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Obesity a disease that calls for range of care

I’m writing to express disappointment with Alex Beam’s June 27 op-ed column “My fat problem — and yours.” (Op-ed, June 27). As an internist who oversees a multidisciplinary weight-loss program, I see patients every day looking for help with serious medical issues connected to obesity. Almost all of these patients have tried to eat better, exercise more, and improve their health before they come here.

Is obesity a disease? Absolutely. Diabetes, hypertension, and asthma can all be exacerbated by poor lifestyle choices, but no one would argue that they’re not diseases. Patients who are 50, 80, 100 or more pounds overweight are making lifestyle choices that contribute to their situations, set atop physiologic circumstances that they didn’t choose and can’t control. This reality makes treatment extremely difficult to deliver. We have gifted providers who can help patients modify their diets and increase the quantity and quality of their physical activity, but these changes bump up against bodies that have learned to essentially defend their new (and damaging) weight levels.

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With regard to bariatric surgery, those of us who work in accredited, high-volume centers set the bar very high with regard to which patients should be encouraged to pursue this intervention. Far from celebrating projected volume increases, we’re concerned about the ongoing misconception that these procedures replace the hard work necessary to achieve lasting weight loss.

As the American Medical Association joins other professional societies in defining obesity as a disease, we need insurance carriers to look at covering options in addition to surgery, especially multidisciplinary weight-loss programs.

Assigning the entirety of obesity and weight-related disease to poor lifestyle choices is at best an oversimplification and at worst a message to patients to lose hope.

Dr. Mitch Gitkind

Worcester

The writer is medical director of the UMass Memorial Weight Center and clinical associate professor of medicine and surgery at University of Massachusetts Medical School.

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