www.baltimoresun.com/news/opinion/editorial/bs-ed-obesity-20130624,0,543922.story

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Diseased or just fat?

Our view: AMA decision to label obesity as a disease could prove helpful if it brings more resources to bear against a worsening national epidemic

6:00 AM EDT, June 24, 2013

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Last week's decision by the American Medical Association to categorize obesity as a disease brought out the expected reaction — cheers from advocates who believe this growing health threat has been neglected and a collective shrug from others who would prefer that matters of weight and body fat be left to the individual.

Certainly, the AMA decision by itself does not change much about the nation's obesity epidemic. It carries no legal weight, and even the AMA delegates were not certain whether the move would help patients get treatment or only further stigmatize the condition.

But this much is certain. It is a costly problem and getting more expensive every day. On that basis alone, the AMA classification was overdue, particularly if it persuades more insurance companies to reimburse doctors for arguably the most cost-effective treatment of all — talking to their patients about the problem and monitoring their progress.

That Americans are carrying around too much body fat is well documented. That the condition contributes greatly to serious and potentially life-shortening conditions such as Type 2 diabetes and heart disease is just as certain. What is less clear is what policies health care providers, insurers, employers and governments should adopt to address the problem.

New York Mayor Michael Bloomberg was roundly jeered when he supported a partial ban on large, sugary sodas, but at least it represented a concern for the impact of excessive consumption of sweet soft drinks on his constituents. A growing number of school systems and local governments have joined in the fight by banning such zero-nutrient beverages from vending machines and government property.

But that's just one battleground. Poor diets and eating habits and a sedentary lifestyle are obviously factors as well, and it's simply not enough to warn people of the risk. That sort of hands-off approach has helped drive America to its current circumstances, with 1 in 3 Americans regarded as obese, a percentage projected to climb to 1 in 2 by 2030.

Fighting obesity requires a broad effort to encourage a healthier lifestyle from early childhood on. That could mean everything from employers introducing "wellness" programs that reward workers for better choices to growth policies that get people out of their cars and elevators and provide more walkways and linear parks for them to get around.

Ensuring more people have access to fresh and healthy food choices ought to be a high priority as well. Recent efforts to provide fresh fruits and vegetables (and a bit of counseling to boot) in Baltimore neighborhoods long regarded as food "deserts" fits that bill nicely. So do improved nutritional standards in school lunches.

But for some, a more serious intervention may be necessary. Certain drugs and surgeries such as stomach banding have shown promise in treating those who require more than diet and exercise. Experts say there are some who will not otherwise have full control of their weight. These people develop what the AMA calls a "multimetabolic and hormonal disease state" that is beyond the reach of lifestyle choices.

Expecting insurance companies to help pay for these treatments is hardly beyond the pale. Medicare already covers certain therapies up to and including bariatric surgery. Greater investment by private plans could save money in the long run. Obesity is thought to raise the nation's health care costs by more than $150 billion annually, according to the Centers for Disease Control and Prevention.

That's not to suggest such treatments ought to be offered to every patient who walks into a doctor's office with love handles and an unwillingness to eat a salad or climb stairs. As the AMA also cautioned, classifying obesity as a disease ought not turn people away from healthier lifestyle choices in favor of expensive drugs or surgeries.

The point is not to be our brother's nag or even keeper but to stem a problem that is costing all of us too much. Too many 21st century trends — jobs that require less physical labor and more time in front of computer screens; the proliferation of high-salt, high-fat, high-caloric convenience foods; and auto-oriented development — are literally killing us. Calling obesity a disease may at least remind everyone of how serious our circumstances are and inspire a change not only in behavior but also in the public policies and private practices that are helping lead us astray.