Money Changers —
Trigger warning: Discussion of current treatments for your fatness.
As you’ve probably heard by now, I’ve got a disease. You probably do too. In fact, about one-third of the nation now has the dreaded disease known as obesity.
It’s okay, though, because the American Medical Association (AMA) is on it.
“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, said in a statement.
Oh good, they’re going to change the way they “tackle” fatties. Obviously,. they haven’t had much success in the past, but now, ladies and gentlemen, they’re on their way to getting this whole nasty business of being fat under control.
Sarcasm aside, I’ve seen a few people express concern and even fear about this latest development in the War on Fat, but I hope we can all take a deep breath and see this decision for what it is: another example of pathologizing bodies for fun and profit.
There was a great discussion on Science Friday a few weeks back about this subject from a psychiatric standpoint. They discussed whether it was appropriate to classify Binge Eating Disorder or Attention Deficit Hyperactivity Disorder as psychiatric illnesses, or whether these are simply normal human behaviors brought about by the current environment. One caller suggested these diagnoses are part of a broader conspiracy cooked up by the pharmaceutical industry to drive doctors to prescribe more drugs to their patients. And while this is certainly an appealing claim, Gary Greenberg, author of The Book of Woe, explained that you don’t need a conspiracy theory to see the motivations.
“Every diagnosis is a market, whether the people who make the diagnosis up intend it to be that way or not. And that’s a symptom of a health care system that’s in trouble. So that’s a much larger problem,” Greenberg said. “I don’t have a big animus against drugs. I just think that we need to be more transparent about the fact that we don’t know much about their long-term effects, that we don’t know exactly why they work, that they are treating symptoms and not underlying disorders.
To me, this is the most important point in this whole controversy: Dr. Harris talks about defining obesity as a disease as though it will bring about some new treatment, some new approach that will finally — FINALLY! — help turn the tide against the tsunami of fatties. But what would that “new treatment” look like? New drugs? New surgeries? Hell, Sam Klein’s got the personal stomach pump that can purge 30% of your calories through a permanent port in your stomach. Is this our Brave New World of obesity treatment?
But even if this new diagnostic approach changes the way the medical community responds to fat patients, does that necessarily mean it will improve outcomes? Obviously, we don’t yet know for sure. What we do know is that many experts seem certain that the AMA’s decision will make reimbursement for “obesity treatment” easier.
Doctors, meeting in Chicago for the AMA’s annual meeting, said such an endorsement would lead to greater investments and potentially health insurance coverage specifically for a diagnosis that someone is obese when there is a payment mechanism for evaluating and managing obesity.
But we’ve long been heading in that direction, according to The New York Times:
The Internal Revenue Service has said that obesity treatments can qualify for tax deductions. In 2004, Medicare removed language from its coverage manual saying obesity was not a disease.
Of course, as the NYT points out, Medicare Part D, the prescription drug benefit, currently does not pay for weight loss drugs. The AMA’s decision may help both government and private health insurance companies get in line with a clinical approach to obesity. In the end, it seems that whether professional organizations believe obesity should be defined as a disease or not seems to rest on what you think the treatment should be.
For example, according to SourceWatch, the AMA has a long history of support from the pharmaceutical industry. Meanwhile, the American Council on Science and Health (ACSH), which wrote a vigorous argument in advance of the AMA’s decision, promotes “personal responsibility,” rather than drugs or surgery as “the cure.” Coincidentally, SourceWatch says the ACSH has a history accepting funding from corporations and trade associations. Elizabeth Whelan, founder of the ACSH, describes herself as “more libertarian than Republican.” This makes me the ACSH seem more similar in philosophy to the Center for Consumer Freedom, which often cites “personal responsibility” as the cure for obesity, even though that’s really just a convenient argument for an organization funded almost entirely by the restaurant, meat and alcoholic beverage industries.
But just because the ACSH fronts for the Big Food doesn’t mean their warnings against prescribing away obesity aren’t worth heeding: (PDF)
Concern exists that more widespread recognition of obesity as a disease would result in greater investments by government and the private sector to develop and reimburse pharmacological and surgical treatments for obesity, at the expense of clinical and public health interventions targeting healthy eating and regular physical activity. “Medicalizing” obesity could intensify patient and provider reliance on (presumably costly) pharmacological and surgical treatments to achieve a specific body weight, and lead to prioritizing body size as a greater determinant of health than health behaviors.
It’s important to be aware of these associations before you throw your support behind either the AMA or the ACSH because their conclusions on how we should “treat obesity” often seems influenced by their financial interests. But as with the medicalization of psychiatric conditions, this doesn’t necessarily mean there’s a conspiracy, just that there are financial interests who have a stake in how society views fat people. The American Healthcare Industry wants us to see fat as a disease that requires their cure and the American Food Industry wants us to see fat as a natural consequence of the freedom of choice we all hold dear. And both approaches are a larger symptom of an economic system that puts profit above true health and welfare.
Personally, I think that the AMA’s decision is just another symptom of our for-profit healthcare system. In my opinion, transforming obesity into a diagnosis, when there’s still controversy over diagnosing insulin resistance as a syndrome, is all about feeding the beast of out-of-control medical spending. If this were really about “curing obesity,” then they’d look at the long-term research on current obesity treatments and see that the current approach is failing miserably.
Nothing about the AMA’s decision changes what you or I or anyone else is doing personally to be healthy as individuals. If this decision makes your doctor more likely to prescribe Belviq or Qsymia or bariatric surgery, then your doctor was never worth your time in the first place. The only way this decision changes life for you or me is if it makes fresh fruits and vegetables cheaper, provides reimbursement for heart-healthy activities or gives us more free time to focus on improving our health.
Other than that, it’s just another brick in the wall of overpriced medical treatment that yields little objective improvement in long-term outcomes.