The breaking medical news last week (June 18) was the American Medical Association recognizing obesity as a disease. “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, said in a statement. She suggested the new definition would help in the fight against Type 2 diabetes and heart disease, which are linked to obesity.
The organization doesn’t have any kind of official say in the matter, but it’s influential nonetheless, and the vote of the AMA’s policy-making House of Delegates is one more step in the evolution of social attitudes towards obesity. This decision has spurred a lot of discussions and debates about whether or not obesity should be considered a disease. However, this is not the first time this has been debated. The Obesity Society officially issued its support for classifying obesity as a disease back in 2008.
“More widespread recognition of obesity as a disease could result in greater investments by government and the private sector to develop and reimburse obesity treatments,” the AMA said in one statement on the issue. 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.
The downside, the AMA says, is that people may expect that they should be able to take a pill and “cure” obesity. Unfortunately there is no magical pill to cure obesity. It is a tough battle and one that each individual needs to be prepared and dedicated to fight. I often remind our patients the appetite suppressing medications are not a “Disneyland pill” in which you take it and wake up in “skinnyville”–you have to put forth the work and sweat equity. The pills are only meant to be used to help “jumpstart” your efforts or as a spring board to get you going.
With the designation of obesity as a disease, it could make it easier for policymakers to make changes as we have seen in the past with both smoking and driving safety. With smoking, first the U.S. Surgeon-General declared that smoking could cause disease; gradually workplaces and then public places began banning smoking. Taxes on tobacco and restrictions on who could buy tobacco products helped – and smoking rates plummeted from above 40 percent in the 1960s to 18 percent now. With traffic safety, first speed laws, then requirements for vehicles to have seat belts and air bags helped reduce deaths. We have also seen the implementation of state laws against texting and driving and using hands-free devices.
To help us better understand obesity, let’s start with the definition of obesity. As written on Medline Plus (a service of the US National Library of Medicine National Institutes of Health), obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person’s weight is greater than what is considered healthy for their height. Being obese increases your risk of diabetes, heart disease, stroke, arthritis, and some cancers. If you are obese, losing even 5 to 10 percent of your weight can delay or prevent some of these diseases.
Working in obesity medicine, I am pleased and ecstatic to hear of the AMA’s decision to designate obesity as a disease. On a daily basis, I work with patients who struggle with their weight and for most it has been a lifelong struggle. Speaking with patients I know firsthand society, family, friends and other health care providers often blame the individual for their weight issues. Battling with weight is a daily issue for most Americans. Even for people who do not have weight issues per se, they still have to work to maintain their weight.
We have become a less physically active country and one that tends to over indulge. With portion sizes as big as they are and the constant suggestions of “upsizing” our meals, it is very easy to eat too much unintentionally.
I teach a restart lecture for patients who have been here in the past and require our assistance again. Each lecture, I begin the class by telling my patients this is the last lecture I want them to have to sit through. My goal for each lecture is to “arm” the patients with the ammunition they need to battle weight issues and learn how to maintain their weight loss. I do not want my patients to think of this as a “diet”. A diet gives you the mindset that you do what you need to do to achieve your goals and then once the goals are met, you stop doing what you have been doing. With this mindset, the battle with weight becomes a vicious cycle. I ask my patients to do five things on a daily basis:
- Count Calories: Weight loss or maintaining your weight is all about calories in and calories out. In order to lose one pound of weight in a week, there has to be a deficit of 3,500 calories. This breaks down to a deficit of 500 calories per day. We recommend tracking calories through journaling, using an application on your smart phone (Lose it or MyFitnessPal) or using a calorie tracking website (www.loseit.com or www.myfitnesspal.com).
- Eat frequently: eating small meals (approximately the same number of calories each meal) several times throughout the day will help keep your metabolism elevated, keep you from feeling hungry, regulate your blood sugar levels, and help you keep your intake of calories in check. We recommend eating 5-7 small meals per day. For example, breakfast, mid-morning meal, lunch, mid-afternoon meal and dinner (evening time meal is okay if you are eating 6 times per day) with your caloric intake being approximately the same for each meal.
- Prepare your meals in advance and plan how many meals you will need each day. Think about what your day will involve and whether or not you will be home to eat when you are due to eat or if you need to pack meals to go with you. For example, I drive almost an hour to work every day. I usually eat breakfast in the car, I bring a mid-morning meal, lunch, and mid-afternoon meal with me day. If I know I am leaving work and heading to a sporting event for one of my kids, I will bring my dinner with me as well. This way I can eat my dinner at the ball field or on the way home instead of running through a drive-thru and ruining what I have done well all day long.
- Exercise regularly with the ultimate goal being four to five days per week for 30-45 minutes. This does not mean you have to start out with 30-45 if you have not been physically active. It means starting with what you are able to do and building from there. I suggest patients start out with 4-5 minute walks 4-5 times per day. As this gets easy, increase the time. I also suggest exercising during commercial breaks if you watch television. For an hour long show there is typically 15-18 minutes of commercials. Get up every commercial break and do something that elevates your heart rate; it can be marching in place, walking in place, jumping jacks, sit-ups, push-ups or a combination of these activities. Perform the activity the entire commercial break, when the show comes back on, sit down and rest. Repeat for every commercial break. Keep in mind: the goal is to get more physical activity throughout your day however and whenever you can!
- Eat protein: for females we recommend at least 65 grams of protein per day and for males, 75 grams of protein per day. Protein stays with you for a longer period of time and will help you feel full and satiated longer. What is a protein? If it “walks, crawls, swims, flies or has a mother”, it’s a protein! Dairy products, lean cuts of red meat, fish, chicken, seafood, pork, beans/lentils (plant based proteins), nuts and butters (peanut butter, soy butter, almond butter) are examples of proteins. A serving size of protein is the size of the palm of your hand and the thickness of your hand. Make sure you eat at least a serving of protein at breakfast, one at lunch, mid-afternoon meal and at dinner.
As far as medicine goes, we still have a long way to go in helping patients battle and defeat weight issues. The AMA’s support of defining obesity as a disease should help. Hopefully medical programs will start educating our medical professionals about obesity and how to treat it. I hope there will continue to be advances in medicine in order to help our society turn things around and become more healthy individuals!