The American Medical Association (AMA) announced on June 18, 2013, that it will officially recognize obesity as a disease—a decision that impacts not only patients, but payers and providers, as well. While this vote has no legal authority, AMA policies are often used by policymakers to determine health policy, regulations, and reimbursements.
Despite media reports and infomercials to the contrary, there is no “silver bullet” to treat obesity. The new AMA position reflects the changing perception of obesity among healthcare professionals as a complex medical condition that requires a multipronged approach to treatment. It will require the combined efforts of every segment of society to address this “disease,” which is exactly how the U.S. has addressed other public health issues such as HIV/AIDS, infant mortality, polio, car safety, and tobacco. It will likely force payers to reexamine their coverage policies and consider reimbursement for obesity surgeries that currently may not be covered.
Similarly, hospitals and healthcare systems may scramble to ensure that their organizations are equipped to handle the rising number of surgeries and the long-term follow-up care obese patients who undergo these surgeries will require. Payers and employers may also have to grapple with issues related to coverage and reimbursement of fitness, weight loss, and smoking cessation programs.
Another outcome of the AMA’s decision may be more dollars flowing into research for obesity medications. Two new obesity drugs have been FDA approved in the past year, following long and careful deliberation by the agency’s regulators. However, it is not yet clear what role these medications will play in the treatment of obesity because the actual percentage of weight lost is not very large. And early data suggest that healthcare providers are less than enthusiastic about prescribing them, based in part on the ill-fated fen-phen fiasco of the 1990s. After only a year, the medication combination of fenfluramine and phentermine was withdrawn from the market after an estimated 30% of patients taking the medication developed heart valve damage linked to the fenfluramine component. We need to learn from this experience and monitor the evidence that all FDA-approved weight loss drugs continue to be safe over time.
Patients, caregivers, clinicians, payers, and healthcare organizations continue to be faced with the challenge of how to manage obesity and reduce its adverse effects on health and quality of life. There is uncertainty about which treatments are most effective and for which groups of people, especially as high-risk populations are often among the underrepresented in studies of obesity treatments. While there are efforts in process to develop population-specific interventions and treatments for obesity, there is currently no consensus on the best ways to reach different populations. Evidence will inform that consensus and help guide decisions about how to reduce the long-term complications of obesity and overweight and to ensure that people receive care that addresses their physical and behavioral needs without compromising their safety.