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Obesity: A Disease By Any Other Name

(Photo: Yale Rudd Center for Food Policy and Obesity)

(Photo: Yale Rudd Center for Food Policy and Obesity)

By Melinda J. Watman
Guest contributor

When the American Medical Association declared obesity a disease last year, most of us — advocates who work to help those with obesity — were thrilled.

We saw the new definition’s potential to change how medical professionals regard people with obesity, increase society’s focus on obesity, push insurance companies to cover obesity treatments, reduce social stigma and moderate the anxiety and depression often afflicting those with obesity.

Already, we see some of those hopes being realized. Just last week, the federal government’s Office of Personnel Management issued a ruling that health insurers who cover federal employees may no longer exclude coverage of weight loss drugs on the basis that obesity is a “lifestyle” condition or that obesity treatment is “cosmetic.” This is one more significant step in the recognition and treatment of obesity as a disease.

But nothing is that simple or easy.

The high-fiving was barely over when the first study came out saying “not so fast.” It would seem, according to an article published in the New York Times, no good deed goes unpunished. The article presented a summary of a research paper titled “‘Obesity Is a Disease’: Examining the Self-Regulatory Impact of this Public-Health Message.

Melinda Joy Watman (Courtesy)

Melinda Joy Watman (Courtesy)

The three authors concluded that labeling obesity a disease led their subjects to want to eat more, eat worse and care less about their weight. They suggested that labeling obesity a disease leads to the belief that it is futile to try to manage one’s weight.

Whether one agrees with the study’s findings and conclusions or not, the underlying question of whether obesity should be accepted as a disease is the critical point. The authors certainly question its validity based on the findings that their subjects suffered an “undermining of beneficial self-regulatory processes.”

What is interesting is that if it were any other chronic illness with comparable results, we would not be questioning whether the illness should be classified as a disease. Rather, we would be trying to find better ways to engage, educate, support and treat those patients as we continued to work on new therapeutics to manage the disease.

As is often the case with obesity, it would appear this line of thinking and research has the potential to further marginalize the problem and those affected by it. This is completely counter to what the AMA policy strives for – the same medically accepted framework to diagnose, treat and support patients as exists with any other chronic illness. Continue reading

Calling Obesity A Disease: Fat Acceptance Advocates Predict More Stigma

obesekid

Disease. That word carries so much weight, and as of this week, it also concerns weight: The American Medical Association decided to officially define obesity, a condition that affects over one third of American adults, as a disease.

The decision went against the recommendations of the AMA’s own Public Health Committee to do the opposite, and it means that obesity will now be joining alcoholism and drug addiction as a “condition” whose elevation to “disease” sparks controversy.

So will calling fat people diseased pave the way to a healthier society?  Members of the fat acceptance community — advocates for reducing the stigma of obesity– say that all depends on what you consider “health” to be in the first place.

“The AMA’s decision makes a body size into a health diagnosis,” says writer and fat-acceptance activist Ragen Chastain.  She is upset by the AMA’s decision and thinks that it is an affront to her movement’s mission.

“The goal is to create a world where fat people are treated with respect, free from bullying, oppression and stigma,” she says. “I think this will absolutely lead to greater stigma.”

The AMA argues the opposite: It cites the reduction of stigma as part of its reasoning for labeling obesity as a disease.

Some advocates of the AMA’s decision say that labeling obesity as a disease is the wake-up call that doctors need to start treating their fat patients using more serious weight-loss strategies, such as bariatric surgeries.

Some also speculate that obesity’s new, serious status will put pressure on insurance companies to start covering fat-fighting procedures and treatment as they would, say, smoking cessation.

Lesley Kinzel, a senior editor of Xo Jane and a longtime Boston-based fat-acceptance ativist, says she recognizes that, from a medical standpoint, it is good to address stigma attached to fat patients. Continue reading

True Transparency: Doctors Who Admit Errors, And How To Help Them

A patient who had a different operation made things very clear...


It’s easy to be snarky. I confess that when I posted this story last November about a Mass. General surgeon who admitted performing the wrong operation on a patient and analyzed why, my headline began “Oops!” But the truth is, of course, its incredibly courageous of doctors to admit their mistakes publicly, to break the medical omerta.

The topic is timely today because of a new Harvard study finding that most doctors will face a malpractice lawsuit at some point — and interesting work under way in Massachusetts to encourage medical apologies. The Patrick administration, too, supports making admissions and apologies easier. And the American Medical Association’s amednews.com has just posted an inspiring piece on three doctors who came clean before their colleagues, including Mass. General’s Dr. David C. Ring and Dr. Jo Shapiro of Brigham & Women’s.

The piece begins with a heartbreaking story of a Seattle nurse whose dosage miscalculation led to a baby’s death — and to her own suicide. (A recent study found that doctors have about double the usual suicide rate to begin with, and major medical mistakes triple their suicide risk, amednews reports.) And the piece ends with some of the efforts, in Boston and elsewhere, to help medical staffers who have made errors:

Supporting physicians when things go wrong

Few physicians talk publicly about their medical errors, but a growing number are benefiting from programs dedicated to helping doctors deal with the emotional turmoil that often comes in the wake of adverse events.

Jo Shapiro, MD, helped start the Center for Professionalism & Peer Support at Boston’s Brigham and Women’s Hospital in October 2008. There are 55 physicians and other health professionals at the hospital trained to offer emotional support to peers involved in cases of patient harm.

“When there’s any kind of adverse event that we hear about, one of us will make an outreach call to the physician involved,” Dr. Shapiro says. “We ask them simple questions like, ‘How are you doing? How are you feeling? Is there anything I can do to help you?’ ”

Continue reading

Report: Economic Worth Of Mass. Doctors

The Massachusetts Medical Society has just sent over this Lewin Group report, commissioned by the American Medical Association, on doctors’ contribution to the economy. Says the MMS:

Alice Coombs, M.D., President of the Massachusetts Medical Society, said: “As the state’s number one industry, health care plays the leading role in the economic well-being of Massachusetts. This latest report clearly demonstrates that physicians contribute enormously to the economic health of our communities and the state, as well as to the personal and public health of our residents.”

That’s good news, of course. As well as problematic news: The economic importance of health care makes it all the more perilous for reformers to tinker with it, even though change is clearly needed.

More from the MMS: Continue reading