In June of this year the American Medical Association voted to classify obesity as a disease. This was done against the recommendation of the AMA’s own Council of Science and Public Health, which researches and offers its recommendations on these matters. Over 26% of American adults met the criteria of being obese in 2012, meaning a Body Mass Index (BMI) over 30. An additional 36% were officially overweight, with a BMI 25-30. Perhaps an even greater tragedy is that around 25% of children aged 2-5 are overweight or obese, as are a full 1/3 of school-aged children. The number of morbidly obese adults, those with a BMI over 40, is now up to 6%.
Obesity is a scourge, to be sure. It sits stubbornly at the confluence of some moderately influential genetic and hormonal factors, and an absolute deluge of social and environmental assaults. In any respectable court of law, an obese individual offering a defense of their weight could present a rock-solid case that they were framed, completely set up. Billions are spent every year to convince us to consume all manner of substances that masquerade as food. The least healthy of these are also the most easily accessible, whether that is measured by the ubiquitous corner location of the fast food dispensaries, or the eye-level grocery shelves replete with artificially colored, ultra-refined and thoroughly preserved packaged foods.
The greatest mystery is not that so many people are obese, but that more aren’t. Among other reasons, fat accumulates on our bodies in a desperate attempt to encapsulate the persistent organic pollutants (POPs) that perfuse our foods, as well as our home and working environments (source, source). Both diabetic and obese patients frantic to lose their excess weight are often mystified that their most heroic dietary and exercise efforts have no effect.
What is not realized is that the fat stores chemicals that are better kept out of circulation. The POPs sit for years, even decades, quietly acting as endocrine disruptors in their gracious hosts. Accumulation of fat is, in this circumstance, a byproduct of simply living in the modern world. Obesity is the exhaust of an industrial engine that roars on. Evidence of these things can be seen on lab work, but only in hints, so it remains hidden to the eyes of doctors not trained to look for clues regarding environmental contributions to our maladies.
The medical system’s interest in bringing obesity into the land of disease has to do primarily with economics, not health. We should not be appalled by this, even if we’re saddened. Modern medicine does reasonably well with acute illnesses. No one, though, has acute obesity; it is a chronic condition. In fact, as a percentage, those with acute illness are a trifling next to those with chronic illness.
Ironically, we have a medical system that does virtually nothing to reduce the burden of chronic illnesses, or even to alter their course beyond the superficial suppression of symptoms. The system manages, when it works, to poorly manage some of those chronic symptoms into perpetuity. The great majority of health care expense is racked up in the ongoing treatment of chronicity: diabetes, heart disease, cancer, respiratory disease, and now obesity officially joins this team.
Like smallpox, asthma and cancer, obesity is now a diagnostic island unto itself. No longer simply a confluence of circumstances, it stands alone, and as such it is calling out for treatment as a billable medical condition. Sure, it was recognized as a problem before, but being billable makes all the difference. Advocates of the change have suggested, apparently with a straight face, that this disease classification will bring doctors to finally give it the attention it deserves.
“(Diagnosing obesity as a disease) acknowledges that obesity is a chronic health condition that has genetic as well as environmental causes that requires lifelong treatment using medical and psychological support,” said Connie Crawley, a University of Georgia Cooperative Extension nutrition and health specialist in the College of Family and Consumer Sciences. (source)
One can imagine an almost palpable wave of renewed compassion sweeping through the medical community as physicians, who once thought obesity to be a problem of self-control, now understand it as a disease that takes hold and, in its chronic way, doesn’t let go of its target.
Would that this were the case. In reality, the new classification means that instead of offering generic advice about exercise and eating healthier, physicians can prescribe medications to their frustrated but hopeful obese patients. What is treatment, after all? In a system of for-profit medicine, it’s hardly noteworthy that the diseas-ification of obesity comes less than a month after FDA approval of two new drugs to “treat” obesity. They each cost about $150/month.
Consuming pills, we should come to believe, will shrink our waistlines, tighten our thighs, and negate a lifetime of exposures and patterns of eating. Our medical system is expert at seeing a raging fire, and finding ways to make money off of the smoke. This is not conspiracy; it is a fact of daily business.
In the conventional model of health and disease, chronic illnesses don’t go away. Obesity is now officially granted a lifelong sanction, the medical seal now firmly in place, tens of millions of obese individuals – men, women and children – are a welcome new market. The commercials are not far behind, where the actor, heavy and moribund, convinces viewers that there is new hope in these pills to manage obesity.
Regardless of its new classification, obesity is still sitting, unchanged, at the tangled intersection of individual and social/environmental influences. Opening it up to management by prescription does little to address these underlying causes except in the most trivial way. But a new market has been created, and enormous amounts of money will be made from obesity’s medical management.
The culprits who have set us up for this disease – through cheap and degraded foods, through the chronic stress of financial and food insecurity, through the obfuscation of basic relevant health information, and through allowing an environment laden with the chemicals that push us toward accumulation – have no reason to fear they will be asked to account for their contributions to this epidemic. Like obesity itself, these circumstances are now permanent, invisible aspects of this modern world.