Designating obesity a disease may lead to better care
Decision expected to open door to better treatment
Published 2:03 pm, Friday, July 26, 2013
Houston doctors say a recent decision by the American Medical Association to designate obesity as a disease could improve treatment options for patients.
The policy change by the association, which represents more than 200,000 doctors and medical students, comes in the midst of a 20-year battle against rising obesity rates in the United States, according to the Centers for Disease Control and Prevention. Experts have debated the issue for years, with many saying that obesity is the result of personal choices.
More than one-third of U.S. adults and about 12.5 million children and young people ages 2 to 19 are obese, government data shows.
"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans," said association board member Dr. Patrice Harris in a written statement. "The (association) is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and Type 2 diabetes, which are often linked to obesity."
The association's declaration is expected to lead to payments for efforts of obesity prevention and treatment, doctors say. Currently, insurers typically don't cover weight-loss counseling or programs.
Dr. Willa Hsueh, director of Houston Methodist Diabetes and Metabolism Institute, said the association's decision could change the way patients get weight-management help from their doctors.
"The biggest problem has been there has been an increasing rate of obesity, but no ability to treat it," she said.
Hsueh said many patients want lifestyle, nutrition and exercise guidance, but insurers instead are more likely to pay for bariatric surgery, which might be necessary in some cases. Even after surgery, patients require lifestyle, nutrition and exercise counseling, she said.
Institute researchers, including Hseuh, are working on a vaccine that would reduce the strain on organs and organ systems related to obesity, allowing doctors to better treat obesity itself. They found that high-calorie diets cause fat cells to send false distress signals through certain proteins. The proteins indicate the fat cells are fighting off bacteria and viruses, although that isn't the case.
But the body's immune cells are tricked and they become inflamed. Fat-tissue inflammation contributes to development of Type 2 diabetes and other diseases.
"It's the excess fat that's causing this disease," Hseuh said. "The root is obesity. It's definitely a disease."
Dr. Erik Wilson agreed that obesity is a disease, saying the association's decision is long past due. Wilson is medical director of Bariatric Surgery at Memorial Hermann at the Texas Medical Center. He also is chief of elective general surgery at University of Texas Medical School at Houston.
Wilson said obesity causes physiological and metabolic changes that make it difficult for people to lose weight and keep it off. The condition is more complex and should be approached in that manner, rather than accusing patients of making poor choices and leaving them to fix themselves, he said.
"We need to go a long way from the blame game to figure out ways to treat it," he said. "If it's a disease, you have to treat it. We have been oversimplifying it. No one deserves to be fat."
Wilson's patient, Ashley Falco, considers food an addiction with which she still struggles. After years of dieting, Falco, 33, had bariatric surgery, which has helped her lose 95 pounds.
"It was the best decision I've made in my life," she said of her 2011 surgery. "I got tired of trying every diet. I needed something more drastic."
Falco, a second-grade teacher in the Dickinson Independent School District, said she wants to lose 10 more pounds and tone her body. She works with a trainer twice a week and is proud of her accomplishments.
"The hardest part is I try to eat right," said Falco, who turns to exercise to fight food cravings. "I'm living a healthy lifestyle. I'm staying healthy and keeping the weight off."