Last month the American Medical Association made a recommendation that obesity be classified as a disease. This announcement was met by applause and frustration by the dietitians at Hendricks Regional Health. Obesity is a complex and multi-factorial condition (now perhaps a disease). One pill, one prescription, one set of advice does not work for each person and effective solutions have continued to elude millions of Americans. Ninety million Americans are overweight and obese. Seventy-eight million adults and 12 million children fit into these two categories. Specifically in Hendricks County 23% of our citizens are considered obese and another 40% are considered overweight.
The diagnosis of obesity is made using a person’s body mass index (BMI). Using the Centers for Disease Control definition of obesity, a BMI over 30 means an obesity diagnosis. While BMI is not the perfect tool for measurement it is the quickest, cheapest and routinely gets clinicians in the ballpark. Thus it is widely used to assess and document a person’s weight status.
The AMA’s recommendation changes the way the medical community and insurers look at obesity and moves the issue from a major public health problem to the category of a chronic disease. So, will this recommendation start to move the needle, increase awareness and initiate change? The dietitians at Hendricks Regional Health offer these pros and cons to the issue:
- Clinicians will increasingly initiate discussions with patients.
- Insurers will start covering non-surgical weight loss interventions (sadly, insurers often do not cover weight loss initiatives or education).
- Patients can be proactive about caring for their disease.
- We can treat obesity interventions earlier and prevent future health consequences.
- The mental health aspect of overweight and obesity may rise to the top as we help folks improve their nutrition, behavioral and activity habits.
- Bariatric treatment including surgery can benefit those that meet the criteria.
- Our public health system will place more emphasis on prevention instead of treatment.
- The ongoing and continued expense of paying for the cost of obesity will continue to drain our healthcare systems and economy.
- Obesity will continue to be a burden to healthcare and insurance industry.
- Mental health strategies and support for those dealing with a chronic disease are not robust enough to support all those needing services.
- We may experience an increase in the number of patients seeking bariatric surgery without understanding the life-changing aspects to bariatric surgery. Bariatric surgery at times is viewed as a solution that doesn’t require the difficult work of changing their nutrition, behavioral and activity habits.
- An important consideration of this decision will be how we initiate efforts to reduce weight gain. If obesity is classified as a disease will some people adopt a passive, victim approach rather than a more intense approach of moving more and curbing calorie intake?
- We know those with obesity have encountered stereotyping and discrimination. Will this classification increase disability claims?
So, what are the solutions? It is essential to understand obesity is a cultural phenomenon as well as a public health concern. In our free market society consumers still are king and determine what we deem as important and of value. With the recent recommendation perhaps we will begin to place value and importance on prevention instead of treatment? That is the frustrating part of the discussion. For far too long we have paid for treatment but ignored prevention.
What does it take to begin to move the needle? These lifestyle choices are well-proven to help improve health and lower BMI among children and adults:
- Encourage all new moms to breastfeed their infants to six months of age.
- Remember fresh is best when choosing foods.
- Decrease the portions you serve and eat. We all can benefit from smaller portions.
- Make a point to choose less processed, less packaged, less fast food for you and your family.
- Increase your activity and that of your family. Children mimic parent’s activity levels.
- Seek intervention. Check out our 16-week Lifesteps® program. Hendricks County also offers other weight loss programs. The Hendricks Regional Health YMCA offers STOP Taking on Pounds, a 12-week pediatric weight management program.
- Support and encourage (but don’t nudge/tease/embarrass) a person to seek a healthy lifestyle.
- Encourage physical activity in your own family and community.
An easy solution isn’t available. We believe the answer to overweight and obesity starts with each person and each family. And sometimes the answer starts with our next meal or snack or opportunity to be more active. By taking it one step at a time we can begin to “downsize” our community and lead the way for healthier communities.