Some of the arguments that have been put forth in this article:
Pros
-could force more insurance companies to cover treatments for obesity
-could result in greater investments by the government to fight obesity
-encourage physicians to talk to patients about their weight problems
Cons
-stigmatizes obese people
-could “doom patients to endless nagging”
-could shift the focus of treatment from behavioral changes to drug and surgical treatment
What do you think?
I think in a minority of cases obesity is a disease and medical treatments are appropriate. But the substantial majority are simply a case where people have decided eating more is enjoyable and exercise is not.
Why not call all bad habits diseases?
Being obese isn’t a habit. Overeating is a habit. Smoking is not a disease (though I think it appears in the ICD-9 codes as “tobacco use disorder” or somesuch), but the lung cancer it causes is.
god forbid obese people be stigmatized and exposed to chronic nagging, that would be a change from today.
I think it’s good. lifestyle has a role, but for most people lifestyle alone won’t do it (a well publicized study from several years ago found lifestyle changes can decrease mortality and diabetes risk by about 60%, but on led to a 5% weight loss) hopefully this will lead to more use of other tools to lose and maintain weight.
I’d think being seen as a sufferer from a disease would be less troubling than being seen as someone without will power.
This doesn’t happen now? (I’m genetically thin, so I don’t know.)
Since trying to enforce behavioral changes doesn’t seem to work so well, a preventative drug-based solution might be better.
I’m mixed on this one but lean towards not so great of an idea.
Obesity is not a problem per se; it correlates with problems. Obesity is a disease to the same general degree that a lack of cardiorespiratory fitness is one. Yes both are commonly present in the same person but not necessarily so. One can be obese and be very healthy even if the odds of being so are less for an obese individual than for a mildly overweight or normal weight one; and one can be normal weight and have all of the metabolic dysfunctions that are considered the complications of obesity.
The more I think about it the less I like the idea. It moves away from a focus on the behaviors and the metabolic consequences being the targets and more on the scale itself being the end point, contradicting all we know about how that someone who is obese who loses and maintains even a modest weight loss of 5 to 10% of body weight with improved nutrition and exercise lifestyle has captured most of the possible benefits of weight loss even though they are still clinically obese. It calls those people as still being “diseased.”
All this is going to do is shift focus from prevention to treatment, just like pretty much everything else. The insurance companies (and fast food joints) are the ones who will benefit from this.
Prevention > Treatment
Treating it as a health problem instead of a moral flaw seems more likely to persuade people to try to lose weight.
And the “Willpower! Just eat less” plan isn’t working. I think that in the long run a medical approach such as appetite affecting drugs or the like is going to be necessary to make much of a difference.
How is it going to do that? What changes are you anticipating?
I agree except for:
Prevention $ < Treatment $$$$$$$
Doesn’t declaring something a ‘disease’ change how it’s treated by insurance companies? Not that there’s a lot of focus on prevention anyway. Insurance companies would much rather treat a continual disease than prevent it, they make more money that way. I think we’re going to see some changes in treatment in that direction.
That could be really bad for you people in the US. It would be a pre-existing condition and they could not cover any of the resulting ailments from it.
Eeep!
Really? My insurance plan, even before ACA mandated it, paid 100% for prevention, more than paid for treatment. The problem with obesity is that there isn’t as easy a prevention method as there is for chicken pox. And stopping obesity might prevent other diseases like diabetes.
I think you have that wrong. Insurance companies benefit financially from people paying their premiums, but NOT utilizing or accessing their benefit. If obesity is now treated like any other disease, benefits will need to cover treatment, and people accessing care COST the insurance companies.
Not so, at least bef=ginning in 2014. Affordable Care Act and pre-existing conditions.
There is a possible point to be made about paying for “treatment” versus “prevention.” Many plans will cover well care visits, one a year. Let’s say I see someone for a well visit and identify obesity, nothing else but, no metabolic derangement, no hypertension, so on, come up with plan, and arrange for follow up in say 3 months. Coding that next visit as a well will not get covered; they get one well a year. As a sick visit? With what illness? For what disease? What is the diagnosis? Obesity, not being a disease, often does not get covered when matched with a sick visit code. Some might pay something under a nutrition therapy code but less than a sick visit or a well visit gets even though the time is more. In kids at least, where prevention is perhaps the most important, getting insurance to cover wellness programs, cognitive behavioral programs aimed at both the kids and their parents that have a tremendous body of evidence behind them for efficacy, is … difficult. Would it get paid better if it was labeled as a treatment of a disease state? Maybe.
This hits on my issue with it. Being overweight isn’t (always) the issue, and being thin doesn’t mean you’re healthy. Also, and I know this is going to start a fight, but no one has hit on a way to achieve true long term weight loss. The focus should be on creating better health outcomes for people with diabetes/heart disease/whatever because weight loss is mostly just not happening. It sets fat people up to fail. Fat people can get healthier; they can exercise and eat better, and that will be reflected in their blood pressure and blood sugar numbers. They may not lose any significant weight though.
Basically what this is saying (to me) is that, even if all your numbers are great, and you’re biking five miles a day and eating well, if you are overweight you are sick. And I just don’t agree with that, and I don’t think current research does either.
You think the insurance companies want to pay for more care?
I wish they would define it less generally, given the latest research. Abdominal fat, regardless of overall BMI, seems to matter a lot more to health than overall fat composition. There are plenty of non-obese people who are at high risk for heart disease and diabetes because they are carrying all their fat around their waists. It would have made more sense to come up with a better term that would include these people but exclude healthy obese people.
Yours may, but that is not the norm.
I have heard several AMA spokespersons note that the move was specifically (or primarily) intended to bring the insurance companies into the game. Today, physicians do not focus on obesity or preventive health issues because they cannot (generally) be compensated for making the time to do so. By designating obesity as a disease, the hope was that more physicians could claim that they were engaged in treatment rather than in mere discussions with patients, bringing pressure to bear on insurance companies to pay them for their time, encouraging more of them to address the issue with their patients.
Of the article is right:
That’s ~ 1/3 of all Americans with this particular “disease”. That’s not chicken feed, and we should tread carefully in terms of what that means given things like ADA, etc.