Obesity: Is It A Disease Or Not?

Oh, what a difference 18 hours or so makes.  Like many of you, I subscribe to many electronic tables of contents & news headline/summary emails.  I woke up yesterday morning to the headline, "Obesity Not a Disease, AMA Council Says" sent at 3:45AM.  I came home yesterday evening to the USA Today headline, "Medical group recognizes obesity as a disease".  So which is it?  It turns out that both are correct!  Remember that we're talking about medicine here, where things are never as simple and black & white as we'd like them to be.

The American Medical Association's Council on Science & Public Health report declared that there is insufficient evidence to declare obesity a disease (see page 19 of 87), despite all the issues associated with excess weight & body fat.  Key among their concerns was the inexactness of body mass index which does not take into account lean vs fat body weight.  In other words, BMI prizes a "skinny fat" desk jockey or a fit athlete who is overweight by virtue of tremendous muscle.  

However, the AMA's House of Delegates ignored the CSAPH's report and voted by 60% to declare obesity a disease (see page 78 of 87).  Good triumphs over evil, right?  Well, not so fast.  While we, the general public, like to think of the AMA as representing all physicians (and certainly the AMA would like us to think so), it turns out that, in reality, the AMA represents just 25.6% of all American physicians, most of whom are not primary care providers.

But if you delve deeper into the numbers, medical students represent 22.2% of AMA membership while resident physicians (those still in training) represent 17% (in effect, only 60% of active members are licensed to practice w/o supervision, for whatever that's worth).  In essence, while 1 in 4 "physicians" is a member of the AMA, only 1 in 7 physicians (no quotation marks) is represented by the AMA, and of those, only 3 out of 5 voted to declare obesity a disease.  

So does this really matter?  Or is this just semantics?  By declaring obesity a disease, the idea is to destigmatize a condition that affects over one-third of the population (toss in those who are overweight but not yet obese and you've now included two-thirds of the population!) and increase funding for research as well as payment of both medical & surgical options.  Time will tell whether this declaration really makes a difference.  As for me, good nutrition, as evidenced by the Mediterranean diet, and regular physical activity, are still key to health (and weight).

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