Nobody likes squeezing into a favorite pair of jeans or realizing you should buy a dress the next size up—but sometimes weight gain is more than just a slip in healthy habits. Excessive weight can be a serious threat to a person’s wellbeing. But where is the line between being healthy and unhealthy when it comes to weight gain?
Recently, obesity has been re-designated as a disease; defined as a person who has a Body Mass Index of 30kg/m2 or above. Similar to other diseases, a set of common symptoms accompanies this definition such high blood pressure or physical inactivity, which allow physicians to more accurately diagnose a person as obese.
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 consideration of 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 and coronary artery disease.”
However, categorizing obesity as a disease has provided its own set of challenges.
Increasingly, medical professionals and nutritionists are running into problems when narrowly focusing on outwardly physical factors such as BMI and waistline as indicators of disease. Concentrating too much attention on these aspects ignores the possibility that certain patients fall into the category of “metabolically healthy obesity.” These people are by definition obese, but they don’t have any other symptoms, such as diabetes or heart disease.
Earlier this year representatives from Joslin attended the 2014 AACE/ACE Consensus Conference on Obesity in Washington D.C. The purpose of this conference was to bring together various organizations and groups concerned with obesity care to develop a set of parameters to manage and treat obesity in the United States. They were also interested in creating a set definition for obesity as a disease. Those gathered comprised four different sectors: biomedical; government and regulatory; health industry and economics; and organizations, education and research.
While some of the stakeholder groups believed these “healthy” obese patients simply carry excess body weight and are not necessarily unhealthy, others focused on their potentially increased risk for cancer and diabetes. And there is also the flip-side to be considered. Some people are at a technically low BMI, but have high levels of fat tucked away inside their abdomen, putting them at higher risk for obesity-associated diseases.
Now that obesity is classified as a disease, a better, more dynamic definition of the condition must be created for better treatment more specific to the individual, something many healthcare professionals are struggling to find.
“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. You see this common scenario in people of South and South East Asian origin”
While the definition has yet to change, it is still a vigorous point of discussion.
Despite lack of a solid consensus at the conference, re-categorizing obesity as a disease has already impacted patient care. Obesity treatment was previously ineligible for reimbursements from insurance companies. Under this new category, Medicare now reimburses primary care providers for a service called Intensive Behavioral Therapy (IBT) for obesity. Patients meet with their primary care doctor at regular intervals for weight assessment, nutritional planning, exercise goals, as well as counseling to support emotional wellbeing. There are specific criteria for eligibility and certain parameters that must be followed. While it’s not perfect, it’s definitely a step in the right direction.
Although serious obesity-associated disorders such as cancer require pharmaceutical interventions, one of the most effective treatments for obesity is a change in lifestyle. This means healthy, well balanced meals, daily exercise, stress reduction and smoking cessation.
Joslin care and research illuminates the link between a healthy lifestyle and medical well-being. For those diagnosed with obesity-associated type 2 diabetes one of the first steps towards recovery is to revamp old habits into healthful practices, through either individual efforts, or through groups such as WhyWAIT?. (Why WAIT? is a 12-week program that gives participants an individualized exercise plan, a structured diet, and adjustments to diabetes medications to enhance weight reduction.)
Learn more about weight management programs at Joslin