Treating it as a disease is just going to give obese people more excuses. “You can’t tell me I’m lazy, it’s a DISEASE!!”
No it isn’t. People who are looking for excuses have already found them.
The general trend has been for courts to treat (at least severe) obesity as an ADA-covered disability anyway. See EEOC v. Resources for Human Development, Inc., 827 F.Supp.2d 688 (E.D.La. 2011), for example. Mostly the disagreement is only over whether it should count when not due to some other dysfunction.
So? How many people are “severely obese”? I’m guessing it’s well under 1/3 the population of the US. Is your point that you do want it to apply to 1/3 of the general public?
Labeling obesity as a disease means nothing as far as ADA goes. I don’t get disability for having asthma, for example, just because it is a disease, as it in no way disables me, and as pointed out those disabled by obesity can get so labelled now without its being labelled a disease.
It does mean that visits to the doctor and the nutritionist specifically to review the nutrition and exercise plan and how it is working as an obesity treatment are more likely to be covered. Currently they might be if you have diabetes already, or hypertension already, or a dyslipidemia already, but not if you do not. A sick visit needs to be linked to a disease state and well visits are limited usually to one per year.
Yup** romadea**. It’s the labelling obesity as a disease state that is going to stigmatize the obese. No doofuses stigmatize them now.
Will this mean the obese can collect social security?
No. The SSA has its own list of impairing conditions. You can also qualify if you have a condition “equally disabling” to one on the list. I think morbid obesity has qualified in a very few cases (shut-ins, basically).
Hmmm…well, the short to medium term, the obese will get medical treatments and the doctors will line their pockets. Aggravating, but potentially better in the long run, if they can treat the 20-40 year old obese and prevent the expensive medical issues they’ll be seeing in their 50s and 60s if they don’t do anything. But I’m not sure we’ll be truly helping ourselves over the long run unless we address the crap in our food and the lack of nutrition education. It’s too easy in this country to unthinkingly shovel empty calories into your mouth.
I can’t get my mind around how classifiying something as a disease increases the stigma attached. Can someone please explain that to me?
I encounter people daily who - to be kind - have personality/lifestyle factors that comprise at least a large portion of the reasons they are unemployed. Yet - to a person - their condition is in no way the result of their own choices or (in)actions. No - it is their “disability,” not their smoking, overeating, failure to adhere to diabetic diet, etc.
IME there is a large number of folk who will greatly appreciate being able to ascribe their body habitus to a “disease,” as that reduces any personal responsibility.
Also, the article pretty clearly reveals that this change is - at least in part - about money. The AMA is not a disinterested group. As our current healthcare system exists, categorizing obesity as a disease increases caregivers’ ability to be compensated for time they spend addressing it. Not saying that is a bad thing. Just suggesting this change is primarily a matter of economics and linguistics.
Re: SS disab - obesity used to be set forth as a presumptively disabling condition. Listing 10.08 I believe. Basically (from memory), if you exceeded a certain weight for your height and had an additional condition that would normally accompany, adversely interact with, and be exacerbated by obesity - like bad knees, a heart condition, etc. - you were presumptively disabled. That listing has been obsoleted sometime ago - without looking I’d guess 10-15 yrs ago.
Currently, obesity has to be considered at all steps of evaluating disability, to assess whether and how it affects the impact of an individual’s other impairments.
What exactly IS the treatment? Are things like gastric bypass going to get covered?
Because otherwise I don’t see how the Dr’s can do things the person couldn’t do.
Calories In
Calories Out
Add to the nutrition trend, we are trending the removal of physical education from schools
Most people’s perception of what is a healthy weight and how an overweight or obsese person looks is drastically unrealistic. Of course there are plenty of obese people who are already very concerned about their health and have major insecurity about their appearance.
But there are also way too many people who in reality are severely overweight or obese, but are convinced they’re just a little overweight, or that they’ve got nothing to feel bad about.
Of those people, many will continue to ignore reality… there’s no reason to think one decision by the AMA would change everyone’s self perception.
But at least some people are going to go from thinking they’re merely out of shape and a little heavy to diseased. Being diseased has always carried a lot of social stigma.
I agree with all your points, especially this one. I’d suggest that perhaps a more effective strategy would be to increase the number of allowable well care visits per year, so that you can see them to monitor/address their obesity or their risk for taking up smoking or whatever may come up three months after their annual well visit.
Nurses have a slew of nursing diagnoses prefaced with “Risk for,” as in, “this patient doesn’t have this condition yet, but circumstances are such that they’re at risk for developing it, and we might wanta watch for it and provide interventions to avert it.” An recently widowed man who wears loose dentures and doesn’t drive is at Risk for Imbalanced Nutrition: Less Than Body Requirements. He may have mouth pain which affects his food choices, not know how to cook on his own, may not be able to grocery shop on his own, and may experience a reduced appetite congruent with grieving. We have lots of things we can do to reduce the chances of malnutrition becoming an actual problem…but we can’t bill for any of them until he actually develops 263.0 Malnutrition of moderate degree or something similar.
I don’t know if doctors use/view medical diagnoses with a similar “risk for” terminology, but maybe that’s what we need to start doing in billing preventative care. If you can support a “risk for” diagnosis with concrete risk factors and implement interventions to diminish that risk, I think you should get paid for that.
I think you are misusing the term. Being “diseased” is quite different from having - or being the victim of - a disease.
I’m also somewhat dubous about relying upon BMI as the determinant of a disease diagnosis. Personally, I’m 6’3, and my weight is right around 200#. According to the BMI chart, I’m obese. Can’t tell you how often people refer to me as “thin.” Got the same comments when I ballooned up to 215.
In my nonmedical opinion, the diagnosis of a disease of obesity would involved considerably more than a number alone. As you have suggested, people are capable of carrying vastly different weights, having no necessarily direct correlation with their overall health. I also think a diagnosis of obesity - whithout specifying the cause/contributing factors - obscures rather than clarifies. In most instances, I believe obesity is more of a symptom of something else - either physical or mental/emotional, rather than a unique condition.
Not just the doctors; the nurses are limited by diagnosis/billing constraints, too. And we really can do a lot for people if we can see them more often. It’s amazing how much better my patients are about their food and movement (I hate the word “exercise”, it bores and scares people) when they know I’m going to be coming to their house once a week and asking to see their food/movement journals and taking a walk together and getting them up on a scale to report the number to their doctor. Many people need an external locus of control to keep them accountable and motivated, and to remind them, more than once a year, why they’re doing this. Right now I can only do this for people who have another diagnosis (like diabetes or hypertension) that can be correlated to their weight; I can’t do it if they’re supermorbidly obese and can barely walk but are otherwise stable.
Purely anecdotal, but I suspect many similar stories are out there:
Somewhere a couple of years ago, I read that in many people weight loss produces something in the system that makes the body preserve weight. I’ve seen more than one reference to this problem.
That might be why a lot of people seem to be able to lose weight, but only for a limited time.
Looking for an excuse? Not me. I was on nothing but liquids for six months. Lost lots of weight, but gained it back when I had to “refeed.” Then I lost 155 pounds in less than a year with surgery. My stomach is still small, so I can eat very little.
When I had lung cancer, I just couldn’t eat much at all. Nothing tasted good. I didn’t even know what the cause was. I became dehydrated and malnourished, but I was still overweight In the hospital, they gave me something to increase my appetite. It worked and is still working. I’m gaining weight again.
Exercise? I used to lead exercises in my PE classes and rode a bike all the time. Loved it. I can now stand no longer than two minutes without terrible pain from a fall. And fracturing my tailbone ended bike riding.
The disease of obesity has hurt me more than my lung cancer. If obesity is treated as a disease, maybe science will come up with solutions. And maybe doctors will be better informed about weight loss.
But don’t tell me that I don’t have will power.
I’m not sure how I feel about this decision (although I think if it makes it easier for people to fjord treatment, it may be a good decision). I think it’s less problematic if “obesity” is defined by body fat percentage, and if the threshold is set high enough t hat it’s not labeling everyone with ten pounds to lose as “diseased.”
I beg to differ. It’s called Weight Watchers. The program works and has worked for a long time, and they are continually refining and improving it.
I think this is true. If the doctors can start to get compensated for treatment of obesity, the insurance company actuaries are probably already sorting out what that means for rates:
Money out
Money in
I agree with Clothy, unless we refine the statement to “no-one has hit on a universal method of long-term weight loss.”
I’ve found no studies that show long term obesity busting weight loss maintained with Weight Watchers, or any other behavioral intervention program. The weight loss on Weight Watchers is just as good as or even superior to other behavioral intervention programs though, yes. That would be with a median of 10 pounds lost at the 24 month mark. Hardly enough to push any but the barely obese into overweight, and not enough to take anyone from obese to normal weight. 10 pounds may be enough to put some over that 5% goal, but it’s not the 10% or more most of us are looking for.
Weight Watchers works as well as anything else, because nothing else works real well, either. Don’t get me wrong, it’s better than nothing, and may indeed help people to achieve modest weight loss - and that may be enough to reduce the health risks of obesity, and therefore if I were Queen of the World, the cost would be covered by health insurance. But it ain’t curing obesity, disease or not.
Of course* if* the interventions have an even very modest impact on the rates of the complications of obesity and the lifestyle often associated with obesity (poor nutrition habits and a lack of fitness) then the long term savings far off set the cost. The key is that every insurer has to cover it else one pays up front and the other benefits when the patient switches carriers later. And it has to have some measurable efficacy.
Doctors do what they are incentivized to do to some very real degree. If you want them to work harder on treating obesity then you have to be willing to dangle the carrot.
Mind you I think there are better ways, some already included in the Affordable Care Act. Individual physicians in their offices are likely not very effective at treating obesity. OTOH as part of teams they can be at least modestly effective. Reward population outcomes of those taken care of by large healthcare teams, call them maybe an “Accountable Care Organizations” … and you can incentivize the formation of systems that can prevent obesity and, more importantly, the behavioral choices that are associated with adverse health outcomes. Yes, that is the plan.