13 Weeks: Experiment 3, week 4

Well, the AMA now thinks so. On June 18, the AMA voted to classify obesity as a disease, where in the past they’d called obesity an “urgent chronic condition,” a “major health concern,” and a “complex disorder.” But not a “disease.”

The motivation, like a whole lot of things in medicine right now, really came down to insurance. If obesity is a disease, then doctors are obliged to treat it and insurance plans are obliged to cover it.

But is obesity really a disease? Let’s look at that a little bit more. Here’s the definition of disease from the Apple dictionary:

a disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury: bacterial meningitis is a rare disease | a possible cause of heart disease.

Long-time readers of this column may remember that back at the end of my first 13 week experiment, I wrote a little science-fiction piece from the point of view of 100 years in the future, when the underlying causes of obesity had been discovered and it had been redefined as a particular variety of lipodystrophy, that is, a metabolic condition in which fat distribution in the body becomes abnormal.

It does kind of sound like obesity, doesn’t it? And lipodystrophy is certainly considered a disease. But lipodystrophy is normally defined in terms of an abnormal loss of fatty tissue. If we look at the various kinds of lipodystrophy, though, many of them are actually characterised by loss of body fat in some areas and abnormal deposits of body fat in other areas. Now think back to “syndrome X,” “metabolic syndrome,” that is, the collection of characteristics that appears to indicate someone is heading for type-2 diabetes. These include high triglycerides, high blood pressure, high blood sugar, and a particular distribution of excess body fat around the abdomen — the so called “apple body” — but not around the legs or arms.

Looked at that way, honestly, it seems a no-brainer to at least characterize “metabolic syndrome” as a disease, and in particular a variety of lipodystrophy.