Obesity as a disease
Doctors who specialize in weight loss say people need to view obesity as a disease, not as a reflection of lifestyle, to start to slow the spread of the dangerous condition.
Like other diseases, obesity has an agent – food – that in the right environment strikes genetically susceptible hosts and makes damaging changes to the way their bodies function, according to authors of a World Obesity Federation paper in the latest edition of journal Obesity Reviews.
The American health care system has not fully embraced that view, said Pittsburgh doctors who specialize in weight loss.
“It's a major burden on people's health, on the economy and on society, and I don't think we have enough resources to tackle it,” said Dr. George Eid, system director of Allegheny Health Network's Bariatric and Metabolic Institute.
More than a third of U.S. adults are obese, according to the National Institutes of Health. The “mother of all diseases,” as Eid calls it, increases risks of heart disease, diabetes, cancer, liver and kidney problems, stroke, mental illness and other deadly diseases.
The characterization of obesity as a disease goes back at least 250 years, to when Scottish physiologist Dr. Malcolm Flemyng said it tended to shorten life by obstructing the “free exercise of the animal functions,” according to the paper. The American Medical Association recognized it as a disease in 2013 and other organizations followed.
The Centers for Medicare & Medicaid Services eliminated language saying obesity is not a disease in 2004, but hasn't fully recognized it as a disease, according to the paper. Insurance coverage for FDA-approved weight loss medications remains spotty, doctors said.
Once obesity reaches a certain threshold – typically a body-mass index of 30 – it changes the body in ways that make it extremely difficult for people to return to a healthy weight, said Dr. Vicki March, medical director of the comprehensive weight loss program at Magee-Womens Hospital of UPMC.
Long-term studies have shown that obese people reach a “set point” weight to which their bodies tend to return gradually over time. At a BMI of 30, which would be about 200 pounds for someone who is 5'8”, changes in metabolism and hormone production affect caloric needs, March said. People who lose dozens of pounds by limiting their calories to 1,500 per day might never return to eating 2,000 calories per day without regaining weight, she said.
At BMIs of 25 to 30, people can often reach a healthy weight through diet and exercise, she said.
Weight-loss medications, which are indicated for people with a BMI of 27 or higher, can help people lose up to about 15 percent of their body weight, she said. Those with a BMI above 35 often need surgery, she said.
Lynne Erlich, 72, of Robinson Township, tried “every diet that came down the pike” after she gained weight in her 50s and 60s following a divorce. Erlich, an administrator of liability for Eat'n Park, said she would lose 10 pounds and the weight would return, over and over.
She had high blood pressure and her knees hurt and she worried she would get diabetes. She asked her doctor about gastric bypass surgery, and underwent the operation five years ago. She lost 83 pounds.
Now she feels full after eating less food, she said. She runs up flights of stairs for exercise. She eats better, having made adjustments to her diet such as replacing mashed potatoes with mashed cauliflower. She participates in UPMC BodyChangers, a group networking program to support weight loss, and keeps her weight around 140 pounds.
“I'm a much happier person,” Erlich said.
Jim Delman, 62, of Bridgeport, Ohio, had the surgery after being overweight for most of his life. He graduated high school weighing 185 pounds and at his heaviest weighed about 420 pounds, Delman said.
The weight wore his knee down to the point where it would need to be replaced. He saw a need to change, and he and his wife both decided to try surgery. Dr. Eid performed bariatric surgery on him February of last year, he said. He lost 50 pounds before the surgery and since then has dropped his weight to about 172 pounds.
Now he rarely eats bread, choosing salads and vegetables instead. He drinks water instead of soda or beer. He said he went to the gym every day but one in April.
Doctors' discussions with overweight patients often go no further than telling them they need to lose weight, said Dr. Mark Woodburn, a primary care physician with Pittsburgh-based Genesis Medical Associates.
Of the 86 million Americans estimated to be obese, only about 3 million are treated for it, he said.
“Imagine if that was our treatment rate for hypertension; you'd be an awful doc if you were only treating three percent of your hypertension patients,” he said.
Each of the doctors said insurers rarely cover weight-loss medications, nor does Medicare.
Highmark Inc. spokeswoman Wendy Morphew said in an email that the insurer covers the drugs for people with severe obesity and in some cases for people with moderate obesity. Employers may choose not to include the drugs in their plans, Morphew said in the email.
UPMC Health Plan spokeswoman Gina Pferdehirt said in a statement that the insurer doesn't cover the drugs, but is considering it.
“UPMC Health Plan is collaborating with physicians and our specialists to evaluate new and existing anti-obesity medications to determine what is both safe and effective for our members,” Pferdehirt said in the statement.
Woodburn said he took an interest in treating obesity more aggressively after realizing how differently he was treating obesity than hypertension and other weight-related diseases. Now he said he makes a point of setting up follow-up appointments to talk about obesity, refers patients to dietitians and follows obesity treatment guidelines that he said many doctors haven't learned.
“Any doctor can incorporate this,” he said. “You just have to be comfortable bringing it up with patients.”
Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676, firstname.lastname@example.org or via Twitter @wesventeicher.