Does America Really Want to Solve the Obesity Epidemic?
On Tuesday, June 18, 2013, the American Medical Association officially recognized obesity as a disease. As an obesity medicine specialist intimately involved in this battle, I never expected this decision to be met with such apathy.
Since the landmark decision, a flurry of accusations have occurred:
- The AMA has been accused of making the decision with the sole purpose of profiting from pharmaceutical companies.
- Obese individuals have been blamed for creating another reason to ignore personal accountability.
- Obesity advocates have been charged by fat activists of increasing stigma for obese individuals (the very people they advocate for) by supporting this decision.
Why so much finger pointing?
The implications of this ruling are greater than many of us can comprehend. By acknowledging obesity as a disease, the AMA is placing obesity on par with the same diseases that sick fat cells create: diabetes, hypertension, high cholesterol, and heart disease. With obesity legitimized, we are all forced to change the way we think. But is America ready?
For an obese individual, classifying obesity as a disease forces you to view yourself differently. There is no such thing as a healthy obese person. Even if you do not have a formal diagnosis of diabetes, hypertension, or high cholesterol, you are not immune to the mass effects of fat itself: arthritis in the weight bearing joints, chronic back pain, gastric reflux disease, sleep apnea, vascular compromise, skin problems and right sided heart failure. Even the strongest frame cannot offset such mechanical stress.
Declaring obesity a disease causes non-obese Americans to look into their own biases. One blogger wrote, “Does this mean that I can call in ‘fat’ to work now?” It is easier to ostracize than make the effort to educate oneself about the complexity of obesity. Even a small weight gain can cause dysfunctional or “sick” fat cells. These cells produce more than 100 chemicals, some of which make it extremely difficult for an individual to feel a sense of fullness- which feeds the rolling snowball of weight gain. Are non-obese Americans willing to accept that obesity is more than just a character flaw?
Legitimizing obesity forces the medical community to face our own weight issues and biases. The Physician’s Health Study showed that 44% of male physicians are overweight. Despite this, we are some of the harshest critics of our obese patients. The AMA’s ruling should provide an opportunity to teach students, residents, and practicing physicians how to treat obesity effectively and with compassion. We will also need a paradigm shift. Instead of band-aiding obesity with medications for the affected illnesses, physicians will need to learn how to treat the core issue, i.e. the dysfunctional fat. Our focus will then shift from disease treatment to reversal and prevention. Are physicians ready for this?
Disease reversal is going to force national organizations that profit from chronic diseases to redefine their roles. Speaking at the American Diabetes Association EXPO in New York City, I was pulled aside by another speaker and reprimanded for discussing how weight loss could reverse type 2 diabetes. “We don’t talk about reversing diabetes here,” I was told. Are such organizations, and their constituents, ready to put patients ahead of the money and be honest with them about what truly works?
Calling obesity a disease will also highlight our completely dysfunctional agriculture system. The obesity epidemic coincides with the loss of diversification of agriculture, and the increase in production of high fructose corn syrup. It also mirrors the increased production of highly palatable processed foods. The sizable cost disparity between healthy and unhealthy foods continues to grow. Changing this will require a complete overhaul of our agriculture policies. Is the government ready for this?
Obesity costs the U.S. $190 billion per year, 21% of total health care costs, 4-5% of our GDP. It affects 33% of adults, and 17% of children in this country with no end in sight. So, does America want to solve the obesity epidemic? It is no longer a question of want, but rather an impending need. We are in a crisis. The economic and human toll from obesity is past its tipping point. There is no longer time for denial, drama, resentment, finger pointing and band aids to fix this issue. We must make big changes in our communities, our government, and in our individual lives to resolve this epidemic NOW.
By: Dr. Wendy Scinta