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The American Medical Association Goes Against Recommendations And Says, “Yes.”

In a controversial move, The American Medical Association’s (AMA) declared obesity is officially a disease. In doing so, the AMA disregarded findings by the Council on Science and Public Health, which had closely studied the issue over the last year. The AMA asserts that this new classification might encourage physicians to pay more attention to the “condition,” and entice more insurers to pay for treatments.

This decision, made by the nation’s largest physician group, could have far reaching consequences. Many doctors, mental health professionals, and advocates enthusiastically predict that the AMA’s decision might draw even more focus and attention to obesity. However, many fear it might not be positive attention or focus; rather it might be more “obesity panic.” Although many within the medical community strongly believe that obesity has a direct correlation with poor health, legitimate questions from critics around the validity of this new obesity definition have already developed. Current research suggests that people living in larger bodies may actually live longer than people who live in “clinically normal body weight” bodies. This research should give pause to wonder if the AMA’s perceptions (misconceptions?) about the negative effects of large body size are more deeply entwined with cultural attitudes rather than fact.

How did the AMA determine that obesity should be named a disease? There is an assortment of definitions for what it means to have a disease in the medical community, including a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment. The AMA’s definition of obesity as a disease relies on a measurement of BMI (body mass index), which is simplistic, antiquated, and flawed.

BMI is a mathematical calculation taken from the person’s weight divided by his or her height squared. (Weight in pounds/height in inches x height in inches)x703). The whole concept of BMI was first introduced by a Belgian mathematician, Lambert Adolphe Quetelet in about 1830. Quetelet was not a physician and had no medical background. Instead, he sought to conceptualize the “average man” and scientifically map the normal physical characteristics of man in order to assist the government in allocating resources….in 1830! Unbelievably, however, society at large, particularly physicians and insurance companies, promote and exclusively rely upon this 183 year-old calculation. Furthermore, in June of 1998, millions of Americans became “fat” overnight as the federal government adopted a change in BMI standards.

When examining the topic of obesity, it is important to discuss those who are both obese and suffering from Binge Eating Disorder (BED). BED is the most common eating disorder in the United States, affecting all ages, races, levels of income and education. According to CEO & Founder of Binge Eating Disorder Association (BEDA) Chevese Turner, 15-20% of the obese population can be diagnosed with BED. In order to prevent further damage, this illness must be identified, recognized, and understood among health care providers. Simply suggesting a diet or behavioral weight loss for a patient with BED “will not be productive in the long term and set people up for more self-perceived failure, self-loathing, and weight cycling (internalized weight stigma),” explains Turner.

With a strong focus on dieting and weight loss as the “solution” for obesity, the stigma attached to those who cannot successfully maintain a “normal” weight will only escalate. Weight stigma permeates our culture, including within the medical community. Research shows this causes many larger bodied patients to feel reluctant or embarrassed to seek out healthcare. Further, weight bias creates a lower standard of care. Research also shows that as doctor visits have grown increasingly focused on weight and BMI, and solutions to address those two “problems,” the result is that broken bones go undiagnosed, symptoms of depression get diagnosed as asthma, and weight-loss is the resulting prescribed solution. In a country where two out of three adults and one out of three children are overweight or obese, weight bias affects millions, at a steadily increasing rate. The Yale Rudd Center defines weight bias as “serious and pervasive, leading to negative emotional, social, economic, and physical health consequences for overweight and obese.”

Suggesting weight loss, dieting, and weight loss surgery as the answer (for obesity or BED) will only provide limited and short-term results. According to ASDAH (the Association for Size Diversity and Helath), restrictive dieting is an ineffective long-term prescription for “obesity,” as up to 95% of
dieters regain the weight they lost, and sometimes more, within three years. In the words of professor, researcher, author, and Health at Every Size expert Linda Bacon, “research demonstrates that most people, regardless of willpower or diet or exercise, regain the weight they lose. In fact, research shows that dieting is a strong predictor of weight gain!”

Furthermore, ASDAH anticipates that if this decision becomes widely adopted by doctors and policy makers, levels of weight stigma, bariatric surgery, dangerous weight loss drugs, and disordered eating will increase, while health levels decrease overall.

So, what’s the solution? Advocating on behalf of those suffering with BED, Turner contemplates the value of this new definition of obesity. “We must look at this in a risk/benefit assessment,” she explains. “Do we recommend the pursuit of something that has a high failure rate (diets/behavioral weight loss), or do we help these individuals pursue an approach to life that values health over size, and enables them to have a high quality of life (free from self-loathing and feelings of failure)?”

How will the “obesity epidemic” resolve? Only time will tell.

For further reading, see: NY Times article dated June 18, 2013.