Monday, June 24, 2013

Yes, Virginia! Obesity Is A Disease

As you may have heard this week, Obesity has been formally classified as a disease by the AMA.  A big deal in some ways, not so much a revelation in other ways.

In the strict terms of a disease-state, certainly Obesity qualifies.  In fact, it has already been formally recognized so by a number of health organizations previously, including the NIH (National Institutes of Health), the SSA (Social Security Administration), and the Center for Medicare and Medicaid Services.  Now the AMA has added their name to the list.

“Similar to many other medical conditions, obesity is a complex, multifactorial chronic disease, requiring a multidisciplinary treatment approach. This approach must encompass the best standards of care, both in terms of the treatments chosen, and the care coordination and clinical environment in which they are delivered. Because of the complex nature of obesity and its variety of impacts on both physical and mental health, effective treatment requires the coordinated services of providers from several disciplines and professions (both physician and non-physician) within both of these treatment areas,” said AACE President Dr. Mechanick. “Adoption of this policy position by the AMA will help advocates in the obesity community address a number of key hurdles to individuals receiving critical medically necessary obesity treatment services.”

The hope is that with this new AMA-endorsed designation, patient access to proven treatments will become aligned with insurance coverage policy.  It may also put an emphasis on developing, or reinforcing, new treatment and prevention strategies, and additional resources to accelerate the compliation of that data.

Obesity is a complex condition with numerous casuses and manifestations.  It is attached to enormous social stigma and discrimination, causes poor quality of life, poor health, and accelerates premature mortality.

The additional take home message that we, as health care providers, need to keep in mind is responsibility.  It can be a fine line to walk, but despite there being a number of genetic, and even environmental factors (to a degree) that are beyond the control of the individual, we cannot disempower patients with such an emphasis on "Disease" to the point of encouraging fatalistic despair or helplessness.

Having patients "give up" and not even try to do what they can to control and reverse their overweight status is truly "the easy way out", as opposed to numerous patients that report receiving that same comment to us from their friends and family after successful bariatric surgery.

Similar in some ways to Alcoholism, the designation of the disease state certainly applies, but can tempt an effected individual to resign themselves to the fact that they have no power to do anything about their condition as a victim in the grand scheme when they acknowledge their current state of health.

The idea that the genes load the gun, and the environment pulls the trigger is still a good way of thinking about it, but must also take into account that there is a great deal of potential trigger-preventing behavior that can be actualized to have a profound impact on a patient's life in many aspects.

Optimally, caught early enough, and with due lifestyle diligence and persistence, the need for a Bariatric Surgery referral would not be necessary.  However, when treatment is needed in those who repeatedly fail lifestyle intervention, and/or have deteriortating lifestyle quality (and likely reduced quantity) from burgeoning commorbidities, there is a certain time and a place for bariatric / metabolic surgery. 

Finally, I think that noone would argue that bariatric surgery is the end-all, be-all for Obesity as a diease state.  There abviously is no preventative aspect to what we do in terms of forestalling the development of increasing body weight in the first place, but that shouldn't diminish its role in the treatment of advanced obesity and comorbidites, especially when another reasonable alternative doesn't exist.

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