Fat becomes a disease

On June 18, the American Medical Association’s House of Delegates signed off on a statement arguing that obesity is a disease. It said that obesity — the condition of being excessively overweight — meets all of AMA’s criteria for defining a disease. These criteria include impairing normal functions of the body, having characteristic signs or symptoms and leading to harm or poor health.

The AMA is a group of more than 215,000 U.S. doctors and medical students. AMA’s House of Delegates is a committee that sets official policy for the organization.

The House of Delegates observed that the AMA would hardly be the first organization to view obesity this way. Already, it notes, “The World Health Organization, Food and Drug Administration, National Institutes of Health, the American Association of Clinical Endocrinologists, and Internal Revenue Service recognize obesity as a disease.” So too does one of the United States’ largest health insurance companies, the policy committee adds.

Some people have argued that obesity is not a disease but just the unhealthy result of lifestyle choices to eat too much and to exercise too little. But the new AMA policy statement rejects that idea. It states that such an attitude makes as little sense as “suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.”

Doctors have long known that excess body weight puts people at high risk of developing diabetes, heart disease, joint disease, cancer and more. The growing prevalence of obesity is especially troubling, the AMA notes. Although obesity rates are rising throughout the world, the problem has reached epidemic proportions in the United States. There, the number of people who could be classified as obese has doubled in the last 20 years.

Already, more than one in three U.S. adults is obese, according to the U.S. Centers for Disease Control and Prevention. Among non-Hispanic blacks, the rate is far higher: one in two adults! And the rate of obesity among U.S. children between the ages of 2 and 19 has nearly tripled since 1980. Today, obesity afflicts nearly one out of every six American children.

The AMA did not design its new policy statement to make people who are fat, for whatever reason, feel bad. Instead, it encourages doctors to open discussions about body weight and its medical implications with their overweight patients. The new policy also suggests that doctors should take the initiative in recommending treatment and counseling (where needed) to their obese patients.

In fact, it’s hard for people to lose weight once the body gets used to carrying around excess flab. And that’s because the body will try to maintain any extra weight. When people consciously eat less, the body may experience this as an increased risk of starvation. Without thought, the body responds by releasing more hunger hormones. These hormones signal the brain that more food is needed. At the same time, these signals inform the body that it should slow its burning of body fat. This conserves energy — and body fat.

Doctors can help patients counter these biochemical signals, which can sabotage the body’s efforts to slim down. Indeed, the new AMA statement recommends that doctors give overweight people more encouragement about the many measures they can adopt to return to a healthy weight.

Power Words

diabetes A disease where the body either makes too little of the hormone insulin (known as type 1 disease) or ignores the presence of too much insulin when it is present (known as type 2 diabetes).

endocrinologists Doctors who specialize in conditions affecting the production of hormones or the body’s response to hormones.

hormone A chemical produced in a gland and then carried in the bloodstream to another part of the body. Hormones control many important body activities, such as growth. Hormones act by triggering or regulating chemical reactions in the body.

type 2 diabetes A disease caused by the body’s inability to effectively use insulin, a hormone that helps the body process and use sugars. Unless diabetes is controlled, a person faces the risk of heart disease, coma or death.

obesity Extremely overweight. Obesity is associated with a wide range of health problems, including type 2 diabetes and high blood pressure.

overweight A medical condition where the body has accumulated too much body fat. People are not considered overweight if they weigh more than is normal for their age and height, but that extra weight comes from bone or muscle.