On June 18, the American Medical Association (AMA) officially endorsed the recognition of obesity as a disease. While this announcement is a fairly new development, obesity has been a recognized risk factor for a variety of serious health problems, including cardiovascular disease, stroke and last but not least, type 2 diabetes for quite some time.
At Joslin Diabetes Center, 60 percent of the patients seen in the clinic have type 2 diabetes, making obesity a common medical issue treated at Joslin.
Some doctors raise concerns about the classification of obesity as a disease versus a condition. By definition, a disease is a set of symptoms that interrupt the normal function or structure of any body part, organ or system. While a condition by definition, is the state of a person’s physical health that interferes with their well-being.
From a medical standpoint, Osama Hamdy, M.D., Ph.D, F.A.C.E., Medical Director of the Obesity Clinical Program at Joslin, Director of Inpatient Diabetes Management at Joslin and Assistant Professor of Medicine at Harvard Medical School, agrees with the decision to recognize obesity as a disease.
“I welcome the announcement of the AMA of considering obesity as a disease, since it is for sure a disease that has many drastic medical consequences,” said Dr. Hamdy. “[Whoever] denies that definition is blind to the fact the fat cells secretes hormones and several chemicals (called adipokines or cytokines) that initiate inflammation and blood coagulation and increase the risk for diabetes.”
Concurring with Dr. Hamdy is Robert Gabbay, M.D. Ph.D., and Chief Medical Officer and Senior Vice President at Joslin, who asserts that this classification is evident to anyone familiar with obesity and diabetes.
“The AMA’s decision to designate obesity as a disease, although in some ways, self-obvious to those of us in the field for many years, has some potential significant implications,” commented Dr. Gabbay.
According to Dr. Gabbay, these implications include increased opportunities for insurers to cover obesity treatments, for providers to more aggressively treat obesity and lastly, for obesity to be viewed as a disease as opposed to a personal weakness.
While Dr. Hamdy and Dr. Gabbay stand behind the AMA’s decision to recognize obesity as a disease, Cathy Carver, M.S., A.N.P., C.D.E., Vice President for Advocacy and Planning at Joslin, questions if and when obesity should be considered a disease.
“Sometimes I think obesity can be considered a disease, often I think it is not, and differentiating when it is a problem and when it is not is important,” said Carver.
Regardless of the disease versus condition debate, Dr. Hamdy feels that the more important argument is whether the current definition of obesity, which relies on the Body Mass Index (BMI), is an accurate measurement of obesity. The BMI is a measurement of an individual’s height and weight, and if a person has a BMI of 30 or higher, then they are classified as obese.
“The argument is not if obesity is as disease or not, but it is on how to define it since body mass index is not an ideal method and is frequently misleading,” explained Dr. Hamdy. “BMI is calculated from weight and height, so if a person has higher muscle mass he may wrongly labeled as having obesity.”
Instead, Dr. Hamdy believes that the percentage and placement of fat in the body should be used to determine obesity.
“The disease should be defined based on a measured percentage body fat, higher waist line or better yet on higher intrabdominal (visceral) fat, which is where the risk lies,” commented Dr. Hamdy. “Many people with low BMI, who are labeled now as normal, are metabolically obese for having higher percentage body fat or higher abdominal (central fat). In other words, people who are lean, but have big waist lines have the same risk, or even a higher risk than people who are apparently obese by BMI calculation.”
There are also concerns among healthcare payers, specifically private insurers, employers and the federal government, that the acknowledgement of obesity as a disease will increase obesity-related healthcare expenses, such as weight loss medications and surgical options.
Contrary to these beliefs, Dr. Hamdy believes that covering weight loss treatments will actually lower healthcare costs.
“There was some fear that when you define a condition as a disease, then you will increase insurance claims and the insurance costs, but I argue from the other side – if you define it as a disease, then you will use insurance coverage for intervention and management,” said Dr. Hamdy. “The management will actually yield positive results that will ultimately cut the insurance costs.”
The weight loss program at Joslin, called Why WAIT, has produced these positive results and lowered healthcare costs.
“We were able to show [in the Why WAIT program] that [participants] cut down on their medications significantly and the average savings on their medication was around $561,” commented Dr. Hamdy. “The estimated reduction of the total medical costs was 27 percent and the estimated reduction of the diabetes costs was 44 percent.”
Although the larger medical community is abuzz with this announcement, life at Joslin, including the management and prevention of obesity, remains the same.
As healthcare providers well versed in the complexities of type 2 diabetes and obesity, Joslin has developed effective treatments for obesity that revolves around the mindset that obesity is a disease. This unique approach relies on using a variety of behavioral tools, such as lifestyle changes and incorporating a strong support system, to combat obesity.
“For the management of obesity, you have to combine different interventions together in a multidisciplinary approach, you will get much better and durable results,” observed Dr. Hamdy. “It is not just one management tool that will do the job.”
As Joslin looks to the future of preventing and treating diabetes and obesity, they will continue to utilize this multifaceted approach.
“At Joslin, we are committed to treating diabetes in a multi-modal manner thorough innovative successful programs that address this complex disease that can often lead to diabetes,” said Dr. Gabbay.