Should obesity be classified as a disease?

[PrincessFiona]

Recent medicare changes have resulted in obesity being classified as a disease. Where do you guys stand on this?

Speaking as an overweight (gulp..obese) person who is working on losing weight, I have to say that I don't support this move. I do support treating the underlying causes of obesity including treating depression, etc...but I know that my weight problem is a result of my poor eating habits/exercise habits. Obesity in itself though I don't think is a disease...

Yes.
I'm make my arguement later.

[PrincessFiona]

Obesity results in health care needs and subseqently, costs. Obesity is a costly disease and classifying it as a disease will lead to treatment covered by Medicare, Medicaid, and private health insurance. Hopefully, treatment would reduce the incidence of disease.
Obesity is a risk factor for many diseases, including heart disease, type 2 diabetes, and some types of cancer. Obesity also proves to be costly with recent research finding a 36% increase in inpatient and outpatient costs for obese adults. Costs of care for obesity are estimated to be as high as $92 billion dollars (2002 dollars).
There are also indirect costs associated with diabetes and resulting disease such as income lost from decreased activity and illness.
Obesity affects minority groups disproportionately when compared to white populations.

Classifying obesity as a disease will likely lead to coverage for treatment (which should be medically managed and monitored, IMO, not Jenny Craig). Already the IRS has classified obesity as a disease and allows taxpayers to deduct some costs associated with treating it (as medical costs). It is listed in ICD-9 as a disease. Other government agencies view obesity as disease (CDC, NIH, FDA for example) and I think that CMS (m'care) has been among the last largely because they realize they would have to cover costs of treating it.

One downside of classifying obesity as a disease is that coverage could lead to higher health care costs -- namely the premiums that we pay. I venture to guess that would be a short term issue as the rate of diseases associated with obesity decrease and costs associated with obesity decrease. And, we already pay for the costs of obesity in our taxes (for Medicare and unreimbursed costs) and health insurance premiums.

(btw, I could just as well make an argument for it not being a disease.)

[PrincessFiona]

I understand the obesity-related health risks, but I'm hesitant to say that obesity itself is a disease. I think the only way that I could sign on to this is if they finally discover a solid neurochemical link to overeating behavior/weight gain and resistance to weight loss. Otherwise, I still see it as a behavioral issue....one that should be treated.

I have a problem with the idea that my tax dollars will now go to fund stomach stapling (which is what the bottom line is on the medicare bill, isn't it?). That is also not the be-all-end all solution because (from my limited understanding) these procedures don't attack the underlying issues and many people that initially lose weight end up regaining it...or they suffer other health-related issues.



moi

I see what you are saying. In that regard, obesity would perhaps be covered by mental health benefits? Viewed as other eating disorders, like anorexia or bulemia? Or, as you suggest, if there is evidence of addictive behavior it could be classified that way.

I know that I can't make a strong point for a biological or chemical cause for obesity (like diabetes) but it does create a huge cost burden that we all end up paying. I don't think that everyone will end up getting their stomachs stapled. I'm sure that Medicare will make that a treatment of last resort (I think that is how it's handled now). But, yes, it will add cost to Medicare. Over time, that may be negated if obesity rates (and complications) decline.

[DCJenn]

I gotta say that I'm waffling on this one-

I know that there are plenty of conditions that have obesity as a side effect, particularly in the disabilities field. (Prader-Willi Syndrome, Downs Syndrome, some mosaic disorders, etc) But- those side effects CAN be managed with appropriate support and education. For example, when I ran a home for people with Prader-Willi, everyone was on a reduced calorie diet depending on the weight they needed to lose, everyone exercised twice a day and we had all of the food locked up. FYI PWS is a chromosomal disorder that prevents the feeling of satiation so that people will literally eat themselves to death. I have had people eat rotten meat from trash cans, steal the bag of bags of peanuts from an airline- 500 of 'em, and order 5 pizzas delivered to the bedroom window of his group home. and one guy once stole someone's entire barbeque dinner, brisket, chickens, sausages, potato salad, etc.

So, Medicaid is actually already paying for the treatment and support of these people. It's people who are the living on the edge of poverty that need help.

Now, people make bad choices. True. But, let's look at this from an economic/educational perspective. Look at the prices of foods- how much does a box of mac and cheese cost? Store brand at my Safeway is less than 50 cents a box. Now, how much is that apple? How much is the lettuce? White bread? about a dollar. How much is the wheat bread? About $2.50? Twinkies? Cheaper than buying the ingredients to make a fruit pie. Soda? Store brand is cheaper than juice/milk.

and, when you're working two jobs because you can't find a full time job - even one without benefits, and you have to take the bus because you can't afford a car but your two jobs aren't walking distance- when are you going to exercise?

Obesity is so much more than "people with out of control eating". That's certainly part of it- but economics and education certainly are related.

Jenn

[Auspicious]

Is there some official medicare definition for "disease"? By dictionary definitions I would say obesity is not a disease, it's more of a syndrome . . . with, like Kris said, a huge behavioral component.

I don't care what terminology they use, though, I think it's a good idea for Medicare to pay for obesity treatment for all of the economic reasons stated by Nellie.

Just as an anecdotal example, I feel pretty confident in saying that my mother-in-law wouldn't have had the gall-bladder removal, diabetes, amputation, strokes, heart disease, and now uber-expensive nursing-home care that she requires if she weren't obese (maybe the gall bladder would have still happened--I don't know that much about gall bladders). Clearly it would have been much cheaper for John Q. Taxpayer to bankroll a gastric bypass (or whatever) for her ten years ago, because he's paying through the nose for the nursing home now.

It makes sense to not want to pay for something the person should have just prevented him- or herself in the first place, but really we end up paying in the end anyway. It's like when you car mechanic says "You can pay me a little bit now or a whole lot more later on."

We do end up paying for what a person could have prevented -- just think about smoking and tobacco use.

I don't know what the definition of disease is but I believe that obesity is considered a disease in ICD-9 (disease classification system managed by WHO...I think??).

[houseelf]

Not to waffle, but I see both sides of this debate. Without further research or insight, I would have to say that it probably is appropriate to treat it as a medical condition.

Obesity is a disease directly correlated to diabetes, heart disease, certain cancers, and other life threatening diseases. True obesity profoundly affects quality of life. My MIL is a morbidly obese Type II diabetic double amputee. Her disease severely has impaired her mobility and quality of life since her early forties and has cost an untold fortune in health care expenses. Had her weight been properly managed, perhaps she could have minimized some of her complications, including multiple surgeries, rehabilitation, extensive use of prescriptions, etc.

Further, eating can be an addiction just as pervasive as any other addiction. In fact, many recovering alcoholics turn to other addictions when they become sober, and overeating is one of them. For many, morbid obesity is a condition that is grounded in a psychological condition such as an addictive personality or depression. Admittedly, however, the psychological unpinnings undercut reclassification because obesity is a symptom of a disease, not the disease.

In the end, however, I would support the reclassification but I can see the other side.

As a tangent to this discussion, I believe that obesity is one of the last acceptable prejudices in this society. While most polite conversation would never tolerate outright sexist or racist remarks, many people engage in rampant obesity bashing. Additionally, obese individuals often earn less than their trim counterparts for the exact same work. I find this to be a repulsive commentary about our society.

Kelly

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[PrincessFiona]

eating as an addiction, Kelly? I don't buy it...unless you can bring the neurobiological data my way. Addiction implies not just a loss of control, but tolerance and withdrawal. I think addiction is a feel good term that we have used now to explain behaviors like gambling, shopping, etc. The underlying issue there (and I still believe for the most part with obesity) is a psychological one. This can't be cured, in my opinion, with a stomach stapling. Really, this is the crux of the 'treatment' for obesity under the new medicare agreements.

Hmmm..come to thing of it....
There have been studies (at UF btw) that looked at dopamine release and eating behavior. Some of these studies did suggest cellular changes took place that perpetuated the feeding behavior. I'll have to look into it and get back to you.

I guess (here comes my waffle) it all depends on what the treatment is...are we talking counseling/nutritional advising/physical therapy or just a quick stomach staple? I'm totally anti stomach stapling!

[PrincessFiona]

It makes sense to not want to pay for something the person should have just prevented him- or herself in the first place, but really we end up paying in the end anyway. It's like when you car mechanic says "You can pay me a little bit now or a whole lot more later on."

Well I do have to agree with this...but why not pay for it without classifying it as a disease? Pretty soon everything will be a disease...there will be those diseased thrill-seekers who like to bungee-jump, etc But seriously, I see your point...and it is also part of an argument that I would make about making some kind of universal healthcare plan available to the 42 million uninsured..... 8)

[Auspicious]

I'm totally anti stomach stapling!

How come?

[PrincessFiona]

I guess I have a few reasons:


Thomas often treats the people with complications....and there are some awful, awful complications. He's also seen 30 year olds die from this surgery...

20% of people who have the surgery require other surgeries to correct complications (The National Institute of Diabetes and Digestive and Kidney Diseases data)

1/3 develop gallstones, 1/3 suffer from nutritional deficiencies..there are people with lifelong diarrhea problems and to top it off, some people end up regaining the weight anyway.

What was once billed as a last ditch surgery is now being done on children with little knowledge about what the long term consequences could be.

In my eyes, there are no quick fixes.

But..this is all just my opinion..

kris

I think that Medicare has to classify it as a disease to treat it. For example, wanting a nose job is not a disease and Medicare would not pay for it. I think that classifying it as a disease implies some medical necessity from treatment.

I'm sure that Medicare will pay for the stomach reduction surgery for some people. But I'll bet that it's not going to be as easy as going into a bariatric (sp?) surgeon and saying, "Hey, now that Medicare will pay, sign me up!" Stomach reduction has been a last resort treatment and I think it will continue to be that way. I'm sure that there is a treatment "flow chart" for obesity now and that it starts with nutrition counseling, diet monitoring, etc. I know there were some obesity programs at the Univ of Colo that people could participate in but paid for themselves -- now Medicare may pay for those (or private insurance).

And, insurance does pay for the complications (?) of risk taking activities - horse back riding, motorcycling -- and even things that aren't considered risky but healthful -- I know lots of people who have had running or biking injuries covered by their health insurance. In that way, the consequences of lifestyle choices are covered. I guess the difference is that we aren't suggesting that a love of running be treated as a disease (though affected family members may sometimes disagree). If we have tools that can reduce or eliminate cases of obesity and thus eliminate disease and suffering, why not make efforts to use them?

Part of the problem too is that people do not like to pay for these things themselves. I think that one of the programs through the Univ of Colo was $1,000 for six months or something. Isn't your health and well-being worth at least $1,000? But people don't want to shell out for it. Just like they don't want to pay higher co-pays or have to use generic drugs. Or buy smoking cessation products without their pharmacy benefits kicking in a little. Now that is a behavior problem.