New solutions?

Is obesity a disorder or disease? The American Medical Association (AMA) last week voted to place the condition in the latter category. According to the professional association, such a classification would lead to the condition being paid more attention by the medical fraternity and encourage insurance companies to pay for treatments. Some may see it as merely matter of semantics, but the way in which something is defined does matter since it is the first step in changing perceptions and eventually, finding solutions.

Currently, poor exercise and dietary habits are considered to be the main cause of excessive weight gain. The implication therefore is that obesity is something that persons bring on themselves through laziness or a lack of discipline and restraint. We have long been told that obesity is a contributing factor to ‘lifestyle’ diseases, such as diabetes and hypertension. Our health authorities are currently devoting considerable resources to reducing the incidence of these chronic non-communicable diseases, focusing largely on reducing obesity levels among the population through encouraging more active lifestyle and improved nutrition.

Unfortunately, one consequence of this reclassification may be the psychological impact on the population’s approach to their own health. People are already finding it difficult to maintain healthy lifestyles; now some may feel justified in not even trying – they can simply turn to the modern strategy of popping a pill for every ailment. While not discounting the tremendous importance medication plays in controlling and reducing diseases, there is no cure better than prevention. So we stand behind our position, reiterated just two days ago, that persons must take charge of their health.

However, this step by the AMA also opens up new considerations in the matter. Rather than seeing obesity as a gateway to a disease, it labels the condition as an illness in its own right. Of course, this doesn’t change the fact that for more people, regular exercise and good nutrition can help avoid obesity, but it does provide a counterbalance to the strong emphasis on lifestyle choices that has pertained up until now.

It highlights the possibility that some may be inherently more predisposed to gain weight than others. This may lead to further medical research into obesity and its causes, and more sophisticated treatments. Perhaps it may be discovered that, like diabetes, obesity comes in different forms and some cases might be due to a physiological anomaly as opposed to lifestyle choices. This is already seen in cases of persons with an inactive thyroid gland. Perhaps it may be discovered that a lifetime of obesity or extreme levels of obesity may actually change the body at the cellular structure, making it more difficult to achieve weight loss by traditional methods.

In addition to the physicians who voted for the reclassification, this move will probably be looked on favourably by the pharmaceutical industry. Currently, there is a booming trade in weight loss supplements and medication, but as they are not seen as part of a medical treatment, the full cost is borne by the consumer. Should the definition of obesity as a disease gain currency, then a case could be made for having anti-obesity drugs being covered under insurance plans, or being placed on the drug formulary. This would mean an increase in revenue for the pharmaceutical companies, who would be able to market their products as a necessity for good health, rather than a discretionary expense. And considering the high incidence of obesity, this would be a significant new expense for an already overburdened public healthcare system. It is a timely reminder of the need to find more creative solutions for funding healthcare.