Obesity classified as disease, may improve patients' care

SEATTLE -- The American Medical Association officially recognized obesity as a disease Tuesday, a decision local physicians believe will make it easier for them to treat the overweight. But, opponents argue obesity is a lifestyle choice and classifying it a medical illness will increase health care costs.

The U.S. Centers for Disease Control and Prevention defines any person with a body mass index above 30 as obese, including more than one-third of U.S. adults.

While the AMA's classification has no legal authority, federal and state policy makers have adopted the association's positions in the past when setting medical policy and health regulations.

Dr. Richard Lindquist, a bariatric medicine specialist at Swedish Medical Center, said the AMA's action could make it easier for him to treat obese patients. Currently, Lindquist said he can bill insurance companies for conditions which affect the obese - diabetes, high blood pressure or sleep apnea - but he is not reimbursed for having a conversation about weight loss.

"I hope the standard of care will improve," Lindquist said. "Physicians may finally be compensated for treating the problem, and there will be more impetus to other providers to learn how to treat obesity."

While opponents argue the AMA's classification could lead to an increase in insurance premiums, Lindquist said treating obesity will reduce health care costs in the long run.

"We pay now or we pay later," Lindquist said. "If we continue our current approach the health care system will be swamped by diabetics with an incredible cost of care. The direct and indirect costs associated with obesity now surpass those of smoking."

Unfortunately, Dr. David Cummings, an endocrinology professor at the University of Washington, said it takes years for insurance companies to profit from investing in obesity treatments and insurers are unlikely to see long-term benefits when U.S. patients switch plans every three years on average.

Still, Cummings said he is surprised obesity has not already been classified as a disease.

While there is no universally recognized definition of what constitutes a disease, Cummings said most medical professionals agree it is a disorder beyond your control, in many cases caused by a mix of genetic and environmental factors. Cummings said the majority of body weight factors are genetic, citing studies published decades ago in the New England Journal of Medicine.

"Each of us has a different body weight ball park set by our genes," Cummings said. "Body weight should be determined a biological condition."

Lindquist said he believes obesity has not been classified as a disease until now because of a stigma associated with the overweight. He said many physicians are biased against obese patients, largely due to poor training on the condition.

"People don't choose to be obese any more than they chose to have cancer," Lindquist said. "By not treating it as a disease we can't be in position to deal with it effectively, we end up thinking of it as a lifestyle choice. We assume that all people who are obese are slothful and gluttonous."

The AMA's decision went against the conclusions of the association's Council on Science and Public Health, which had studied the issue over the last year and issued a 14-page report. The council said obesity measures are simplistic and flawed and some people with a BMI that qualifies them as obese are still healthy.

But, several medical societies, including the American College of Cardiology and the American Urological Association, urged the AMA to classify obesity as a disease.

The AMA overrode the council's recommendation with a resolution stating, "The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes."