Vol. 93 July 1, 2013 “Do You Have Obesity or Are You Just Fat?”

hub_2“Obesity is much more like drowning than a disease…We are drowning in calories.”

-David Katz, MD, the Health Care Blog, June 22, 2013


.The House of Delegates of the AMA just voted to designate obesity as a disease. This means that you will no longer “be fat”, you will “have obesity” like you “have diabetes”.  The AMA Scientific Council recommended to retain obesity as “a condition”. A spirited debate about the consequences has begun, but so what?

Proponents claim that disease designation will increase physician attention to the problem and that insurers will pay more. Medicare reimbursement for a disease of obesity could incentivise more “obesity care coordination” which could “widen the range of effective treatment” beyond bariatric surgery (now covered by Medicare) and drug therapy (NOT covered by Medicare).

Opponents point out that the American life expectancy has increased by 12 years since 1970 despite the increase in obesity, that the definition of obesity is ill-defined, that BMI numbers are imprecise (many people with high BMIs are quite healthy), and that designating it as a disease is unlikely to change any outcomes.

My pediatric office computer, and therefore the insurance companies, already let me diagnosis obesity (CPT code #278) just as I can for diabetes (CPT code# 250.0) or drowning (CPT code #E910; the E designates “accidental”). What are the practical differences between a diagnosis and a disease?

I suspect that it is all about money. Medicalizing a societal condition will cause more money to be spent on surgery and drugs.  “Insurers will pay more.” The upside of that could be more provider reimbursement for prevention and life style counseling, but surgery and big pharma are usually first in line. Two new anti-obesity drugs (Belvig and Qsymia) came on the market this past year. More than one-third of Americans will instantly be labeled as “ill” and therefore eligible for more medical services.

Seconding the opinion that money is involved is one investment analysis:

“Increasing efforts to tackle obesity over the coming decades will form an important new investment theme for fund managers…Global obesity is a mega- investment theme for the next 25 years and beyond…”

The definition of obesity and a consensus of its cause(s) remain elusive. Different countries even use different BMI thresholds so international comparisons of obesity percentages are not always accurate. Is obesity caused by genetics, culture, or environment …or all three? Japan and Korea are in the lowest 10 countries of percent obese, BUT their rate of increase of obesity is close to ours, and we are in the top ten. One writer compares obesity with drowning and carbon monoxide poisoning, both results of a “toxic environment”:

“We don’t just wait till the person almost drowns and provide essential resuscitation services. We pass laws regarding pools, fences, life guards, encourage swimming lessons for children, etc. to prevent the drowning condition in the first place.”

The AMA vote has no legal or regulatory weight. It is merely an expression of an opinion, but it shines another spotlight on the problem of increasingly overweight populations, whatever you call it.

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