Posted on June 21, 2013 by admin
As a psychologist who has devoted his entire career to obesity treatment and research I am thrilled that obesity has finally begun to be legitimized by the AMA. I am hopeful it will lead to great things in our battle for improved public health. However, I am somewhat concerned by the overall impression in the media firestorm that we have somehow achieved a solution.
From the advocacy side I see statements like “Finally we are recognizing that obesity is not about eating too much or being lazy and not exercising enough.” Certainly the use of words like lazy is unacceptable; the assumption that all who struggle with weight are gluttonous eaters is simply wrong. What well-intentioned folks are trying to convey is that there are many factors (biological, environmental and psychological) that contribute to obesity- it’s not just a lack of ‘personal responsibility.’ I agree completely. However these statements serve to create an impression that calories in and calories out no longer matter – they do.
As a clinician specializing in obesity I work daily to help people identify personal lifestyle factors (e.g. work and family stress, emotions etc), food environments, societal influences, psychological factors and medical issues that represent barriers to achieving a healthy weight. These barriers often represent obstacles that interfere with eating less, eating healthy and exercising more. To address these issues we may include the use of weight loss medication or surgery to influence biological and metabolic contributors. We may also focus on behavioral or psychological interventions to help with those types of contributors and of course we provide nutrition and physical activity education to improve eating and exercise habits. This is what is required to treat obesity. Nothing changed when the AMA labeled it a disease. Also, unless attitudes toward TREATING obesity change, the disease designation will be meaningless. The ultimate goal of treatment is still to reduce calories consumed and increase physical activity. This is done in the context of biological, environmental and psychological influences. In other words, we assist patients in gaining control over personal choices in spite of barriers that are not in their direct control.
This will not be achieved by simply paying physicians in primary care to deliver sub-optimal obesity treatment. Effective weight management intervention, whether surgical, diet/behavioral or pharmaceutical requires a comprehensive multidisciplinary (physician or surgeon, physician extenders, dietitians, fitness professionals and behavioral specialists) extended care paradigm. These treatments need to be delivered by those with specialized obesity training. Until this happens, this new ‘disease’ designation is most likely to simply start paying for treatment that fails in having any meaningful impact on the lives and weight of those who struggle with obesity.
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