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A.M.A. Recognizes Obesity as a Disease

By ANDREW POLLACK

Published: June 18, 2013

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The American Medical Association has officially recognized obesity as a disease, a move that could induce physicians to pay more attention to the condition and spur more insurers to pay for treatments.

In making the recommendation, delegates at the association’s annual meeting in Chicago overrode a recommendation against doing so by a committee that had studied the matter.

“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, said in a statement.

To some extent, the question of whether obesity is a disease or not is a semantic one, since there is not even a universally agreed upon definition of what constitutes a disease. And the A.M.A.’s decision has no legal authority.

Still, some doctors and obesity advocates said that having the nation’s largest physician group make the declaration would focus more attention on it.

“I think you will probably see from this physicians taking obesity more seriously, counseling their patients about it,” said Morgan Downey, an advocate for obese people and publisher of the online Downey Obesity Report. He said it would help improve reimbursement for obesity drugs, surgery and counseling and help spur sales.

“Companies marketing the products will be able to take this to physicians and point to it and say, ‘Look, the mother ship has now recognized obesity as a disease.’ ”

Two new obesity drugs — Qsymia from Vivus, and Belviq from Arena Pharmaceuticals and Eisai — have entered the market in the last year.

Whether obesity should be called a disease has been debated by other societies in the past. The Obesity Society officially issued its support for classifying obesity as a disease in 2008, with Mr. Downey as one of the authors of the paper.

A reason often given for making the declaration is that it would help remove the stigma that obesity is a result of eating too much or exercising too little. Some doctors say that obese people do not have full control of their weight.

But the A.M.A.’s Council on Science and Public Health, which had studied the issue for the last year, recommended against the move.

The main reason, it said, was that the measure usually used to define obesity, the body mass index, is simplistic and flawed. Some people with a B.M.I. above the level that usually defines obesity are perfectly healthy while others below it can have dangerous levels of body fat.

“Given the existing limitations of B.M.I. to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes,” the council wrote.

It also said that “medicalizing” obesity by declaring it a disease might lead to more reliance on costly drugs and surgery rather than lifestyle changes. It said some people might be overtreated because their B.M.I. was above a line designating them as having a disease, even though they were healthy.

The delegates however, rejected the reasoning of the council and voted instead in favor of an opposing resolution pushed by the American Association of Clinical Endocrinologists, the American College of Cardiology and some other organizations.

This resolution argued that obesity was a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like Type 2 diabetes and cardiovascular disease.

“The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes,” the resolution said.

The American Medical Association is considering whether to endorse recognizing obesity as a disease in what supporters say would spur more U.S. and private investment to what is a national epidemic.

Such a move, supporters say, would result in greater investments and potentially health insurance coverage specifically for a diagnosis that someone is obese when there is a payment mechanism for evaluating and managing obesity. The AMA’s policy-making House of Delegates is discussing “recognition of obesity as a disease” during its annual meeting this week in Chicago.

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“More widespread recognition of obesity as a disease could result in greater investment by government and the private sector to develop and reimburse obesity treatments,” a 14-page report released by the AMA’s Council on Science and Public Health said.

While any action this week by AMA delegates has no legal authority, its policy stances in the past have been used by policymakers in Washington and in state capitols across the country when medical policy and health regulations are debated and made.

In a 14-page report, the AMA’s science and public health council offered its membership pros and cons of classifying obesity as a disease. On the proponent side, the report said obesity is “similar to other diseases . . . (such as) hypertension, diabetes, lung cancer that result from a combination of genetics and environmental factors.”

On Sunday, several doctors who testified at an AMA panel on public health issues said doctors needed to be compensated for treating obesity and a disease classification would help in that regard.

Dr. Virginia Hall, an obstetrician from Hershey, Pa., said the AMA should endorse declaring obesity as a disease so “insurers can stop ducking their responsibility” in paying for treatment of the obese.

Yet opponents to classifying obesity as a disease reason “obesity results from personal choices to overeat or live a sedentary lifestyle,” the report states. Therefore, opponents say obesity is not an illness, the council on science and public health said.

Some, including AMA delegates testifying this week, worry that classifying obesity as a disease would lead unnecessarily to a spike in health care costs and not necessarily improve patient outcomes.

Employers and insurance companies say the current reimbursement structure for obesity as a condition is adequate and those who pay for health care have increasingly added new benefits to address the obesity epidemic.

“We understand obesity as a condition and a risk factor for other diseases,” said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, which includes the nation’s largest health plans, UnitedHealth Group UNH -0.55% (UNH), Aetna AET -1.72% (AET), Cigna (CI), Humana (HUM) and many Blue Cross plans among its membership.

“The important thing is to get programs and supports in place to address it, as health plans have done and are doing,” Pisano added.

The resolution regarding recognition of obesity as a disease is among scores being debated at the AMA’s 524-member House of Delegates, which runs through Wednesday at the Hyatt Regency Chicago

Slim results. People who take the drug for a year can expect to lose just 3 to 3.7 percent of their weight, and may gain the weight back, research suggests. In one trial, patients taking Belviq did lose up to 5 percent of their body weight after 12 months, but gained back 25 percent of it by the end of the second year.

Why? Nothing good about Arena or Belviq? Seems not

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Jefferies raises targets, advertising begins, news stories support, Belviq on shelves in pharmacy and shorts will continue to try and manipulate rather than cover. Why can't they get the message?