While the American Medical Association may not have the clout it once did, it's still the largest single group of doctors making waves about health and the practice of medicine.
So it's not nothing when the AMA's House of Delegates approves a measure to label obesity a disease. The group's deliberative democratic body passed a measure in Chicago Tuesday that broadly, if vaguely, says obesity is a medical condition:
"RESOLVED, That our American Medical Association recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention."
The AMA isn't vested with legally binding authority on what's a disease and what's not. And, in fact, when it comes to the labeling of diseases, there's a whole other global ball of wax called the International Classification of Diseases, which already has a range of categories covering obesity — from the type "due to excess calories" to the kind that's a side effect of prescription drugs.
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So what's the big dea with the AMA? The group still has a considerable bully pulpit. And the vote could give more oomph to efforts to have obesity interventions paid for by insurers and to get the public focused on the problem.
"We felt it's time to take a stance and say we're going to identify this as a disease," Dr. Douglas Martin, chairman of the AMA public health committee that referred the resolution for vote, told MedPage Today. "We think that's going to send a message not only to the public but to the physician community that we really need to make it a priority and put it in our cross hairs."
Before the voice vote, Dr. Virginia Hall, an obstetrician from Hershey, Pa., said the AMA should call obesity disease so "insurers can stop ducking their responsibility" in paying for obesity treatments, according to a Forbes report by Bruce Japsen.
After the vote, the AMA cited board member Dr. Patrice Harris praising the measure: "Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans."
But even within the AMA there was some uneasiness about the disease label. A report on the proposed resolution from the group's Council on Science and Public Health didn't support it. The analysis noted the lack of a clear definition of what constitutes a disease and whether obesity would fit, in any case. The report also raised practical concerns:
"Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive. Obesity, measured by [body mass index], is clearly associated with a number of adverse health outcomes, with greater consistency across populations at the highest BMI levels. However, given the existing limitations of BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a 'condition' or 'disorder,' will result in improved health outcomes. The disease label is likely to improve health outcomes for some individuals, but may worsen outcomes for others."
In January, NPR talked with sociologist Abigail Saguy about the perils of defining obesity as an illness. "People think that being obese means being sick, and there are some health risks, but risk is not the same thing as illness," Saguy said.
She also criticized the typical tool doctors use to assess the health aspects of weight: body mass index. A BMI of 30 or more puts a person in the obese category. "It's a very arbitrary threshold," Saguy said. "There are plenty of people with BMI well over 30 who are perfectly healthy, and plenty of people at 'normal' weight with metabolic issues."