AMA Declare’s Obesity A “Disease” – Good or Bad Idea?

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If you haven’t heard the news, last week the American Medical Association reclassified obesity as a “disease” (it was previously known as a “condition).  This decision is largely symbolic, and has been hotly debated over the past few years.  In fact, the AMA’s council on Science and Public Health actually recommended not defining obesity as a disease, due to the many limitations of defining obesity based on BMI (something that we’ve discussed several times in the past).

Last year the Canadian Obesity Network student group at the University of Ottawa hosted a debate with the title “Is Obesity A Disease?”, and given these recent developments I thought it would be a good time to republish a summary and video of the debate.  Arguing that obesity should be considered a disease was Dr Arya Sharma, and arguing that it should not be considered a disease was Dr Jacqui Gingras.

One thing that I found disappointing about the AMA’s decision was that they decided to stick with a definition of obesity based on BMI alone (UPDATE: this isn’t technically the case – see below comment from AMA committee member Ethan Lazarus for details), which many clinicians and reseachers (myself included) think is an extremely problematic measure.  In fact, at the debate last year, Drs Sharma and Gingras agreed emphatically that BMI should not be the sole measure used to determine if a person is considered “obese”.  And if we were to use some other measure which focused on overall health risk rather than just body weight (for example, the Edmonton Obesity Staging System), then I think many of the potential problems with this decision would be minimized.  As it is, I’m hoping that the benefits (improved treatment for those who need it) outweigh the downsides (obesity-related bias, fat shaming, etc).

The video of the debate can be viewed below. For a higher resolution version of the video which is more suitable for lectures, public presentations, etc, feel free to contact me through the comments section below. Also, feel free to distribute/embed/edit the video, as it has a Creative Commons Attribution licence. Thanks to Joseph Abdulnour for doing a fantastic job with the video!  The debate can also I be downloaded by (clicking here), or simply subscribe to the Obesity Panacea podcast in itunes (click here).

The debate was broken into 3 subsections, and moderated by Dr Mark Tremblay:

Section 1: The health impact of obesity – does obesity cause increased health risk, or is it merely an innocent bystander?

Section 2: The medicalization of obesity – how has obesity come to be viewed as a medical condition, and is this a good or bad thing?

Section 3: Concluding statements: Should obesity be viewed as a disease?

Each section also included an opportunity for a brief rebuttal from each of our experts, as well as 10 minutes of Q&A with the audience (which included a fair number of obesity experts as well).

Areas of agreement

One of the first things that the two debaters agreed upon is that BMI is useless as a means of defining obesity.  Instead, Dr Sharma argued that obesity should be defined as “as a condition in which excess body fat threatens or affects health”, and that it is in this sense that obesity should be considered a disease.  Similarly, there was no disagreement whatsoever about the very real harm done by weight bias and discrimination.

Areas of disagreement

As expected, the primary area of disagreement came over whether the medicalization of obesity would be helpful or harmful to people with excess body weight.  Dr Gingras argued that obesity has already been medicalized/pathologized, and that it is this very medicalization that promotes weight bias.  As people are constantly exposed to the message that “fat kills”, they have begun to look down upon people with above average weight as being unhealthy or worse (scroll through the comment thread on any obesity-related mainstream media article to see how individuals with obesity are viewed by the general public).

In contrast Dr Sharma argued that it is precisely because obesity is not viewed as a disease by the medical establishment, it has instead been positioned as a “lifestyle” problem.  From a post on his website the morning after the debate (the entire post is well worth reading):

It is exactly because we do not exclusively leave the diagnosis of obesity (which I define as a condition in which excess body fat threatens or affects health) to trained, licensed, and regulated health professionals, that we have created a ‘free-for-all’ where we continue propagating the myth that everyone with a few extra pounds is unhealthy and needs to lose weight. This is the key downside of not medicalising obesity – if only a trained health professional can tell whether or not your weight is affecting your health then someone without this training, should not be making assumptions about your health simply based on your size – indeed, it will hopefully become common knowledge that only your doctor or nurse can tell whether you have obesity or not.

Dr Sharma also argued that by failing to medicalize obesity, we continue to allow charlatans and snake-oil salesmen to promote their ridiculous (and often harmful) “cures” for obesity, which would not be possible if obesity were viewed as a legitimate disease by the government and medical establishment (as an example, he pointed out that you can’t open up an unregulated “cancer treatment center” in a strip mall, but you certainly can open a weight loss center wherever you please).

My thoughts, and one more area of agreement

Both Drs Sharma and Gingras made excellent points, and to be honest it’s tough to decide exactly where I come down on this issue.  It almost seems as though obesity has been medicalized in every way except the one that matters.  It has certainly been medicalized in the eyes of the general public, and on this issue I agree with Dr Gingras that it has had very real negative consequences for people viewed as being too heavy.  However, the fact that the government/medical establishment continue to view obesity (defined using Dr Sharma’s definition, rather than BMI) as a lifestyle problem rather than a genuine disease, has also led to lack of qualified medical support on this issue, as well as evidence-based public health strategies.

In the end Dr Gingras pointed out one other key area where she and Dr Sharma were in agreement, and that was the issue of improved training for healthcare professionals.  Regardless of whether or not you think that obesity is a disease, there is little doubt that healthcare professionals receive inadequate training in how to deal with obesity-related issues, and that this has negative consequences for their patients.

The podcast is released with a creative commons license, so feel free to repost/embed/edit/reuse as you see fit.

Thanks everyone!

A big thanks to the many people and organizations who helped organize the debate.

  • Our presenters (Drs Sharma, Gingras, and Tremblay)
  • Our funders (CIHR through a Cafe Scientifique grant, as well as the Canadian Obesity Network Student and New Professionals organization, and in-kind support from the Healthy Active Living and Obesity Research Group at the Children’s Hospital of Eastern Ontario Research Institute),
  • The organizing committee at the University of Ottawa CONSNP  (Joseph, Zach, Angela, Megan and Richard)
  • The press officers at the Canadian Obesity Network (Brad Hussey), the CHEO RI (Adrienne Vieanneau) and University of Ottawa (Thalie Tremblay)
  • Our hosts at the Richelieu Vanier Community Center
  • Last but not least, all of the individuals who attended the event and contributed to the discussion.

Travis

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