Physicians sharpen focus in addressing obesity epidemic

New AMA policies balance societal action with personal responsibility, but stop short of defining obesity as a disease.

By Victoria Stagg Elliott — Posted July 5, 2004

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Chicago -- Kids should run around, and communities should have safe places for them to play. Recreation facilities should also be accessible for adults to get exercise. And when everyone stops moving and starts eating, restaurants as well as school and workplace cafeterias should post nutritional information to enable healthy choices.

These are just a few of the recommendations advanced last month during the American Medical Association's Annual Meeting in Chicago that take aim at the obesity epidemic.

"If we can not only do something about food intake but also exercise, that's a one-two punch against obesity," said Patricia Randall, MD, a diagnostic radiologist and delegate from Fayetteville, N.Y.

The organization first officially recognized obesity as a major public health threat in 1998, and the AMA has now increased its focus.

"Physicians are becoming more and more aware -- as is just about everybody in our society -- that we have this raging epidemic of overweight and obesity," said AMA Trustee Ronald Davis, MD. "It's having devastating effects on our public health, and people are suffering."

The positions taken by the AMA strike a delicate balance between societal and individual responsibility. On one hand, the Association envisions a society in which both recreation and exercise facilities as well as posted nutritional information are readily available, making it easier for people to maintain a healthy weight and lifestyle. Still, the organization also recognizes that individuals need to make better choices.

"The obesity epidemic is not the fault of Krispy Kremes or McDonald's," said Paul B. Handel, MD, a urologist and an alternate delegate from Richardson, Texas. "Unless we rekindle some sense of personal responsibility for our own lives and our families, 20 years from today we will still be struggling to treat the sequelae of the obesity epidemic."

The AMA also endorsed the availability of healthy food options in hospitals for both staff and patients. Outside the institutional setting, the AMA called for the consideration of cultural and socioeconomic factors in nutritional research and guidelines, particularly the U.S. Dept. of Agriculture's food pyramid.

"Obesity and its complications disproportionately affect minority populations," said Dr. Davis. "The current USDA guidelines do not include foods that are staples in many minority communities, and they do not include low-cost options."

The AMA will also study ways to address issues related to insurance coverage. Most medical treatments for weight problems are not covered by third-party payers unless there is another illness such as hypertension or diabetes that would be helped by a patient losing weight.

"The biggest obstacle for our patients is coverage," said Michael Gonzalez-Campoy, MD, PhD, vice chair of the Minority Affairs Consortium and an endocrinologist in St. Paul, Minn. "Insurance won't pay for a bariatric procedure unless the BMI is 40 or more. Unfortunately, for many of our patients, they have to actively gain weight to meet this criteria for coverage for surgery and then turn around and lose weight, which is ridiculous."

But while the AMA members concluded that obesity is a problem that requires attention, the organization stopped short of declaring obesity a disease. Still, some view such a declaration as the only way to get coverage for it.

"Obesity is not just overeating," said John A. Seibel, MD, a delegate from the American Assn. of Clinical Endocrinologists. "It claims over 300,000 lives a year in this country. That's a disease in our book."

Others, however, worry that attaching this label could either increase the stigma of being overweight or undermine the connection between personal responsibility and excess poundage.

"Defining obesity as a disease is premature," said Samuel Blackman, MD, PhD, a member of the AMA's Council on Scientific Affairs. "There are far-reaching social implications well beyond the medical implications that we need to consider."

The AMA will hold a national obesity summit in the fall.

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"Do as I do" sends a strong message

Michael Fleming, MD, president of the American Academy of Family Physicians, has lost 37 pounds since taking office in October and is challenging his colleagues to eat better and become more active. Janice Kirsch, MD, an internist from Mason City, Iowa, has lost 104 pounds. John A. Seibel, MD, an Albuquerque, N.M., endocrinologist has shrunk from a body mass index of 31 to 23.

These physicians are just a few among the growing number of doctors who are realizing that the first step to tackling America's growing waistlines may be to start dealing with their own.

"I have patients who [say] ... that if I wasn't losing weight, why should they, but now that's changed. It's definitely had a positive effect," said Dr. Fleming, who announced his success along with the others at an obesity forum at the American Medical Association's Annual Meeting in Chicago last month.

Experts view these efforts as comparable to the culture change that occurred after the landmark 1964 surgeon general's report that declared smoking unhealthy. At the time, Surgeon General Luther Terry, MD, quit smoking to set an example -- as did many other physicians.

"We all need to practice what we preach," said Sandra Adamson Fryhofer, MD, former president of the American College of Physicians. "It's not just do as I say but do as I do."

Anecdotal evidence suggests as many physicians may have weight problems as do their patients.

According to an informal survey of attendees at the recent AMA meeting, 66% were overweight or obese, which is comparable to the most recent data for the general population. A study in the June 16 issue of JAMA found that just over 65% of U.S. adults were in a similar weight state.

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External links

AMA Board of Trustees report on culturally responsive dietary and nutritional guidelines, June (link)

"Prevalence of Overweight and Obesity Among U.S. Children, Adolescents and Adults, 1999-2002," abstract, Journal of the American Medical Association, June 16 (link)

"Roadmaps for Clinical Practice, Assessment and Management of Adult Obesity," an AMA primer for physicians (link)

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