that everyone agrees on. The AMA committee viewed the conflict over obesity, according to MedPage, as it would clinical guidelines when the science is unclear-by consensus. And by putting obesity under the category of disease, it would force attention onto its epidemic numbers in the U.S., and prompt health insurers to take more responsibility for treating it. According to the Centers for Disease Control and Prevention (CDC), 36 in 100 Americans are obese, and according to NPR, obesity costs about $190 billion a year in the U.S.
See our backgrounder on bariatric surgery.