Obesity is a public health issue that affects 42% of the American population and significantly increases risk for other health conditions, such as heart disease, stroke, certain types of cancer, and type 2 diabetes – which are among the leading causes of preventable, premature death. Obesity also increases risk of death from other factors, including COVID-19 with estimates that nearly 30% of COVID hospitalizations were attributed to obesity.
In 2019, the estimated medical costs associated with obesity in the United States exceeded $170 billion, or nearly $1,900 higher per person than medical costs for people with a healthy weight.
Solutions for the social determinants of obesity are complex and multifactorial, touching everything from neighborhood design to access to healthy food, safe communities, and healthcare. Acknowledgement of obesity as a stand-alone disease with its own symptoms, progression, and impacts will help open doors to new solutions, and break down many of the barriers and biases that have hindered progress.
Out with “Calories In Calories Out”
Until recent years, medical professionals viewed obesity as an inevitable consequence of calorie consumption and a sedentary lifestyle. And there are still many in the medical community who view obesity as a risk factor for comorbidities, but do not acknowledge or understand obesity as its own disease classification.
Obesity is often looked at as a moral failing, and the unfortunate echoes of this thinking are pervasive in society today. Just look at depictions of overweight people in popular media, “fat-shaming”, and the multi-billion dollar commercial weight loss industry selling the idea that self-control, motivation, and “this one simple trick” are all that is needed for success.
The bias against obesity has limited insurance coverage for obesity treatment, preventing many from seeking or being able to afford care. Additionally, the general misunderstanding about obesity as a chronic disease means that many patients may not be aware that medical treatments exist as an option, so available treatments are underutilized.
The Shift in Thinking
By definition, a disease is a condition that impairs normal functioning and typically manifests by a characteristic set of signs and symptoms. It may affect the whole body or any of its parts. The American Medical Association designated obesity as a disease in 2013, shifting the thinking about obesity away from calories consumed and towards the disease process and its impact on health – essentially prioritizing the patient over the cause of the condition.
This is a momentous change in the trajectory of obesity research and care. By classifying obesity as a disease that affects all ages, the medical community now bears responsibility for developing appropriate and effective treatment options. While patients must still be active and engaged in their care, the medical provider is now a partner in providing treatment for obesity, avoiding or reversing negative consequences of excess weight, and driving meaningful positive health outcomes.
According to the Obesity Medicine Association (OMA), obesity is a chronic relapsing disease where increased body fat promotes tissue dysfunction that results in adverse, potentially life-threatening, health consequences. Obesity is often promoted by genetics, medications, or the environment, similar to cancer and heart disease.
Obesity pathology varies depending on what causes the weight gain. The OMA states that there are obesity “subtypes” which include congenital, stress, hormonal imbalances, or genetics. With the scientifically-backed recognition that obesity is in fact a disease, Medicare and most private insurers now cover obesity screenings, counseling and treatment as a form of preventative medicine for persons with a body mass index (BMI) of 30 or more. There is also a greater emphasis placed on assessing mental health and the use of cognitive behavioral therapy, as mental health disorders can lead to obesity, and obesity leads to mental health disorders.
The Responsibility of Medical Providers
With the designation of obesity as a disease, medical providers are obligated to take accountability for their obese patients and provide interventions as they would for any other condition, such as diabetes or hypertension.
The American Heart Association (AHA) has put forth a new set of guidelines which serve as an instruction manual for providers to treat obesity as a disease. These strategies, which are also reinforced by the OMA, are considered the gold standard of obesity management and include nutritional intake, physical activity, anti-obesity medication, behavioral counseling, and, for some patients with a BMI above 40, consideration of bariatric surgery.
Despite the shift in thinking from the American Medical Association, medically-backed, non-surgical treatment options for obesity remain sparse. Primary care settings may not be equipped to manage the complexity of obesity treatment, and providers may look to retail options to make recommendations for patients, especially for diet and exercise, but these options are often untested, not appropriate or desirable for the patient, do not address related comorbidities, and may not be effective over the long-term.
Obesity-focused healthcare organizations, like CoreLife Healthcare, offer a new option for medical providers looking for comprehensive, evidence-based, and collaborative care for patients with excess weight. CoreLife provides high-frequency engagement, based on leading obesity research, that helps patients move beyond episodic or acute care to focus on maintenance and prevention.
Learn more at corelifemd.com/providers.