Obesity, as most people already know, plays a significant role in many of the diseases that plague the United States: heart disease, hypertension and stroke, Type 2 diabetes, osteoarthritis and many cancers, including colon and breast cancers.

But the national medical community took a major step last week in helping recognize that obesity is a disease in and of itself. A person is considered obese if his or her body mass index, or BMI, is 30 or above.

Local professionals say the resolution passed last week by the American Medical Association House of Delegates will have implications for the way obesity is treated, and likely covered by insurance, in the future.

The AMA’s House of Delegates joined an array of other medical societies in recognizing obesity as a disease. Others include the American Association of Clinical Endocrinologists, The Endocrine Society, the American College of Cardiology, the American College of Surgeons and the American Urological Association.

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

Ultimately, Harris says, the new recognition would help fight cardiovascular disease and diabetes.

Overdue treatment

Patrick M. O’Neil, director of the Medical University of South Carolina Weight Management Center and past president of The Obesity Society, says the center has “long seen evidence that obesity is a disease.”

The society recently launched an initiative called “Treat Obesity Seriously” in an effort to recognize and treat it as such.

O’Neill says obesity is a disease marked by numerous physiological and metabolic abnormalities.

“Some of these abnormalities tend to have a self-perpetuating effect for the condition, making it more difficult to return to a lower weight, and stay there, than many people realize,” says O’Neill.

“While this decision does not have the force of law, it should accelerate the existing movement toward treating obesity seriously, as a medical problem that deserves treatment in its own right.”

O’Neill says the AMA’s recognition should promote the insurance coverage of obesity treatments by health care professionals, as is the case for the other diseases often precipitated by obesity.

He also hopes the recognition will strengthen the interest and funding of research into obesity treatments.

Overcoming bias

Dr. Kenneth Mitchell, medical director of the Roper St. Francis Bariatric & Metabolic Services program, says the classification will change the way both professionals and the public view obesity, “not as a personal choice by the patient, but as a complex, chronic, multifactorial disease.”

“Our hope is that this decision will help alleviate the stigma, discrimination and bias currently associated with patients suffering from obesity,” says Mitchell.

He adds that the decision also should cause a shift in the education of medical students, residents, nurses and other health care professionals, as well as practicing health care professionals, that proven treatment options exist and can be successful.

Among the newest are two new obesity drugs, Qsymia from Vivus and Belviq from Arena Pharmaceuticals, which have entered the market in the past year.

Qsymia has not sold well for a variety of reasons, including poor reimbursement and distribution restrictions imposed over concerns that the drug can cause birth defects. Those restrictions are being relaxed.

Belviq went on sale only about a week ago, so it is too early to tell how it is doing.

Mitchell adds that the new policy assures patients that scientific evidence regarding the cause, prevention and treatment of obesity will not be ignored.

“Now patient access to proven treatment options needs to improve so that the previous consensus of leading health organizations ... allows for universal coverage options for the prevention and treatment of this chronic disease process for all patients suffering from the devastating effects of obesity,” says Mitchell.

The declaration could make it easier to get funding for obesity research, says Jacqueline F. McGinty, a professor in the Department of Neurosciences at MUSC.

McGinty also studies brain mechanisms underlying compulsive eating.

Another positive result, she says, “would be the recruitment of more scientists into obesity research that has the potential to lead to novel treatment approaches.”

Parallels with alcohol?

Dr. Suzanne Thomas of the MUSC Department of Psychiatry’s Center for Drug and Alcohol Programs drew a comparison on past and present views of alcoholism and obesity.

“Two decades ago, alcoholism was considered a moral weakness, not a medical condition,” says Thomas, who is an associate professor of psychiatry.

“As the field of study of alcohol addiction grew and we began to understand better the biological underpinnings of alcoholism, and how physical changes in the brain lead to certain behaviors, such as compulsions, cravings and loss of volitional control, this had a few major impacts.

“First, it led to even more helpful studies on treatments. Second, it reduced, though did not eliminate, the stigma of alcoholism. And third, it led to more health insurance plans covering addiction treatment.”

Thomas says the characterization of some forms of compulsive eating as a disease is based on scientific research.

By using imaging studies, for example, psychiatry experts know that some of the changes that are observed in the brains in people who characterize themselves as “food addicts” look very similar to those of alcoholics.

“Basic science studies (studies on animals) also show similarities between substance addiction and obesity. It is not surprising that health care providers tout this new consideration of the disease model for some forms of obesity as a step in the right direction.”

Controversy

According to The New York Times, the vote of AMA’s House of Delegates went against the conclusions of the association’s Council on Science and Public Health, which had studied the issue over the past year.

The council had issues with the definition of obesity being based on BMI, which it described as simplistic and flawed.

“Given the existing limitations of BMI 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 added that “medicalizing” obesity by declaring it a disease would define one-third of Americans as being ill and could lead to more reliance on costly drugs and surgery rather than lifestyle changes. Others with a high BMI, but who may be healthy otherwise, could risk being overtreated.

But the AMA’s House of Delegates sided with an array of other medical societies, noting in the resolution that: “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.”

Impact on policy?

University of Pittsburgh Medical Center bariatric surgeon Dr. Joseph J. Colella specializes in super-obese patients with a BMI of 60 or more, and knows first-hand that the problem with many patients goes beyond the simple formula of eating a better diet and exercising regularly.

He thinks the recognition of obesity may make it easier for policymakers to make changes, as it did with smoking and driving safety.

“As soon as policymakers come to the realization that society’s addiction to sugar is at the root of the problem, they can then begin to push for more aggressive campaigns of awareness and education as to the real dangers of simple sugar ingestion, both to one’s health and to their waistline.”