I was a guest on the Sun News Network in Canada this morning, talking about the American Medical Association’s decision to classify obesity as a disease – not as a marker of disease, but as a disease in and of itself. (That will come as a shock to the many obese people who live into their 80s and 90s while suffering from the disease – and yes, that happens.)
Obesity is not a disease. Obesity correlates with disease because the main drivers of many diseases – chronically elevated glucose and insulin levels – can also make you fat. But lots of obese people are healthy in spite of being fat, and lots of lean people are unhealthy. I mentioned awhile back that a small, lean co-worker asked me to look at his latest lab tests. His HDL was abysmally low and his triglycerides were way too high. Meanwhile, back when I was still classified as “obese” with 31% bodyfat, my HDL was high and my triglycerides were low. My lean co-worker is at much greater risk of dropping dead than I was back in my “obese” days.
As for why the AMA decided to classify obesity as a disease, Dr. William Davis already spelled it nicely out on his Wheat Belly Blog, so I’ll just quote him:
Well, it’s hard to know how the internal discussions at the AMA went until we get a look at the transcripts. But let’s take a look at the Obesity Action Coalition (OAC). I believe it tells the whole story.
The OAC Board of Directors is filled with bariatric surgeons, such as Drs. Titus Duncan and Lloyd Stegemann, people who make a living from procedures and surgeries like gastric bypass and lap-band. The largest contributors to the OAC? Eisai Pharmaceuticals, maker of BELVIQ, the new drug for weight loss; Ethicon EndoSurgery, makers of laparoscopic operating room supplies; Vivus, Inc., another obesity drug maker; the American Society for Bariatric Surgeons; and Orexigen, developer of the combination drug naltrexone-buproprion for weight loss, now in FDA application stage. (Recall that naltrexone is the opiate blocking drug taken by heroin addicts but now being proposed to be gain approval for weight loss.)
In other words, while it is being cast as something being done for the public good, the motivation is more likely to be … money: Bariatric surgeons gain by expanding the market for their procedures to patients who previously did not have insurance coverage for this “non-disease”; operating room supply manufacturers will sell more equipment for the dramatically increased number of surgical procedures; obesity drug manufacturers will have the clout to pressure health insurers to cover the drugs for this new disease.
As always, follow the money.
Over the weekend, I dug out the original footage from my Fat Head interview with Dr. Eric Oliver, author of Fat Politics, and put together a sequence of clips addressing the topic of obesity and disease. He told me back in 2008 that insurance coverage for weight-loss drugs and procedures was behind the push to label obesity itself as a disease. Looks like that push is working.