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Apr 21, 2014 08:31 AM

Who would have thought the AMA got the obesity problem wrong.........

Interesting article about how the American Medical Association declared Obesity a disease last year, however that is backfiring on actually helping obesity in the US.

I find this part of the article rather interesting;

"The nation’s largest physician organization said the new classification would help turn more medical attention toward obesity, as well as increase reimbursement for obesity-related drugs, surgery, and counseling."

The attention of medicine in general is no longer to cure anything, it is in this case to keep us fat and happy. Treat obesity with drugs and surgery rather than prevent it, because obviously if you prevent obesity the medical industry loses millions if not billions of dollars in drugs and surgeries.

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    1. re: beevod

      Cancer, heart disease, Aids/ name the disease and the medical communities attention is focused on treating and medicating, not curing.

      1. re: jrvedivici

        The NYT article quotes the AMA resolution:

        “The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes,”

        The article describes some of the debate within the AMA over this resolution.

        1. re: jrvedivici

          You've never had a doctor suggest you lose weight, eat better, quit smoking, drink less, engage in less risky sexual behaviors, etc., etc., etc.?

            1. re: jrvedivici

              The point is, "you name the disease and the medical communities attention is focused on treating and medicating, not curing" is simply false.

              1. re: carolinadawg

                Not according to many, if not most docs in practice. Or the Harvard researcher who announced "drug companies own medicine."

                Or the Harvard med student protest over being taught only how to use drugs and medical technology, not patient care.

                Drug companies also finance Continuing Medical Education; guess what the curriculum is?

          1. re: jrvedivici

            How does one 'cure' AIDS/HIV? There is no demonstrated cure so treatment is the only option, and treatments have improved dramatically since the condition was first identified in the '80s. Eliminating every copy of a retrovirus from a host is, at present, not realistic. Focusing dollars on suppression of retroviral replication is a more rational approach.

            In most cancer treatment modalities the objective is to eradicate cancerous cells. When cancer cells are eliminated from the patient they are effectively cured.

            Cardiovascular disease causes irreversible damage to cardiac muscle and the associated blood vessels. Short of a heart transplant there is no 'cure' at present so supportive, on-going care is what is called for.

            On the other hand the research community (not the medical community) is actively working on cures for some of what you mentioned. For example cardiac myocyte regeneration, targeted immune therapy for cancers and so on.

            Saying "They just want to keep us sick so they can make money off us" is an easy trope to rattle off but it doesn't really stand up to scrutiny.

            1. re: jrvedivici

              Not the medical community, Big Pharma. There is no money to be made in cures, but maintenance, oh boy. Cholesterol, type 2 diabetes, high blood pressure, all issues that can mostly be eliminated by lifestyle changes. All issues that Big Pharma makes billions on.

              I was in the waiting room for my PCP last year with three Pharmacy reps. That was an interesting conversation to eavesdrop on. One rep said at the last meeting, they announced they were hiring 100 more reps to call on endocrinologists, a field they never bothered with before, due to an explosion of diabetes.

              But the scariest of all is antibiotic resistance. No big companies are even researching new antibiotics any longer, no money in it. This is where govt needs to play a part. We need to invest tax money in research and universities.

              1. re: Jerseygirl111

                Define the difference between cure and maintenance.

                1. re: Jerseygirl111

                  In regard to antibiotic resistance, what we really need to do is simply quit overprescribing antibiotics.

                  1. re: carolinadawg

                    "In regard to antibiotic resistance, what we really need to do is simply quit overprescribing antibiotics."

                    We also need to stop spraying and injecting every dang thing that grows on a farm.

                    1. re: carolinadawg

                      Drop in the bucket. 80% of the antibiotics manufactured in the U.S. are used in agriculture in feedlots and sprayed onto produce.

                      1. re: mcf

                        While I agree that agriculture should quit using so much antibiotic, overprescribing antibiotics is a major contributor to the creation of drug resistant bacteria.

                        1. re: carolinadawg

                          So you think the 80% of unnecessary antibiotic use that helps no one is secondary?


                          1. re: mcf

                            I think it's somewhat unknown at this point exactly to what extent antibiotic use in feedlots contributes to antibiotic-resistance in bacterial strains that are pathogenic in humans. But it's quite plausible that it actually is the smaller part of the problem. The big reason for this is that humans and various animal species tend to be affected by different bacterial strains; the strains that are particularly problematic to humans are likely also most affected by over-exposure to antibiotics used by humans (even though a greater percentage of antibiotic usage occurs in domesticated animals).

                            I haven't studied this matter extensively [informative counter-arguments are welcome], but from what I have seen, it seems to be very difficult at this point to say exactly how much of the problem is caused by any one kind of antibiotic usage. I DON'T support antibiotic use in feedlots, and I'm not trying to argue that anyone else should - it's certainly somewhat destructive and dangerous, and also largely needless. But it may foolhardy to ignore or downplay what is quite possibly the larger danger based on a faulty understanding of the problem.

                            1. re: cowboyardee

                              I so disagree. So does the U.S. CDC.


                              So did the scientists I read about in 1985 or so, predicting the loss of antibiotic effectiveness in humans due to their use in feedlots.

                              1. re: mcf

                                I think you're misrepresenting the CDC. I agree with the CDC that antibiotic usage in feedlots is dangerous. But the report you've listed is focused entirely on the feedlot problem; it doesn't compare that to the larger problem of antibiotic-resistant pathogens in humans or whether the strains of drug-resistant organisms that are currently most problematic are also those that are affected most directly by antibiotic usage in animals.

                                Compare the strains listed in the CDC report you linked to (page 9) with those focused on from another CDC report more specifically focused on the strains that cause the biggest problems in humans.
                                While it's likely that there is some overlap and interplay at work here, you'll see that many of the strains most concerning to humans are resistant strains of (relatively) normal human skin and gut flora - staph, strep, enterococci, etc, which appear to be less affected by antibiotic usage in feed animals than by usage in a medical setting.

                                1. re: cowboyardee

                                  You are completely missing the scope and exposures via food, water, and contacts with low levels of antibiotics of all our human microbes and how sub, way sub concentrations have made them resistant, too.

                                  It's not "some" overlap and interplay; the normally sequestered or contained microbes in humans are getting very comfortable over our lifetimes with residues plus direct usage of all sorts of broad spectrum antibiotics.

                                  We're eating them and drinking them plus a lot of folks are taking them, too. The ones not mostly found on feedlots are still encountering those drugs indirectly in low enough concentrations to build resistance.

                                  Just living in proximity to swine farms, where pathogens are found to be airborne, leads to higher MRSA infection rates.

                                  1. re: mcf

                                    That's likely true, but it doesn't follow that human medical usage is less of a driving factor in resistance than feedlot usage. It's like saying the toxins in the general environment are more responsible for your lung cancer than the cigarettes you smoked casually on and off for years. Not entirely implausible (especially depending on where you live), but somewhat unlikely and impossible to sort out at this time anyway. Ignoring one side of the problem probably isn't very productive. The CDC, who you already cited, certainly doesn't overlook the need for reforming medical practices to address the problem.

                                    1. re: cowboyardee

                                      And donkeys may fly out your butt, too. Over and out. :-)

                            2. re: mcf

                              Let's just agree that the overuse of antibiotics is a problem, and needs to be curtailed. And that is a better idea than sitting around waiting for big pharma to come up with a new antibiotic to combat the resistant bacteria.

                      2. re: Jerseygirl111

                        I don't know what insurance you have, but in much of the country managed care is the rule, and payment is per member per month. Some times meds and hospitalization is part of that. Groups SPEND money when patients get treated.

                      3. re: jrvedivici

                        What are you talking about? Ten years after my treatment for cancer I was considered officially cured. It's been nearly 20 years that I've been cancer free, now. I can assure you my oncologist was focused on killing my cancer cells so they didn't kill me. I had only a 30% chance of survival when I was diagnosed.

                        1. re: rasputina

                          My sincerest congratulations. What a wonderful outcome :)

                          1. re: rasputina

                            "What are you talking about?"

                            The comment which you are referring to is my response to beevod statement "Cancer is a cash cow", to that I added Cancer, heart disease and Aid's/HIV. As a cancer survivor I'm sure you most know the tremendous cost your treatment carried with it, the dozens of drugs and treatments you had to take to successfully beat that disease, even against the Dr's odds.

                            Now if you go back to my original post you will read;

                            " Treat obesity with drugs and surgery rather than prevent it, because obviously if you prevent obesity the medical industry loses millions if not billions of dollars in drugs and surgeries."

                            Just like your cancer......thankfully you beat it, but you still had CANCER, it seems the focus of the medical community (in my opinion) is to treat disease(s) once we contract them rather than find a way to PREVENT them. Wouldn't it have been a better experience if you were able to have received a treatment, or shot, or dare I say *"vaccine" for cancer. A true CURE to disease is to find a way to prevent it, not to treat it, nearly killing the patients in the process then declaring you "cured". The true CURE is finding the science behind preventing it, like polio.

                            So what I mean is it seems the focus of the medical community is in treating disease once we get it, because there are billions of dollars in "curing" us, but there is very LITTLE money in finding a true cure, and preventing these diseases at all.

                            Nobody is debating the medical communities ability or diligence in fighting disease once we contract them. I just feel the focus should be more on prevention of the disease(s) in general, rather than treatment. Or shall I say an equal balance in the two, which I just don't see. Perhap's I'm wrong, but that's "What I'm talking about".

                            (* Vaccine, I don't want to start a debate about vaccine's just using the term for example purposes. )

                            1. re: jrvedivici

                              Prevention is important and under-emphasized in American medicine - I certainly agree with you there. But preventing cancer is a wholly different matter than preventing polio. Cancer isn't one disease with one cause. And the better you prevent other fatal diseases, the more likely you are to eventually get cancer. To paraphrase Kurt Vonnegut, you might as well try to stop war or glaciers*

                              *fascinatingly, 50 years after he wrote on the subject, we're getting closest to stopping glaciers.

                              1. re: cowboyardee

                                As I stated below with rasputina, I didn't inject cancer cures into this conversation, that was rasputina. My comment was regarding the "cash cow" aspect of the disease, which I do feel is accurate. I'm not trying to compare polio vs. cancer again that was just used as an example of preventative cure vs. treatment cure. I agree they are wholly different matters but again that has nothing to do with the over all point of this topic.

                                It seems based on the comments in the article the reclassification of obesity to a disease was at least in part a financially based decision based on; " as well as increase reimbursement for obesity-related drugs, surgery, and counseling". That's all.

                                1. re: jrvedivici

                                  Bariatric surgery is competing with harmful, expensive new drugs for the booming diabetes market caused by grain and sugar lobbies owning FDA diet reccos.

                                  1. re: jrvedivici

                                    "As I stated below with rasputina, I didn't inject cancer cures into this conversation, that was rasputina."

                                    But your first post yesterday stated:

                                    "Cancer, heart disease, Aids/ name the disease and the medical communities attention is focused on treating and medicating, not curing."

                                    So you very much did inject cancer cures into this conversation, before rasputina ever posted.

                                    Regarding the quote you find objectionable:

                                    "The nation’s largest physician organization said the new classification would help turn more medical attention toward obesity, as well as increase reimbursement for obesity-related drugs, surgery, and counseling."

                                    These are the words of the author of the PsyPost article, Eric Dolan, and stated without attribution to anyone; we have no verification from any source that this was a significant consideration in the policy statement of the AMA. Read actual resolution (link in paulj's post below) if you are really interested in a fuller understanding the AMA's reasoning, not some second hand account.

                                    1. re: kmcarr

                                      kmcarr, I'm not trying to be rude with you, however my first post yesterday was a direct response to beevod's comment about "Cancer's another cash cow". I didn't make a post or a statement it was a response to someone else's comment. Just as this is a response to you, that was a response, not a stand alone statement. The response is regarding "cash cow" which the treatment of cancer is. I didn't inject cancer cure's into this conversation, I responded to a comment, there is a difference. Rasputina and others, such as yourself have taken that response out of it's context as an agreement with beevod.

                                      Regarding the quote as you have copy pasted it reads;
                                      "The nations largest physician organization said" that is leading the reader, myself, to believe it was a quote of the AMA.

                                      Now here is a quote from the NYTimes article that the PsyPost article was based on;

                                      "Still, some doctors and obesity advocates said that having the nation’s largest physician group make the declaration would focus more attention on obesity. And it could help improve reimbursement for obesity drugs, surgery and counseling."

                                      "reimbursement" being a recurring theme, a financial one.

                                      Let me also point out this little quote from the NY Times article as well;

                                      "To some extent, the question of whether obesity is a disease or not is a semantic one, since there is not even a universally agreed upon definition of what constitutes a disease. And the A.M.A.’s decision has no legal authority."

                                      But now let's have some fun......let's look at the "official" AMA resolution which you asked me to read. You know what I find curious about the "official" AMA resolution, under the Relevant AMA Policy description, the very first line of the 6 page description reads this;

                                      "H-150.953 Obesity as a Major Public Health Program - Our AMA will: (1) urge physicians as well as
                                      managed care organizations and other third party payers to recognize obesity as a complex disorder"

                                      AND 3RD Party Payers...........I believe that would be a reference to insurance providers, the people who pay the bills. In the very first line, the very first item, they say they want to get the insurance companies on board to paying for the treatment of obesity.

                                      Thank you for having me read and re-read much of this to reaffirm my original feelings. Oh, let's not forget to mention that it seems based on the original topic, this has actually helped increase obesity since now it's a disease and out of people's control.

                                    2. re: jrvedivici

                                      It probably was a financially based decision. But does that mean it was a bad one? I'm not really sure.

                                      At heart, there are two separate issues here.

                                      1) How American medicine treats obesity. I imagine you and I agree that there is room for improvement on this front. A brief lecture on lifestyle factors when you go to the doctors office; a tidbit of nutritional advice (which, likely as not, is already outdated and problematic); a prescription for lipitor, then metformin, then lopressor, then lasix; a gastric bypass or maybe a CABG. Not that these are necessarily bad treatments individually (case-dependent), but the semi-typical order of operations here doesn't seem to be bringing about the best outcomes. Serious (and costly) interventions aren't performed until you have pretty serious disease, and then of course those interventions often don't lead to a particularly high quality of life (which isn't surprising, as they are performed on people who are, by that point, very sick). Would more emphasis and intervention based on prevention lead to better outcomes? Probably.

                                      2) How to fund medical interventions (whether they're good ones or bad ones). Fact of the matter is your health insurance isn't likely to pay for your gym membership (or tennis league or whatever), or educational in-depth classes on nutrition and cooking even if your doctor could somehow prescribe them based on your risk factors. Categorizing obesity as a disease might be one way to allow the medical profession to treat obesity starting at an earlier stage - before it leads to more recognized diseases.* If you want more and better prevention, you have to find a way to fund it.

                                      *the interesting question and one raised tangentially by the original article is whether redefining obesity as a disease also makes lifestyle 'treatments' less likely, as the medical community doubles down on their own medical-iness? Does it make patients less willing to accept lifestyle modification as a legit medical treatment?

                                      1. re: jrvedivici

                                        Um, no I wasn't the first person to mention cancer here, not by a long shot. There are actually numerous posts before I addressed it being brought up.

                                        1. re: rasputina

                                          Please read or quote properly, I never said you were the first to mention cancer, what I said was you were the first to bring up cancer cures. You used yourself as an example of how the medical community cured you against the odds.

                                    3. re: jrvedivici

                                      Well, they haven't been able to determine what the cause is of the cancer I had. Until they do that, it's very hard to work on a prevention plan. My cancer is not one with a specific known cause or even a known associated risk like lung cancer and smoking or breast cancer and family history.

                                      Cancer isn't just one disease. It manifests in a wide variety of ways, has various causes and even more treatments. I can't imagine that there will ever be the ability or have a cancer vaccine that works for all cancers, because Leukemia manifests itself completely differently than lung cancer for example.

                                      1. re: rasputina

                                        Nothing about my OP or my subsequent comment was meant to debate the fight for a cure of cancer. The comment which you asked me about was in reference to Cancer as a cash cow, do you not believe cancer is a cash cow for the pharmaceutical and or medical industry as a whole?

                                        I didn't inject cancer cure(s) into this dialog, that was you using yourself as an example. I'm not going to sit here and try to debate the different cancers and their treatment, that has nothing to do with any of my comments.

                                        It seems to me the AMA should be focused on STOPPING the obesity epidemic in this country (US), and NOT reclassifying obesity as a disease to "increase reimbursement for obesity-related drugs, surgery, and counseling". This reeks to me of chasing money because there is more money to be reimbursed than there is in securing overall healthier lifestyles for generations to come.

                                        1. re: jrvedivici

                                          I think you are unfairly judging the AMA solely on the 1st sentence of that online article.

                                          1. re: paulj

                                            Honestly the more I keep reading about this the more I support my original stance.

                                            It reeks to me of a financial move to make more money off of obesity than it is a sincere effort to do anything to stop the obesity epidemic in this country. (US)

                                          2. re: jrvedivici

                                            No I don't believe cancer is a cash cow for the medical industry or pharmaceutical companies. It costs a huge amount of money in research to get effective treatments to market.

                                            1. re: rasputina

                                              Here's the thing; we taxpayers fund the research and once it's close enough to marketing, the NIH gives the work product to the industry, usually for free They are in it strictly for the huge payload. Their corruption, buying off researchers and even FDA honchos, manipulations of study data, ghost writing under physician's names, etc. are all well documented, it's not some tin hat theory.

                                        2. re: jrvedivici

                                          First a bit of semantics. For the individual cure means treating the disease once they contract it. For society as a whole, cure means prevention.

                                          Prevention, detection, treatment are a better set of words.

                                          For most diseases treatment has been the initial focus, Surgeons were cutting out turmors before anyone had ideas of what caused them. Polio victims were being put in iron lungs long before the vaccine was developed. Especially with cancer early detection makes the treatment more effective (and potentially less expensive).

                                          The HPV vaccine is an example of a cancer preventative. Various campaigns against smoking are another. Successful treatment and/or prevention of obesity can be a diabetes preventative. In fact, treatment of obesity, even with surgery, is a preventative for a whole host of deadly diseases.

                                          The study cited by the OP is an example of research into prevention. It looks at the psychological factors affecting a public health action (the AMA resolution and subsequent NYT article).

                                          In the AMA resolution, 'prevention' occurs 14 times, 'treatement' 10, 'surgery' 4, 'therapies' 3, 'diet' 24, 'lifestyle' 7. 'education' 21.

                                          1. re: paulj

                                            You don't cure something that doesn't exist. The definition of cure is not prevention. Prevention is important but most conditions can not be fully eradicated at this point, so curing the ill is still needed.

                                            1. re: rasputina

                                              NOBODY is saying or disputing that care for the disease once detected is negligent. The point is which you seem to be missing is there is substantially more money in treating and curing disease once contracted, then eradicating them.

                                              Just a FYI I am very familiar with cancer and it's treatments and costs, as I type this both my wife (breast) and my father (prostate) are fighting their battles. If you don't see the treatment of cancer as a cash cow to the medical industry good for you, we agree to disagree.

                                    4. re: beevod

                                      Big pharma needs diseases along with an army of docs to pass out prescriptions after a few cursory intake questions.

                                      A colleague of mine must fly to Switzerland 3x a year for treatments of a rare form of cancer for which there is no FDA approval. It is working but just not approved here.

                                      As for obesity, there's no profit in life-style changes so why should they mention it?

                                      1. re: beevod

                                        Those Cancer Treatment Centers of America that are cropping up all over the place like cancerous sores with their success stories only to read that you should not expect typical results.These people are nothing but vultures IMO...

                                        1. re: miss_belle

                                          Maybe. I haven't looked into how they practice and if their outcomes are actually better than traditional centers. Have you?

                                          1. re: mcf

                                            No and I have no intention of doing so. Cancer centers who "feed" on desperate sick people with commercials have no place in my book.

                                            1. re: miss_belle

                                              Pretty much every hospital, medical service and industry advertises on T.V. including other cancer centers. How do you arrive at the conclusion that this particular one alone is preying on desperation more than others do?

                                              All of the academic cancer centers in NY are advertising just as aggressively, for example. They specifically make the claim or imply that a cure is more likely in their facilities than others.

                                              So is one to avoid one and all on the basis of advertising?

                                              1. re: mcf

                                                Movie night tonight. I'll have to get back to you tomorrow ok.

                                      2. Also from that post:
                                        "The researchers do not dispute that obesity should be classified as a disease. The goal of the study was to better understand how public-health messages can have unintended consequences."

                                        I'd also like to highlight: "and counseling"

                                        What do you expect doctors to do to prevent obesity?

                                        A Canadian doctor is blogging about 13 myths about dieting.

                                        1. if we are going to pay attention to how big pharma profits from obesity and/or cancer,
                                          we should also look at how big ag profits from it.
                                          really, the two are married when it comes to this issue.
                                          not to mention the role big pharma has in livestock production.. . . .

                                          1 Reply
                                          1. re: westsidegal

                                            This is why I love Chowhound. You guys are determined to make me think, aren't you?

                                            I'd never thought about the complicity of pharma and ag in this way. I mean sure, Id thought about antibiotic and antimicrobial usage in agriculture. I'd never linked the two when it comes to obesity.


                                          2. Doctors can't "prevent" obesity, only the individual can. My doctor can suggest I make healthier choices but she's not there while I am opening my B&J to eat while watching Hannibal. Well maybe in spirit.

                                            1 Reply
                                            1. re: Jerseygirl111

                                              Actually, severe obesity occurs in folks who don't overeat and who aren't sedentary due to endocrine disorder. Often.
                                              The kind of hunger that keeps people eating long past the point their lives and comfort are severely compromised is not solely nor primarily a life style nor psych issue.

                                              Doctors are as ignorant as the general public when it comes to obesity as an endocrine disorder. Worse, it's often caused by the diet most commonly recommended by them. The diet that leads to diabetes and the treatment of lipid targets with no benefits.