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From Medscape News Today 6/20/13
CHICAGO — Physicians voted overwhelmingly to label obesity as a disease that requires a range of interventions to advance treatment and prevention.
However, there was impassioned debate in the hours before the vote here at the American Medical Association (AMA) 2013 Annual Meeting.
Although policies adopted by the House of Delegates have no legal standing, decisions are often referenced in influencing governmental bodies. This decision could have implications for provider reimbursement, public policy, patient stigma, and International Classification of Diseases coding.
“Obesity is a pathophysiologic disease. There is a treatment for this disease; it involves behavioral modifications, medications, and surgeons. Obesity affects minorities disproportionately,” said Jonathan Leffert, MD, alternate delegate for Endocrinology, Diabetes, and Metabolism. “The scientific evidence is overwhelming.”
Melvyn Sterling, MD, said this brings to mind to the debate over whether hypertension is a disease.
“I’m a general internist, among other things, and I treat the complications of this disease. It’s interesting to look back in history at a time when hypertension was not thought to be a disease,” said Dr. Sterling, who is from the AMA Organized Medical Staff Section, but was speaking for himself. “Obesity is a disease. It’s very, very, very clear that even though not every hypertensive gets a stroke and not every obese person suffers the complications, that does not change the fact that this is a disease.”
Some Not Convinced
Others testified that the measure for determining obesity is imperfect and although it is an epidemic, obesity does not meet the criteria for disease.
Russell Kridel, MD, incoming chair of the AMA Council on Science and Public Health (CSPH), told Medscape Medical News that there is no debate about the importance and urgency of addressing the problem, but he doesn’t believe it qualifies as a disease.
“It’s more like smoking. Smoking isn’t a disease. Smoking can cause disease such as lung cancer and emphysema in the same way that obesity can lead to diabetes and hypertension,” he explained. “We’re really talking nomenclature here, not philosophy.”
He noted that behavior and dietary choices play a part in obesity. “Thirty years ago, we did not have the obesity problem we have now. If you look scientifically at what has changed, our diet has changed. There’s been no change in our genetic structure in the past 30 years.”
Dr. Kridel said he would like to see more attention focused on prevention and personal responsibility. The CSPH issued a 14-page report opposing the classification of obesity as a disease.
“We did not think the evidence rose to the level where obesity could be recognized as its own distinct medical disease state. Obesity is a very serious condition. It’s a scourge on our nation. It’s an epidemic. It’s a significant risk factor for many other diseases,” said Robert Gilchick, MD, speaking on behalf of the CSPH. “But that does not alone make it a distinct medical disease state.”
He explained that because body mass index, an imperfect measure, is used to determine obesity, people who are otherwise healthy are being diagnosed as obese.
“Why should one third of Americans be diagnosed as having a disease if they aren’t necessarily sick?” he asked.
One Third of Americans
According to the Centers for Disease Control and Prevention, 35.7% of Americans are obese. Obesity-related conditions, including heart disease, stroke, type 2 diabetes, and certain cancers, are some of the leading causes of preventable death.
In other AMA actions, a policy that supports banning the marketing and sale of high-energy drinks to anyone younger than 18 years was adopted.
Also accepted was a policy that supports letting students have sunscreen at school without restrictions. Currently, most states don’t allow students to possess over-the-counter medications in school without a note from a physician. Sunscreen is considered an over-the-counter medication because it is regulated by the US Food and Drug Administration.
Mother’s Cancer Inspires Nutrition Outreach: Elaine Rancatore, D.O.
After losing her mother to cancer, Elaine Rancatore, D.O., began educating everyone from high school students to senior citizens about the benefits of a healthful plant-based diet.
When Physicians Committee president Neal Barnard, M.D., recently gave a lecture on his new book, Power Foods for the Brain, in Broward County, Fla., Dr. Rancatore talked about the benefits of fruits and vegetables in preventing Alzheimer’s disease and demonstrated how to make the book’s Blueberry Breakfast Smoothie.
“There is no time to waste in putting this new brain-boosting diet into action. We should all encourage physicians, dietitians, teachers, parents, and everyone else to spread the word,” says Dr. Rancantore. “And let’s not forget to make these changes in our own homes—it will help ensure that we’ll have as long as possible to spend with those we love.”
A longtime Physicians Committee member, Dr. Rancatore has practiced emergency medicine for 18 years and knows just how serious and debilitating Alzheimer’s can be.
“Patients don’t just forget names and dates—they can often end up in situations that are harmful to their physical health,” she adds. “They may forget to turn off the stove, or they may get lost and end up walking in the street.”
In addition to her position at Baptist Health South Florida, Dr. Rancatore is a co-founder of 2R-Health, which was created to promote healthful nutrition and physical activity, to develop and encourage healthy habits in our nation’s youth, to stem the epidemic of obesity and chronic diseases, and to support and promote research in cancer prevention and treatment.
She also spreads this message as a media spokesperson for the Physicians Committee’s 21-Day Vegan Kickstart, which she has participated in several times.
Dr. Rancatore received her medical degree from the University of Medicine and Dentistry of New Jersey, New Jersey School of Osteopathic Medicine. She also recently completed Integrative Health Coach training at Duke University, which allows her to help patients make behavior changes that foster good health.
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