Community Corner

Calling Obesity A "Disease" Could Change Insurance Coverage

"It's not an infectious disease," Sandman said. "Widespread yes, but not transmissible from person to person."

By Andrew Brady Lowndes

While reporters have been caught up with the technological train wreck of the HealthCare.gov rollout, much of the Affordable Care Act’s fine print is going unexplored. Buried in all this text are the seeds for a debate about obesity as a disease. Some experts think this is bound to heat up as the ACA’s provisions become reality.

“I don’t think anyone knows what exactly will happen as a result of calling obesity a disease,” said Neale Chumbler, who heads the health policy and management department at the University of Georgia (UGA). “Presumably, it will increase awareness, and there may be more funding available for preventative care.”

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The AMA Speaks

The American Medical Association (AMA) made headlines in May when its leaders resolved that obesity should be officially labeled a disease. This decision was not sparked by dramatic new research or understanding, but it did come in time for the launch of President Obama’s key domestic initiative.

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“The AMA’s opinion is significant,” said Chumbler. “They have a great deal of influence over health care policy.” According to the Center for Responsive Politics, the AMA has spent over $13 million in total lobbying efforts this year. This makes them one of the nation’s top ten lobbying clients.

Infighting among one of the AMA’s committees slowed their judgment on this issue. The group bogged down in a semantics argument that had them questioning what both “obesity” and “disease” really mean. Other national organizations did not debate this point as much - the Food and Drug Administration, the National Institutes of Health, and the Internal Revenue Service all classified obesity as a disease before the AMA got around to it.

Obesity is not Infectious

Not everyone is happy about this trend.

“I don’t like buzz words,” said Peter M. Sandman, an internationally known risk communicator who visited UGA in October. Sandman holds a doctorate in communication from Stanford University and knows how to pick apart semantic arguments – he even hesitates to use the word “epidemic” for the obesity problem.

“It’s not an infectious disease,” Sandman said. “Widespread yes, but not transmissible from person to person.”

The AMA no doubt feels justified in its choice of words, Sandman says. “When it comes to a major threat, public health organizations have some room to overstate potential dangers.”

A disease by definition or not, obesity plagues a great number of Americans. The Center for Disease Control and Prevention estimate the prevalence of obesity among U.S. adults at 34.9 percent in 2012.  In effect, roughly 78 million Americans have a disease that is, at least in theory, avoidable. Though obesity increases have leveled off in recent years, the number of people affected remains enormous. 

The language medical doctors use to talk about obesity will not change these statistics.  However, their opinion does contribute to a national conversation that may eventually have that effect.

“It’s a very positive step,” said Morgan Downey, former executive director of the American Obesity Association (AOA).  “We’re probably going to see more attention within the medical community to take it more seriously, and not to overlook it or disregard it as a diagnosis.” Downey fielded questions when presenting a poster about the ACA at this year’s Obesity Week conference in Atlanta.

“It’s pretty widespread coverage for intensive behavior counseling,” he said. “The benefit is now there, and it’s a real challenge to the field to come up with infrastructure to deliver, and that’s what some comments have been about.” Downey also talked about how the ACA outlaws discrimination against persons with health conditions that affect longevity, disability status, or medical intervention effectiveness. 

“That’s a novel concept,” he said.  Persons with obesity often fall into these categories and have had trouble getting desirable health insurance as a result.  In other words, those with obesity can appreciate both recognition from the medical community, and the specifics of new health insurance policies.

“I think for medical purposes it does make sense to call obesity a disease - that’s the physical manifestation,” said a woman from an Overeaters Anonymous group that meets in Athens. “And it’s a more compassionate view.”

 

 


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