Last week, the American Medical Association declared that obesity is a disease. The vote was controversial, given that the AMA’s own review panel had concluded “it is difficult to determine conclusively that obesity is a disease state.”
How could obesity be a disease? A disease is a debilitating condition, sometimes temporary, sometimes chronic. OK, obesity fits in there. What causes disease? Everyone but Christian Scientists believe that heredity, germs, and viruses cause disease. What causes obesity? Almost everyone, including America’s Dietician-in-Chief, New York City Mayor Michael Bloomberg, agrees — eating too much!
Labelling obesity as a disease fits right in with the medicalization of every fitful tic and annoyance in American life. Bummed out? Can’t sleep? Sexually tapped out? There’s a pill for that. Just recently psychiatrists — they’re doctors, too, they’d have you remember — declared caffeine withdrawal to be a mental illness, as one of a number of “caffeine-related disorders.”
What is this really about? Money. With the AMA hoping to “expand coverage for obesity-related services,” newly minted diet pills such as Vivus, Inc.’s Qsymia acquire a sudden legitimacy. Diet pills generally have operated on the fringes of medicine — remember Fen-Phen? — and still offer plenty of risks. “Birth defects . . . suicidal thoughts or actions . . . serious eye problems.” Seeing those “serious side effects” on the Qsymia website, maybe I’ll just stay fat.
(My Body Mass Index is 29, one tick away from the official “obese” threshold of 30. BMI is TMI, I always say.)
Right now Medicare, the nation’s largest insurer, doesn’t cover diet pills. That could change. A bipartisan group of congressmen wants Medicare to start shelling out for fat pills. Who’s going to pay for that, you ask? Do you have a mirror handy?
The AMA’s decision is also a potential windfall for the dubious field of bariatric surgery, a.k.a. stomach stapling, which is experiencing explosive growth. There are now over 200,000 bariatric surgeries a year, a 16-fold increase in 15 years. Stomach stapling is rapidly becoming a subcategory of plastic surgery for celebrities such as New Jersey Governor Chris Christie and weatherman Al Roker who want to slim down, but find dieting to be awfully hard work.
Medicare and some private insurers already cover bariatric surgery for people who are pretty darned fat — BMI of 35 and above — and also have an obesity-related disease. Now there will be pressure to cover stomach stapling for men and women with a BMI of 30 or more, i.e. people like me.
Last week, you could practically hear the corks popping over at the American Society of Metabolic and Bariatric Surgery. In a statement, the Society’s treasurer, Dr. John Morton, called the AMA decision a “tipping point,” adding that “now coverage policy must catch up to that consensus.” Who’s going to pay for that, you ask? Don’t put that mirror away!
It turns out that expensive bariatric procedures, which cost up to $40,000, are of questionable value. “Bariatric surgery does not provide an overall societal benefit,” Dr. Edward Livingston, deputy editor of the Journal of the American Medical Association, wrote earlier this year. The surgery doesn’t reduce health care costs, Livingston noted, and “confers little to no long-term survival benefit,” he concluded in the publication JAMA Surgery.
Yes, losing weight is hard, and how very American to outsource that struggle to Big Pharma and the stomach staplers. AMA board member Dr. Patrice Harris suggests that I may have a simplistic view of obesity. “It’s not just a behavorial issue, it’s much more complex than that,” she says. “It’s multifactorial in its etiology, with behavioral, environmental, and genetic causes. Yes, personal responsibility is a piece of the puzzle, but we can’t say we won’t treat people just because they can’t push back from the table.”
I’m going to outsource my conclusion to Dr. Elliot Berry, a nutrition expert at Hebrew University in Jerusalem. “The AMA statement is dangerous, counterproductive, not useful or constructive,” Berry told the Jerusalem Post. “There is no magic bullet — no medicine — for obesity,” he added. “The way out of obesity is to eat less and better and to move your body.”
Alex Beam’s column appears regularly in the Globe. He can be reached at firstname.lastname@example.org.