Obesity Recognized as a Chronic DiseasePosted: Jun 18 in Medical Weight Loss News by Dr. Lazarus
For many years I have told my patients that obesity is not a problem of eating too much and exercising too little, in spite of this common stereotype that has been propagated everywhere from the lay press to physician beliefs. We have had good science to support that in fact obesity should be considered a disease and not simply a result of conscious behaviors dating back to the discovery of leptin, a hormone that fat cells make which governs appetite regulation, back in 1994. In 1998 our National Institute of Health recognized obesity as a disease. And today the American Medical Association adopted new policy recognizing obesity as a disease.
I was very happy to represent the American Society of Bariatric Physicians as their delegate to the AMA. At the same time, I stood as an advocate for all the patients I have helped in the past 10 years that I have practiced obesity medicine. I testified twice – first in front of the reference committee on science and public health, advocating that we had to move forward recognizing obesity as a disease because this step is necessary to reduce weight bias and weight discrimination in the public, in the workforce, and even in physician’s offices. Recognizing obesity as a disease will encourage teaching the science behind obesity to medical students, residents and the rest of the medical community. And it will spur research in the best prevention and treatment strategies. I also addressed the entire AMA House of Delegates testifying that obesity must be recognized as a disease in and of itself, and not only in situations where a person has other medical problems. I argued that obesity affects an individual’s health, happiness and physical functioning, and causes direct physical symptoms like fatigue and pain. Representatives from many other organizations supported this, and I also received support from the Western Mountain States (including the Colorado delegation).
After hearing testimony on both sides, the AMA voted and passed Resolution 420 classifying obesity as a chronic disease state with a significant majority vote.
What does this mean? In short, it means that obesity is not simply a condition that will go away with a change in behaviors. Obesity is complex involving the cellular biology of our fat cells, hormones produced in our gut, and a complex appetite control center in the hypothalamus section of our brain. Weight regulation is not a simple matter of calories in / calories out. In fact, it too is regulated by a system that in obese patients makes it quite difficult to lose weight. All of my patients know that maintaining weight loss is very challenging because the more weight we lose, the hungrier we get (low leptin / high ghrelin) and the slower our metabolism gets (adaptive thermogenesis). This energy gap predisposes to rapid weight regain.
With the recognition that obesity is a chronic disease, we can stop suggesting that this disease is ‘curable’ and instead focus on managing the condition. Ask any patient who has lost weight and kept it off – the key is to never forget about it and recognize that even if it is in remission, relapse is likely and can occur at any time for any reason. Recognizing obesity as a chronic disease is like recognizing alcoholism as a chronic disease. I have been told that perhaps the most important step in Alcoholics Anonymous is to accept that ‘I am an alcoholic.’ Even if somebody hasn’t had a drink in 20 years, there is still acceptance of that fact. One drink one night will lead to 10 drinks which will lead to out of control drinking and recurrence. It is clear that obesity is a similar condition, and for individuals who have lost weight, a careful lifelong maintenance program is essential.
Indeed, this will result in a fundamental paradigm shift where the medical community will be encouraged to study and teach about obesity and improve prevention and treatment strategies. Perhaps instead of saying somebody is ‘obese,’ we will instead say that they ‘have obesity’ much like having diabetes or having high blood pressure. Perhaps we can break down a wall of bias and stigma and work together on the best solutions.
I applaud the AMA on its decision and am hopeful that it will be the first step of many in reducing weight bias. And I am thrilled that I had the opportunity to participate in this historic debate as an advocate for my patients.
Dr. Ethan Lazarus