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  • November 23, 2014

Obesity as a Disease: A Growing Problem - Ladue News: Health-wellness

Obesity as a Disease: A Growing Problem

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Posted: Thursday, September 19, 2013 12:00 pm

Nothing about the discussion of obesity is simple, according to Katie Thompson, a primary therapist with Castlewood Treatment Center for Eating Disorders. And the American Medical Association’s (AMA) recent decision to recognize obesity as a disease—not just a condition that causes disease—complicates matters even more.

In fact, the AMA’s June ruling was controversial among the organization’s own ranks. The AMA Council on Science and Public Health, after reviewing scientific evidence and debating the issue, recommended against the disease designation. The council expressed concern that using body mass index (BMI) as the primary diagnostic indicator is overly simplistic.

However, the AMA House of Delegates rejected the council’s concerns, voting for recognition of the disease designation. “There are many conditions, diseases, syndromes, etc., with ICD-9 codes (the diagnostic codes used by physicians). Obesity has been no different. Having the AMA and other professional medical societies and organizations publicly recognize it means there will now be an emphasis on obesity regarding its diagnosis and proper treatment,” says Dr. Mario Morales, medical director and weight-loss surgeon for SSM Weight-Loss Institute.

It is known that obesity contributes to a range of diseases, such as diabetes, high blood pressure and heart disease. These diseases have long been diagnosed and treated through approved and accepted medical interventions. If obesity itself becomes the focus of diagnostic and medical intervention, even absent the complications and diseases associated with it, “at the physician-to-patient level, it means that an obese patient will now be told that they have the disease of obesity and a formal treatment plan will be established,” Morales says, noting that the designation also will help obesity to come out of the shadows of being viewed as a personal discipline flaw and begin to be seen more as a complicated disease process that is multi-factorial involving physiology, genetics and social influences.

In addition, “It also makes it more difficult for insurers to hold coverage or avoid providing treatment options to obese individuals,” Morales says. “And it’s expected that there will be increased resources dedicated to advancing diagnostics and treatment interventions in the academic and private sectors.”

Despite this potential, Thompson sees possible downsides to focusing solely on reducing BMI as the ‘cure’ for obesity. “When the focus is on reducing body mass and weight rather than on healthy living, balanced food choices and the incorporation of appropriate movement, research has shown that individuals will feel pressured to use unhealthy means to reduce body weight such as restriction,” she says. “In the long run, restrictive food choices in individuals attempting to control body weight often will lead to compulsive overeating and binge-eating behaviors.”

Thompson adds that by bringing even more attention to obese individuals as ‘sick,’ there may be an increased potential for eating disorders to develop based on negative self-image and subsequent extreme attempts to control weight. “The focus needs to shift from weight loss as a means to increase health to a focus on improving healthy behaviors and reducing unhealthy behaviors to improve overall and long-term health,” she says.

Despite the arguments over semantics and classifications, experts agree that everyone should strive for a healthy lifestyle, including a balanced, moderate diet and regular exercise. When adhered to on a regular basis, these behaviors will help individuals achieve and maintain healthy weight and reduce risk of the many conditions associated with obesity. And that’s the goal, no matter what you call it.

 

 

Obesity as Disease? Two Points of View:

Katie Thompson

Castlewood Treatment Center 

With weight loss as the main approach historically of treating obesity, if more resources and efforts will be placed on the traditional approach to treating it, then it is safe to say that categorizing obesity as a disease with the end goal of reducing obesity will not be achieved in the traditional model.

Focusing solely on weight reduction as a means to treat obesity is limiting and damaging.  Reducing BMI is not a single indicator of health; and unfortunately, this is often the goal of obesity treatment—losing weight and reducing BMI. When the focus is on reducing body mass and weight rather than on healthy living, balanced food choices and the incorporation of appropriate movement, research has shown that individuals will feel pressured to use unhealthy means to reduce body weight such as restriction. In the long run, restrictive food choices in individuals attempting to control body weight often will lead to compulsive overeating and binge-eating behaviors.

Individuals also feel increased levels of weight stigma or ‘fat shaming,’ which research has shown actually motivates individuals to engage in dangerous weight-loss methods such as restriction and compensatory behaviors.  Weight-loss models are also dangerous in that the focus is often aligned with the goals of an eating disorder. An eating disorder thrives in body image dissatisfaction, attempts to control weight, internal negative self-talk and extreme behaviors with food. 

The focus needs to shift from weight loss as a means to increase health to a focus on improving healthy behaviors and reducing unhealthy behaviors to improve overall and long-term health. 

 

Dr. Mario Morales

SSM Weight-Loss Institute

There are many conditions, diseases, syndromes, etc. with ICD-9 codes. Obesity has been no different. Having the AMA and other professional medical societies /organizations publicly recognize it means there will now be an emphasis on obesity regarding its diagnosis and proper treatment. 

It is expected that obesity will come out of the ‘shadows’ of being viewed as a personal discipline flaw and more along the lines of a complicated disease process that is multi-factorial involving physiology, genetics and social influences.

Because it is now considered to be a legitimate disease, it cannot be ignored by physicians and has to be addressed properly. It also makes it more difficult for insurers to hold coverage or avoid providing treatment options to obese individuals. It is also expected that there will be increased resources dedicated to advancing diagnostics and treatment interventions in the academic and private sectors.

At the physician-to-patient level it means that an obese patient will now be told that they have the disease of obesity and a formal treatment plan will be established. It will now be very similar to hypertension, for example. If a patient is found to have elevated blood pressure, a protocol is set in play to treat the high blood pressure.

Obesity is not simply a result of personal decision-making and practice. It is a complex disease that is influenced significantly by individual physiology, socioeconomic conditions and driven by genetics. It should be appropriately diagnosed and aggressively treated.          

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