On June 19th, 2013 the American Medical Association classified obesity as a disease “requiring a range of medical interventions to advance obesity treatment and prevention.”

“Recognising obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” AMA board member Patrice Harris, M.D., said in a statement.

The decision to classify obesity as a disease has been debated for many years but research now supports the classification of it being a disease.

“Once a person is obese, their fat cells function differently, which has an effect on the entire body, influencing hormonal function as well as signaling pathways in the brain,” said Dr. Jeffrey I. Mechanick, clinical professor of medicine (endocrinologist) at Mount Sinai’s Icahn School of Medicine, and part of the group that presented evidence that supported the AMA’s decision. “There are molecules that are made by fat that interact directly on the brain,” he said. “The brain then interacts with other organs in the body, such as the bones, GI tract, and pancreas.”

This decision is expected to change how insurance companies cover obesity, by encouraging insurers to offer more medical options to those who are obese, show early signs of obesity and suffer from related diseases, such as (type 2) diabetes, hypertension, cardiovascular disease and some cancers.

This announcement will have a huge impact on the medical/healthcare industry and related industries, as I review the likely pros and cons of leading stakeholders:

1) Physician – allows physicians to participate in the control of escalating healthcare costs by taking a formal approach to the prevention and management of the disease and its life threatening sequelae and hope that insurance will cover the cost, so patients are will be able to elect these options.

Cons – physicians will have the burden of treating more patients for obesity, taking on the responsibility of educating them about the importance of preventing obesity and encouraging them to treat existing disease. As a result, physicians will have to incur the costs of adding staff.

2) Patients – will now be eligible to receive medical intervention for a condition that had previously been classified as behavioral. Hopefully, insurers will step up and cover medical interventions.

This past April, “Johns Hopkins Medicine researchers conducted a small study of primary care doctors, and found they were less likely to build an emotional rapport with overweight and obese patients than they were with normal weight ones.”

The researchers pointed out that empathy is essential when caring for the obese patients, and patients are more likely to comply with the medical intervention now that obesity has (finally) been classified as a disease and is no longer considered the unfortunate outcome of unhealthy lifestyle choices.

Cons – Certain medical interventions, such as bariatric surgery, pose a higher risk to the patients than diet and exercise.

3) FDA – It was reported in 2003 that “FDA officials met with drug companies and the American Obesity Association in April …to discuss whether obesity drugs should continue to be held to tougher safety and efficacy standards than those for diseases such as diabetes.” Now the FDA will need to revise their guidelines for approving obesity drugs to reflect its classification as a disease.

Cons – FDA will probably be pressed into a less stringent approval process from the medical professionals, pharma/biotech/medical device industry, and patient advocacy groups.

Some have argued that “FDA should reframe their approval process to focus on the ability of pharmaceuticals to decrease adipose tissue rather than to improve other markers of metabolic health, such as blood pressure and lipid levels.”

4) Insurance providers – Medicare and Medicaid recognised that obesity is an issue and for years debated whether the condition should be classified as a disease. For private insurers, the new classification means long term reduction of healthcare treatment cost for disease linked to obesity through prevention.

Employers may be inclined to collaborate more with insurance providers to offer more wellness/prevention programs that will result in a gain for both parties: employers will pay for fewer sick days and workman’s comp claims and insurers will enjoy reduced cost of healthcare.

Cons – the insurance company will pay more money upfront for medical intervention for obesity with expectation of long term reduction in treatment cost. The question will become, which types of treatment should be reimbursed?

5) Pharma/biotech/device industry – if the FDA’s approval process and criteria are less stringent, as noted above, this will provide an incentive for pharma/device companies to develop more drugs or devices to treat obesity. Currently, few companies are focusing on obesity, because so many have failed to receive FDA approval until recently with two new drugs.

If insurance companies start covering weight loss drugs, then devices and procedures, this will eliminate obstacles to marketing anti-obesity products and give companies incentive to develop drugs and devices to treat obesity.

Cons – it is difficult to develop a drug or device for obesity that is safe and effective over the long-term.

6) Federal and state – to curb the healthcare cost of the people today and the children of tomorrow, the federal and state agencies must step in to provide education that demonstrates how obesity impacts those who are afflicted and how it impacts everyone. More programs, incentives and mandates if necessary need to be put in place to change the mindset of the nation.

7) Fast food/soft drink industry – this industry must be persuaded to offer healthy options to customers since fast foods and soft drink maybe be either eliminated or significantly reduced to accommodate a healthy diet. There will be major push back from this industry, due to loss of revenue and revamping of their business to offer healthier options.

However, this industry has already started to move in this direction, by offering some healthy options. Companies will have the opportunity to build a better brand image as they become more responsive to the health of their customers.

Establishments of organic and health food will emerge as the big winners, along with fitness centers and weight-loss brands, who will fare particularly well if insurance companies authorise reimbursement for services to the clinically obese.

Closing Thoughts

I am glad that the AMA classified obesity as a disease for all the pro reasons stated above. We know obesity is an epidemic that leads to an array of debilitating chronic diseases. As a nation, we need to take action in changing because it takes a nation to change the mindset of the people. Government needs to be involved and create a unified message to educate and promote a healthier lifestyle by having laws and monetary incentives in implementing these programs.

However, government support alone does not always bring the desired outcomes, as evidenced by the recommendation to ban soda in public schools. Studies showed that merely banning the availability of soda in schools neither reduces the consumption of soda nor sugar intake, because students resorted to other sweetened beverages, including so-called healthy drinks like Gatorade. In 2011, Boston moved to prohibit the sale and promotion of sugar-sweetened beverages and sodas on all city property.

If parents also prohibit or limit sugar-sweetened beverages and sodas at home, this would reinforce the healthy lifestyle and benefit both the parents and children. One school district in Massachusetts implemented the “walking bus” where parents and children all walk to school together as part of their daily exercise.

Examples of other Massachusetts legislative initiatives include:

1) Place sales tax on soft drinks and candy.

2) Places tax revenue generated by soft drinks and candy in a Prevention and Wellness Trust Fund (PWTF).

3) Fund physical activity programs in school through PWTF.

4) Include Body Mass Indexing in student’s physical examinations

5) Provide at least 30 minutes of physical activity for all students if physical education classes are not offered.



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