麻豆传媒

CHICAGO -- Obesity is hard to define and diagnose, and partly because of that is not a disease, an American Medical Association (AMA) council said in a report issued here Monday.

The report , released at the organization's annual meeting, angered many medical specialties who do consider obesity a disease.

The report panned body mass index as a proxy for obesity, saying it's limited as a stand-alone. Furthermore, calling obesity a disease may undermine prevention efforts and will do little to impact its treatment, the report said.

"Without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine conclusively whether or not obesity is a medical disease state," the council told the AMA's policy-making House of Delegates. "Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive."

Delegates here are considering that report along with a conflicting resolution from the New York delegation that would change AMA policy to call obesity a disease. They will try to resolve the AMA's stance later in the meeting, which ends Wednesday. Current AMA policy calls obesity a major public health problem, but stops short of calling it a disease.

The topic drew about 45 minutes of back-and-forth discussion during Sunday's public health reference committee session.

Supporters of defining obesity as a disease disagreed with the report and said if the AMA were to agree with them, it would help highlight the epidemic in this country and spur health insurers to take greater responsibility for obesity.

"A condition leads to one set of solutions. A disease might lead to another," said John Armstrong, MD, a delegate of the American College of Surgeons, which co-sponsored the resolution that would call obesity a disease.

"I would like to move away from the tyranny of 'Is it a condition or is it a disease?' and simply define obesity as a chronic disease, combine public health and clinical approaches, and work to bend the weight curve in the U.S."

The obesity-is-a-disease contingent also included the American Academy of Family Physicians and the American Association of Clinical Endocrinologists, who said evidence shows obesity is a multimetabolic and hormonal disease.

Those in support of the council report not calling obesity a disease noted obesity rates have risen along with sugar intake in diets and reduced activity -- which are not indicative of a disease. If obesity is called a disease, they said employers would have to give obese workers special considerations.

"We cannot say just because you are obese you will experience harm and morbidity from this, and that is part of a definition of a disease," said AMA public health council member Ilse Levin, DO, of the American Society of Addiction Medicine.

Defining obesity as a disease will do little to actually change treatment management, she continued. "In this case, I don't really see how it will at this point."

Changing the definition to a disease could have negative public health consequences and worsen the epidemic, others argued.

"I believe telling people they have a disease allows people to throw up their arms and surrender and do nothing," Texas delegate Russ Kridel, MD, said.

Payers already recognize obesity as a serious medical condition and Medicare covers bariatric surgery, he said, noting that people with a BMI greater than 40 can be considered disabled if it's called a disease.

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