Vital Signs September 2013
In June, the AMA voted to recognize obesity as a disease, a move that has received attention in both the popular and medical news media. Vital Signs interviewed three members of MMS’s Committee on Nutrition and Physical Activity — Denise Rollinson, M.D., chair, Rick Buckley, M.D., vice chair, and Mitch Gitkind, M.D. — about the implications of the AMA classification.
VS: What is your opinion about the AMA’s announcement?
Dr. Rollinson: To any physician caring for obese patients, it is clear that obesity is a disease, is associated with hypertension, hyperlipidemia, metabolic syndrome, sleep apnea, gallbladder disease, cancer, etc.
Dr. Buckley: There are so many related issues to obesity that it is long overdue in being labeled a disease.
Dr. Gitkind: And, let’s keep in mind that this is the AMA joining other groups who have already classified obesity as a disease in the past, including CMS and other professional societies.
VS: Will the AMA’s new position change the way obesity is viewed?
Dr. Buckley: The AMA’s decision should raise awareness among physicians of the seriousness of the problem. I still feel some physicians don’t pay sufficient attention to it. Part of that issue may be that it is so difficult of a problem to tackle. Making it a disease may remove some of the stigma that patients now feel.
Dr. Gitkind: The sense that obesity is a “lifestyle choice” as opposed to a public health emergency needs to go away.
Dr. Rollinson: By classifying obesity as a disease, hopefully we can finally help obese patients obtain coverage for medical treatment for obesity.
VS: Speaking of coverage, last December MMS adopted policy based on U.S. Preventive Services Task Force recommendations advocating that third-party payers cover multidisciplinary weight management teams for obese patients. Will the AMA decision help in this effort?
Dr. Buckley: It should allow the conversation with insurers to move forward on coverage of various to-be-named treatments, e.g., multidisciplinary programs, behavioral therapy, office visits specific to obesity, etc.
Dr. Rollinson: I would like to see obese patients (BMI 30) receive prevention before they end up with BMI 35 or 40, which is when they now “qualify” for treatment. While we need to treat patients with higher BMIs (surgically), it would be far better to prevent patients who are overweight from becoming obese and to be able to intervene sooner in patients with BMI of 30 from gaining weight to BMI of 35 or 40.
Dr. Gitkind: Assessments that lead to treatment plans always need to look at more than just weight and BMI. Whether surgery, pharmacologic treatments, lifestyle modifications, or combinations of one or more of these modalities make sense depends on comprehensive assessments that take time and expertise. These just aren’t happening enough right now.
My hope is that the AMA decision will put providers and health care systems on notice that we owe patients much more than advice to “eat less and exercise more,” especially those in high-risk categories.
Moving beyond the argument that patients just “trying harder” will fix the problem, perhaps we can really answer our patients’ needs — and our own professional obligations.
Overall, the AMA decision needs to create urgency amongst providers and payers that pushes us ahead in addressing the epidemic.
— Robyn Alie
