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Weighty disease: Handling of obese patients by doctors, insurers may change with new AMA label

June 20, 2013
by Shelly Bradbury
Chattanooga Times Free Press

Obesity is a disease, the American Medical Association decided this week, and that new label could change the way doctors and insurers handle obese patients, local bariatric experts said.

The new classification could encourage doctors to create serious treatment plans for extremely overweight patients and put pressure on insurance providers to expand bariatric coverage.

"You have another organization of really smart people who are saying this is a disease and we should treat it just like any other disease," said Chris Sanborn, director of metabolic and bariatric surgery at Erlanger hospital. "It's the culmination of scientific evidence and people analyzing the evidence, and now we can more easily treat obesity like a disease -- because it is one."

There's no doubt obesity is a major public health issue in the United States. One-third of American adults are obese, according to the Centers for Disease Control and Prevention. In 2008, medical costs associated with obesity hit $147 billion, the CDC reported. Obesity is linked to dozens of other health problems, like heart disease, diabetes and cancer.

Yet the medical community's current approach to treating obesity isn't working, said Tennessee Medical Association President Chris Young.

"I think [the decision] expresses physicians' frustration that we have this growing problem and what we've done thus far hasn't worked to try to control it," he said, adding that the American Medical Association includes more than 500 voting delegates.

"I've heard proponents say that not treating obesity as a disease because people eat too much is like calling lung cancer not a disease because people smoke," he said. "It is a condition that has a real impact on people's health."

That analogy doesn't quite hit the nail on the head for Jack Rutledge, a metabolic and weight loss surgeon at Memorial Hospital. Smoking is a choice, he said, but obesity, while it can be exacerbated by choices, starts with a biological regulation of how much fat the body is set to carry.

That biological regulation sets the ground level for what amount of fat the body considers normal. Some people, he said, are genetically set up to carry more fat than others. And if a patient is genetically set up to carry more, the body won't lose that extra fat through exercise and diet alone.

"We think, 'Oh the amount of fat we carry is up to us," he said. "The general thought about obesity is that people are lazy, they don't push back from the table, they don't change their habits. But the explanation has come through genetics."

He expects that the American Medical Association's decision to call obesity a disease will push primary care physicians to discuss treatment options with patients more regularly.

"What's happening now is that they don't talk about it at all," he said. "It's so awkward. It's so offensive. And they don't have answers for these people."

Medicalizing obesity could open up a wider range of options for obese patients, like drug treatments or surgery, he said. But opponents argue it could drive up treatment costs and increase patient reliance on medical solutions in situations where just plain diet and exercise could have done the trick.

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