The AMA says obesity is a disease. Is that healthy?

At its recent annual meeting, American Medical Association (AMA) delegates rejected the advice of their own Committee on Science and Public Health and voted to reclassify obesity as a disease rather than a condition or disease risk factor. 

Proponents believe that this reclassification by the nation’s largest physician organization will improve medical providers’ attitudes toward obesity, increase funding for research and treatment and improve patient care.  A substantial body of research has found overweight and obesity are associated with many serious health problems including: type 2 diabetes, coronary heart disease, and cancer.  Rather than seen as a personal failure, obesity will be seen as a disease resulting in greater attention paid to its medical consequences by the medical profession

Others are concerned this will increase unnecessary and costly pharmacological and surgical treatments and will lead to overtreatment of people based on their Body Mass Index (BMI) rather than objective health indicators.  While co-morbidities generally increase with increased BMI, there are many healthy overweight and obese individuals, who in some cases fare better than their lower weight counterparts.  For example, in a study  looking at cardiovascular risk based on BMI in 5,440 U.S. adults,  23.5 percent of normal-weight adults had cardiovascular abnormalities, while 51.3 percent of overweight adults and 31.7 percent of obese adults were metabolically healthy.  Some critics are concerned that the disease label will further stigmatize a group of people who already face pervasive discrimination and will result in physicians overlooking other serious health conditions unrelated to a patient’s weight.

What difference will the AMA’s decision make?  Time will tell.  But I worry.  Studies show what many obese patients know: physicians have negative attitudes and stereotypes about obese patients, viewing them as non-compliant, lazy, lacking in self-control, and even unintelligent. One study found that doctors were the most frequent source of weight-related stigma in the lives of overweight and obese women, and second-most frequent for men. Simply recasting obesity as a disease seems unlikely to reverse these attitudes, especially when they continue to be reinforced by much of society.

In reading about the AMA’s decision I recalled the years when the American Psychiatric Association (APA) classified homosexuality as a mental illness.   Some gay people accepted the medical designation of homosexuality as a mental illness in hopes it would result in more humane attitudes. Instead, it reinforced anti-gay societal prejudices and did nothing to improve the mental health, physical safety and overall well-being of gay people.  As reporter Alix Spiegel says in the “81 Words” episode of the public radio program This American Life: “Now because psychiatrists believed that homosexuals were pathological, it gave scientific sanction for the rest of the country to see it the same way.” 

After the Stonewall riots in 1969, considered the beginning of the modern gay rights movement, gay activists demanded APA remove homosexuality from being labeled a mental illness.  They challenged the doctors to "talk with us, not about us," as the late gay activist Barbara Gittings recalled.

What are obese people writing in response to the recent American Medical Association decision?  At the website, over 1,500 people have signed an on-line petition calling on the AMA to reverse this decision. When asked why they signed onto the petition, they wrote:

Calling a body size a disease will only make matters worse. BMI does not equal health. . . .

... It is wrong to define health on weight. We have been fighting for good self image with our teenagers who are wanting to be thinner. Cataloguing Obesity as a disease just adds to this. Lets focus more on healthy lifestyle. . . . 

... Because I am a very active person who is overweight and I want my children to understand health at every size and not struggle with body image issues their entire life. . . .

... As a fat American, I need to know that a doctor will look beyond my weight when diagnosing me. Even before this ruling, doctors tended to attribute any issues I was having to the fact that I am fat. This is a dangerous practice, as there is often something unrelated to weight that could go completely unnoticed. My life is on the line here.

In 1973, the American Psychiatric Association reversed the determination of homosexuality as a mental illness.  "I was the first chair of the American Psychological Association's gay psychologists group forty years ago this August," said Stephen F. Morin, PhD, a medical professor, chief of the prevention science division, and director of the Center for AIDS Prevention Studies at the University of California-San Francisco. "When we issued our first set of demands, our first demand was that professional associations commit themselves to fighting the stigma that had long been associated with homosexual orientation."

In its public statement, the AMA writes that recognizing obesity as a disease will help change the way the medical community tackles this complex health issue.  Real change will require the AMA and other medical professionals working alongside of people who are obese to commit themselves to fighting the stigma and prejudice of their peers and ensure this recent decision does not serve to further alienate overweight and obese patients.

The Rudd Center for Food Policy and Obesity at Yale University offers an on-line course and toolkit for clinicians to improve the delivery of care to overweight and obese patients and reduce weight-related bias by clinicians.

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