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Money Changers —

June 19, 2013

Trigger warning: Discussion of current treatments for your fatness.

Pill Man

One pill makes you larger and
one pill makes you small.

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.

Pill Plate

Remember when this was supposed to be the “future”?

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.

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21 Comments leave one →
  1. June 19, 2013 11:44 am

    I genuinely hate this country sometimes.

    • June 20, 2013 10:32 pm

      It’s hard not to feel despondent a lot of the times.

      Peace,
      Shannon

  2. vesta44 permalink
    June 19, 2013 12:53 pm

    It was the AMA’s policy-making House of Delegates who voted to make “obesity” a disease, and it wasn’t a unanimous vote, roughly 60% of them voted in favor. That was against the advice of the AMA’s Council on Science and Public Health, who said it would be problematic.

    The resolution was backed by delegates from the American Academy of Pediatrics, the American Academy of Family Physicians, the American Association of Clinical Endocrinologists, and the American Society of Bariatric Physicians.

    The above quote is from the MedPage Today article saying the AMA voted to make “obesity” a disease. And of course the American Society of Bariatric Physicians would endorse that view, it will make it much easier for them to get reimbursement when they prescribe drugs or WLS to eradicate all of us fatty fat fat mcfattersons. Fuckers, every damned one of them, who are ignoring the credo of “First, do no harm.”
    It’s not this country I hate, it’s all the money-hungry doctors, pharmaceutical companies, etc that I hate. “The love of money is the root of all evil” and this just proves that.

    • June 20, 2013 10:32 pm

      vesta,
      Our entire medical system is a for-profit nightmare and though most medical professionals are honorable in their service to the community. I think the proportion of greedy asshole doctors is probably comparable to the rest of the population, but because of their position we notice their scruples more. The problem is the influence of money on these medical associations, which is also a problem in some nutrition groups that have Coke as a major sponsor. It’s just insidious.

      Peace,
      Shannon

  3. June 19, 2013 2:44 pm

    I wrote a little piece as well. Just getting into the whole blogging thing, but I would appreciate any ideas on improvement. Someday I’ll be as great as Atchka!!

    http://www.modernfat.com

    • June 20, 2013 10:28 pm

      Thanks drdeaun, great piece. And thank you for the kind words. You’re adding to the conversation, so you’re doing everything I am already. 🙂

      Peace,
      Shannon

  4. June 20, 2013 8:11 am

    I’m having a very difficult time wrapping my head around the whole idea that now, in the blink of an eye, and snap of the fingers, it’s been OFFICIALLY claimed that being large-fat is a DISEASE in itself… not merely a symptom or result of other diseases, body chemistry or physical conditions. I have a disease! Wow.
    Maybe we need to turn this around to OUR advantage then? Maybe we should *all* claim we can no longer work, (too fat-sick) and apply for SS Disability… and from there start applying for all other government assistance programs. Wonder how fast they would retract this disease bullshit and start saving the big $$ by admitting that fat people CAN BE as healthy as thinner people, and even if we’re not, it’s NO ONE’S FUCKING BUSINESS!

    • June 20, 2013 10:20 pm

      It’s stupid because even insulin resistance isn’t a disease, it’s a syndrome because there’s no strict pathology to it, from what I understand. Not all people get fat, become insulin resistant and develop diabetes and/or heart disease. Fat people without fatty livers (somewhere around 30% of the population) aren’t insulin resistant. And Steven Blair found that 50% of obese people had good cardiorespiratory fitness, one of the best predictors of morbidity and mortality.

      If they want to address a health issue, they should start with insulin resistance, but that’s not what they’re actually interested in. They just want the fatties to lose weight to reverse the epidemic, and they think that making it a disease, the great fatty hordes will turn themselves over completely to their various weight loss approaches, whether traditional diet and exercise, pharmacological or surgical. I think this will backfire, but I’m not sure how, yet. I guess we have no choice but to see how this plays out.

      Peace,
      Shannon

      • Elizabeth permalink
        June 21, 2013 7:07 am

        I hope I don’t upset anyone, but often inherited health issues are a matter of inherited nutritional needs. For example, people with bulgy eyes (can’t remember the medical term) who have children with bulgy eyes have a greater need for Vitamin A than people with the same intake of the vitamin who do not have bulgy eyes. Could the same be true for inherited patterns of insulin resistance? My husband and I are pretty sure his father and uncles were undiagnosed diabetics — had the symptoms, died young of cardio issues — but my husband has none of these problems despite being the same physical type. He has had super nutrition since living with me for the past 40-plus years, and he credits this with being very healthy at the age of 61.

        • June 21, 2013 9:37 am

          Hi Elizabeth,
          I believe this would fall under the concept of nutrigenomics, which is a fascinating field of study. I personally believe that if you are genetically susceptible to certain conditions, like insulin resistance, then your diet definitely matters. Just as some people are more sensitive to the effects of salt or cholesterol, I think some people are sensitive to excess glucose in the blood, which stresses their insulin response and eventually causes all that trouble. Others can have high glucose for their whole life and never experience any major harm from it. The key is to know your family history and to monitor your numbers throughout your life. Your husband sounds like a lucky guy.

          Peace,
          Shannon

      • June 22, 2013 7:48 pm

        Actually insulin resistance can be a disease, google HAIR-AN syndrome.

        I had brown spots all over my body by age 12 before I became severely obese. Insulin resistance sets the body up for many systems to fail.

    • June 22, 2013 7:57 pm

      Please be sensitive to the fact that some of us ARE on disability. I am not on disability just for being fat but its part of the picture. There is backlash among the blame the poor Tea Party and other set, to blame the disabled and the fatties at home getting disability checks [instead of the bankers and wars getting trillions], it’s getting very hateful.

      • Dizzyd permalink
        June 23, 2013 4:07 pm

        I agree. Let’s beat up on the bankers and warmongers. They’re the ones causing all this mess. I mean it’s just so easy to beat up on the ones who can’t defend themselves. I bet it makes the trolls feel so big and bad!

        • Elizabeth permalink
          June 23, 2013 5:14 pm

          I LOVE YOU BOTH!!!!!

  5. Dizzyd permalink
    June 20, 2013 4:50 pm

    Fab – more like we ARE a disease rather than simply having one. If the AMA and public were so worried about the health of fat people, they would be treating us with a hell of a lot more compassion and respect than they do now. Although I like your idea of milking the government disability assistance programs for all they’re worth. New headline: “Those Damn Fatties Are Costing Us Even More!” Our reply: “Hey! You were the geniuses who said we were too sick to do anything, so we’re just gonna kick back and let you take care of us. BTW, I need my poor little back rubbed. It’s soooo hard lugging all this weight around, ohhhh…”

    • June 21, 2013 12:46 am

      Agreed. Let’s just say for the sake of argument that obesity is a disease. If that is the case, then it is treated like leprosy was in the olden days. We are vilified simply for walking around being fat. It isn’t even like fat’s contagious. It’s just that we don’t look the way that’s deemed socially acceptable.
      I wonder if they’ll end up decreeing that being old is a disease too.

      • June 21, 2013 7:19 am

        Well you know, Cie… the vast majority of people who die ARE old….. 😉
        I think you’re right, “Old-timer-itis” will be the next hot disease of the decade!

    • lifeonfats permalink
      June 22, 2013 11:23 am

      I can only imagine the day when a horde of us fatties storm the Social Security offices and Social Service offices demanding our SSI and Medicaid because now that we are officially diseased, so we must not be able to work or move at all, so just hand us our benefits, because this is obviously what everyone thinks we do in the first place.

      Seriously, I wonder if this insane new ruling will actually lead to more disability claims simply because of weight. If so, the AMA may have just set off an even bigger shitstorm, because if it’s one thing trolls can’t stand more than just fat people existing, it’s fat people existing on public assistance.

  6. June 22, 2013 7:55 pm

    Could anyone say to me that obesity is NOT a disease or at least an integral part of a disease process or symptom of a disease for me or others in my size range with a straight face? My weight has ranged from 486-516 over the last 3 months. [water weight etc]

    I have giant kidney stones, I am probably breaking my feet just by trying to walk and live a “normal life”: I still leave the house during weather I can breathe during walker and all. I can see where healthier mid sized fat people are coming through on this, trust me I am with you, in that you do not want to be seen as “diseased pariahs” but look at me, obesity has ruined my body in every conceivable fashion. Maybe some of you will say hey you got the kidney stones from all the endocrine problems but the fat is doing enough damage to be a disease within itself.

    I know I am hoping against hope, that they will treat at least severe obesity honestly where they will look for REAL CURES not harmful money-making stuff that doesn’t work but for some of us obesity is a disease. I try my best but obesity for me is a disease.

    http://fivehundredpoundpeeps.blogspot.com/2013/06/obesity-as-disease-sure-in-my-case-yes.html

    • Dizzyd permalink
      June 23, 2013 4:02 pm

      I still would be hesitant to blame all the problems on the obesity alone, but it does seem in your case that it’s definitely a contributing factor. That might be good reason to see about some sort of sensible weight loss plan to help you get off enough to where you’re not so debilitated, but talk to someone who will work with you to find the best option. It may be that they could help treat the kidney stones and foot issues another way – either through surgery, modified diet, physical therapy, and other medical equipment (like specialized insoles) to help with the problems you’re having meantime. It may not be the whole answer, I’d need to know more, but it might be a starting point. Good luck!

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  1. “Obesity” is a disease | Modern Fat

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