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Professional News
 DOI: 10.1176/appi.pn.2013.7b16
AMA Declares Obesity Disease Requiring Treatment
Psychiatric News
Volume 48 Number 14 page 1-1

Abstract

Interventions for obesity can include medical treatments, including medication or surgery, but also psychosocial and behavioral therapies.

Abstract Teaser

Obesity is a disease requiring a range of medical interventions to advance obesity treatment and prevention.

That’s what the AMA’s House of Delegates declared last month during its annual policymaking meeting in Chicago.

“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately 1 in 3 Americans,” AMA board member Patrice Harris, M.D., said in a statement. “The AMA 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.”

In an interview with Psychiatric News, Harris—a former member of the APA Board of Trustees—said she believes the policy adopted by the House will “elevate the way physicians communicate with patients” about obesity. She said the new policy is in keeping with AMA’s commitment to improve health outcomes, which is one of the organization’s long-term strategic objectives.

Harris added that treatment of obesity should encompass a variety of interventions depending on the needs of the individual patient—medical treatments, including surgery or medication, but also psychosocial and behavioral interventions. She added also that obesity has been viewed by some as a lack of willpower with regard to eating, a stigma that should be dispelled by the understanding of obesity as a disease.

But opinion in the House of Delegates was far from unanimous. A report from the AMA’s Council on Science and Public Health (CSPH) examined in depth the public health implications of obesity and explored the potential benefits—but also the scientific challenges—of defining obesity as a disease.

“Without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine conclusively whether or not obesity is a medical disease state,” the CSPH report states. “Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive. Obesity, measured by BMI, 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.”

Robert Gilchick, M.D., a public health physician and member of the CSPH who spoke for the council, argued against the definition. “We recognize obesity as a serious health condition with increased risk for disease, but the difficulty in screening and measurement and the lack of a precise definition [of disease] are all problematic,” he said. “We feel further that medicalizing obesity with a focus on pharmacologic and surgical interventions may reduce the focus on primary prevention efforts addressing underlying and upstream social determinants of obesity.”

The CSPH report called only for reaffirmation of existing AMA policy regarding management of obesity. However, a separate resolution introduced by the American Association of Clinical Endocrinologists and six other physician groups urged that the AMA “recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention.”

The resolution was supported by a wide range of physician groups and was approved by the House of Delegates.

“Obesity has unfortunately been considered a consequence of lifestyle choices, but we now have an abundance of evidence identifying obesity as a multi-metabolic and hormonal disease,” said John Seibel, M.D., of the American Association of Clinical Endocrinologists. “Obesity is a pathophysiologic process involving characteristic signs and symptoms and morbidity. Hormonal and metabolic abnormalities are heterogenous in nature and are likely to require multiple risk-stratified interventions including but not limited to lifestyle interventions.” ■

The policies and resolutions adopted by the AMA House of Delegates are posted at http://www.ama-assn.org/ams/pub/meeting/reports-resolutions-listing.shtml.

New AMA Policies of Interest to Psychiatrists 
  • Gun safety and mental health: A new resolution adopted by the House of Delegates supports federal and state research on firearm-related injuries and deaths and the rights of physicians to have “free and open communication with their patients regarding firearm safety and the use of gun locks in their homes.” The same resolution also supports “initiatives to enhance access to mental and cognitive health care, with greater focus on the diagnosis and management of mental illness and concurrent substance abuse disorders, and work with state and specialty medical societies and other interested stakeholders to identify and develop standardized approaches to mental health assessment for potential violent behavior.”

  • Welcoming gay and lesbian physicians: The Gay and Lesbian Medical Association (GLMA) was admitted to the House of Delegates. “Gay, lesbian, bisexual, and transgender (GLBT) physicians and medical students will now have an important voice within the house of medicine that will enhance AMA policy and programs, especially those that affect GLBT physicians, students, and patients,” said incoming AMA President Ardis Dee Hoven, M.D.

  • Student debt: Delegates adopted a policy to work with other health profession organizations to advocate for a reduction of the fixed interest rate of the Stafford student loan program. “To help students, residents, and physicians manage their medical student loan debt, the AMA has advocated for numerous policies, including the creation of additional tuition-assistance and loan-forgiveness programs,” said AMA Board member Stephen Permut, M.D. “A reduction in the fixed interest rate of Stafford loans, combined with other advocacy efforts, will help physicians and physicians-in-training better manage their debt burden.”

  • Opposition to genetic discrimination: Delegates adopted a policy strongly opposing discrimination based on an individual’s genetic information and supporting legislation that would provide robust and comprehensive protections against genetic discrimination and misuse of genetic information.

  • Public access to genetic data: Delegates approved policy that encourages companies, laboratories, researchers, and providers to share data publicly on genetic variants and the clinical significance of those variants through a system that assures patient and provider privacy.

  • Pharmacy compounding safety: Delegates adopted new policy recommending that traditional compounding pharmacies be subject to state board of pharmacy oversight. It also supports FDA oversight and regulation of facilities that compound sterile drug products without receiving a prescription order prior to compounding and introducing these drugs into interstate commerce.

  • Opposition to lifetime ban on blood donations from gay men: Delegates adopted policy opposing the FDA’s current lifetime ban on blood donations from men who have sex with men. The policy also expresses support for the use of rational, scientifically based deferral periods that are fairly and consistently applied to blood donors.

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