Obesity is now a “Disease”

My first reaction to hearing that the American Medical Association (AMA) had voted to classify obesity as a disease last month was a positive one. That was until I saw the excited comments from those who will profit most from the increased use (and payment) for bariatric surgery and weight loss drugs. Right away these individuals and organizations began campaigns to gain more reimbursement for their treatments of this newfound disease. The experts main concern is that pushing the same old overpriced treatments on patients is more likely to benefit the wallets of surgeon’s and pharmaceutical companies than the health of Americans. There must be a better way to deal with this newly labeled disease called obesity. 

Unfortunately, obesity is a nebulous diagnosis that is most often defined by body mass index (BMI), which is simply one’s body weight divided by the square of their height. This measure does not take into account a person’s body composition and therefore extra muscle will raise BMI in a similar fashion to extra fat. Using BMI as a measure of obesity labels more than one third of Americans and over half of NFL football players with a chronic disease! This hardly makes sense and it is a stretch to think that assigning such a label is going to improve health outcomes when it is widely acknowledged that using BMI as the gauge for obesity is obviously with error. If obesity is now a disease, clearly we need a better way to diagnose it. 

More concerning to me is the fact that there are currently only three funded medical treatments for obesity; bariatric surgery, weight loss drugs and nutritional counseling. It is interesting to note that the most expensive obesity treatment by far (bariatric surgery), is also by far the one most often covered by health insurance. Is stapling the stomachs of obese Americans really the best way to spend our healthcare dollars? I certainly don’t think so and given the proven effect of exercise in preventing obesity and more importantly mitigating its harmful effects, why is it not funded as a medical treatment at all? 

The problem lies in the fact that the American healthcare systems answer to dealing with most any disease is to prescribe a pill or a procedure.  While weight-loss pills may help in the short run, the long-term effects are rarely significant. The utter failure of the public health messaging around obesity over the past 20-some years is clearly not working. Efforts to inform the public just how fat they are, blaming the food companies, or pushing short-term feel-good solutions like bans and taxes have gotten us nowhere. 

And there is another important factor to consider. At this year’s (and past) ACSM Annual Meeting, there were compelling presentations on the “Obesity Paradox” and the ongoing debate about the importance of “Fitness vs. Fatness”. It is becoming increasingly clear that the best way to combat the harmful health effects of obesity is to get these patients to be more active, rather than just getting them to lose weight. Exercise is medicine for obese patients and getting more active is a much more positive and easily achieved goal than losing weight. Let’s face it, while not everyone can lose weight, almost everyone can go for a walk. I believe we have got to shift the public health focus off of obesity and on to physical activity. We must give Americans permission to be fat and still be healthy. This is possible and the way to do it is by getting them more active and whether or not they lose weight may not be that important. 

Now there could be some positive effects from this new disease label for obesity. Perhaps it will open up doors to introduce more teaching about exercise and diet in medical school, since these are the major determinants of obesity. If obesity really is a disease affecting more than a third of the population with another third being pre-obese (or overweight), shouldn’t this disease be a prime target for medical school teaching? I would certainly think so. Another positive effect of this move could be reimbursement for exercise prescription and nutrition counseling. Currently, physicians are not able to get reimbursed for counseling in this area, certainly not to the degree they are paid for performing bariatric surgery or prescribing weight-loss drugs. 

Closing points:

If you or a loved one suffer from this disease, there has never been a better time to fight it.  First, start moving. Sounds simple? It is! Beginning with some sort of physical activity is the first step to extending and improving your life. You don’t have to have any sort of science behind it. Start a routine of walking every day. Do you have 30 minutes out of your day to move? Don’t answer that…because you do. We OFTEN hear: “I just don’t have the time to exercise.” I call Bullshit. Let me emphasize this…do not find time, MAKE time. MAKE. My supervisor is sometimes training from 6am-6pm every day of the week, yet he still makes time to eat and workout at some point…even if it’s only 20 minutes! 

Second, evaluate your nutrition. As said before, it is much more important to be fit than to have a desired body composition. But, in order to really reach those goals you strive for, you will need to start eating better.  It is not a diet, it is a lifestyle change. Don’t tell those Oreos that you will be back for them soon, because that’s just teasing them and giving them false hope. You are leaving them behind…forever. For-e-ver. 

Once you have started moving more and eating better, you can start a real exercise regime. Exercise is a planned string of movements that use the muscles of your body. That can be anything! It doesn’t have to mean going to the gym, if you’re not ready for that. Do body weight work from the comfort of your home. Squats, in-place cardio, pushups, jumping variations, anything! Visit freefitnessvideos.com for all the exercises you could possibly need under the tab “body weight.”

Lastly, don’t look for the quick fix. They NEVER work long-term. Cheating will never get you anywhere. Popping a pill is not going to make you feel better about yourself, nor will it make you any healthier. Weight-loss supplements can be detrimental to your health and have actually killed thousands.  Most of them just flush your body of its water, anyway, which drops the number on the scale. Here is my favorite one as of late: the IT Works Wrap. This one has me rolling with laughter. America is fat, so what do some people want us to do? Wrap ourselves with some magic pulsating material so that we look skinnier for a couple weeks, but then we go right back to being overweight. What does that do for our health? Our nutrition? Our physical activity? Nothing. It makes us think we can cheat and still live the lifestyle we live. So, nothing is solved. Not sorry. 

There is nothing wrong with asking a professional for help, either. Talk to someone you or a loved one trusts who is qualified in exercise and nutrition. Even if you don’t want to have a personal trainer, they will always be willing to counsel and offer advice at no cost. They are only a visit or a phone call away.

Spread this info to loved ones…because you never know when they may be ready to change their life. 

Happy Moving,

Jared

 

Move to the beat of your own drum.

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