Will obesity’s new status as a disease impact the future of care?

Obesity in the U.S., 2010: Percentage of people with a BMI over 30. (Wikimedia Commons)
Obesity in the U.S., 2010: Percentage of people with a BMI over 30. (Wikimedia Commons)
Obesity is moving up in the world: After much debate, the American Medical Association (AMA) has elevated it from a condition to a disease. Though the decision has sparked provocative discussion in the medical field, delegates from the American Academy of Pediatrics (AAP), the American Academy of Family Physicians, the American Association of Clinical Endocrinologists and the American Society of Bariatric Physicians are in support.

But can obesity’s new nomenclature actually impact treatment, especially for children?

“It’s a hard issue,” says Shari Nethersole, MD, medical director of Community Health at Boston Children’s Hospital. “In our health system, diseases are more incorporated into systems of care and get better coverage.”

On the other hand, she hopes the new definition doesn’t imply that because it’s a disease, obesity has to be a lifelong thing. “It’s not a random event that you become obese. Most obesity we see in children has an identifiable source and can be prevented and managed. Children, especially, can turn it around with the proper interventions,” says Nethersole. “Being obese at age 6 doesn’t mean you have to be obese at age 15.”

But some argue that calling it a disease might actually shift emphasis away from prevention. “People who respond that way will continue to feel that way no matter how it’s defined,” says Stephen Pont, MD, MPH, chair of the AAP’s Provisional Section on Obesity, who supports the new definition. “But this may help most people recognize the seriousness of how their weight impacts their health.”

“When you really consider something as a disease, it opens a door.”

Prevention is especially important for children, who don’t control what food enters the house, or whether they live in a safe enough area to get physical activity outside. Furthermore, most states and insurance companies won’t reimburse for a doctor’s visit solely for weight, but they will reimburse for the comorbidities that develop down the road, like high cholesterol and high blood pressure.

Since most children don’t present with these symptoms and co-morbidities associated with obesity until later in life, they essentially can’t get covered for obesity treatment until they’re already in too deep. “This decision could increase pressure for insurance companies to reimburse these visits,” says Pont. “The sooner we’re allowed to have the conversation and identify the problem, the sooner we can help them live longer, happier lives by preventing future complications and additional health care costs for them as adults.”

But properly identifying the problem is yet another sore spot: Some medical professionals argue that the main diagnostic tool for obesity—body mass index (BMI)—isn’t a perfect diagnostic indicator. “No, it’s not perfect,” says Pont. “But it’s a huge red flag, and it’s easy to obtain and gauge how far a patient is from a normal healthy weight.”

This earlier identification could become a huge step in starting a conversation and helping patients to access weight-related recommendations from medical professionals, and could invigorate efforts to curb environmental contributors to obesity. But Pont recognizes that it’s not all about the doctor’s office.

“There are other huge contributing factors, like advertising unhealthy products to children, or lack of access to healthy foods or safe outdoor spaces for physical activity,” says Pont. “When you really consider something as a disease, it opens a door. It increases awareness for all its components, including environmental.”

But perhaps its new medical attention could underscore and complement societal public health efforts to combat obesity from multiple angles at its conception. “Maybe physicians will start to think more openly and positively about preventing obesity,” he says. “Medical professionals won’t be the whole solution, but we can play a uniquely critical role.”