Human Limits

The recent and controversial AMA decision to categorize obesity as a disease has a raised a number of questions and discussion points.  I thought I would cover a few here to help readers sort through the issue on their own.

 

Definition of Disease

Below is an extended quote from the wiki definition of disease.  It is similar to other definitions I found and if you link to the site there is a pretty comprehensive discussion of the concept of disease and related things like “disorder” or syndrome.  Based on the blurb below obesity certainly seems to fit many of the definitions of a disease.  One interesting recent observation is that if you track obesity in social groups it moves through them with a pattern that looks a lot like the way infectious disease moves through a population.

 

“A disease is an abnormal condition that affects the body of an organism. It is often construed as a medical condition associated with specific symptoms and signs.[1] It may be caused by factors originally from an external source, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. In humans, “disease” is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases usually affect people not only physically, but also emotionally, as contracting and living with many diseases can alter one’s perspective on life, and their personality.”

 

Defining Obesity

BMI or body mass index has emerged as a favored definition of obesity.  This definition is probably OK when thinking about groups or populations of people but does not always tell you much about an individual.  There can be “normal weight” people with a lot body fat and health problems, and there can be heavy people with lots of muscle mass and very little body fat.   Then there is the problem of distribution of fat.  Visceral fat or “belly fat” is worse for your health than fat in your lower extremities. When I started medical school in the early 80s fat was seen mostly as a tissue that simply stored excess energy, but in the last 20 or so years it turns out that some fat cells secrete all sorts of biologically active substances that wreak havoc on the blood vessels, heart, liver, pancreas, skeletal muscle and brain.  One critical thing to note is the physically active “fat people” are largely protected from some or most of these problems

 

What Does Disease “Status” Do?

The AMA decision does not do anything right away other than make a statement and raise a bunch of questions:

• Will disease status increase public awareness of obesity as a medical problem?  My guess is that most people are probably already aware that obesity is a problem.
• Will disease change medical practice and encourage more Drs. to discuss the issue with patients?  Should things like exercise and physical activity be a vital sign?
• Will disease status influence the way insurance covers certain treatments like gastric bypass?  Some plans do, some don’t and here is link to a nice opinion piece on that topic.  What happens if the insurance plans that political leaders get cover it but not the plans the rest of us have?
• Will disease status limit the use of sin taxes and incentive plans linked to weight loss by governments and insurance companies?
• Will disease status encourage people to take more or less responsibility for their own behavior?  Obesity is a lot more than a few bad genes “making us fat”.  In fact genetics likely plays a minor role for most people and the big increase in average body in the US over the last couple of generations has occurred faster than any genetic changes that might explain it.  For the vast majority of us it is all about the environment and our behavior.

 

Our Obesogenic World!

We live in a high calorie low physical activity world primed to make us all fat.  At some level it is amazing that anyone remains normal weight.  The lessons from improved traffic safety and smoking rates over the last 50 plus years tell us that these big public health problems require structural changes in society as well as changes in individual behavior and so-called “choice”.    Where to start with the obesity problem: Sugar and fat taxes or other policies designed to reduce calorie consumption and increase healthy food choices?  Walking and biking friendly urban planning?  Safe streets to encourage getting outside in all neighborhoods?  More PE and better nutrition at school?  Financial incentives via health insurance plans?  Limiting our own screen time and that of our kids?  Drs. and nurses communicating more about the problem with patients with easier referrals to diet and exercise programs?  The short answer is all of the above.

 

This entry was posted on Thursday, June 20th, 2013 at 8:07 am and is filed under Current Events, Health Policy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.