Thursday, June 20, 2013

How the AMA sold out, at our expense

Around the time I started getting interested in real food and knowing where my food comes from, I was also just starting a healthy lifestyle course that included a weight loss/body transformation component as well as exercise. My interest in food issues seemed to go hand in hand with the class, and I’ve never looked back since.

Here’s the thing, though. While eating real food from local, sustainable sources is good for the earth, for animals and for the community, it’s also good for your body. Many of the arguments for eating a diet of real food come from a health standpoint. Because America has an epidemic on its hands. As a country, we eat a lot of just plain horrible food. Junk. Chemical filled, calorie bomb, fake food. And we also don’t move very much.

The media loves to talk about the “obesity epidemic” in America. Just this week, the American Medical Association, against the recommendation of its own Council on Science and Public Health, decided to label obesity a “disease.” You might be thinking, so what? The AMA has no real authority, right? Well, sort of. They don’t have backing by the government, but their recommendations shape the way our health care is delivered and the way insurance works – by determining what insurance companies should pay for and how much. It helps guide the attention of physicians and healthcare practitioners across the country. So it’s important.

But it’s total crap.

AMA leaders said they were happy with the decision (again, against their own advisory panel’s advice) because it will (1) force doctors to pay more attention to obesity, (2) improve reimbursements and coverage for weight loss surgeries and drugs and (3) reduce the stigma surrounding obesity.

In regard to the first point, 51% of primary care doctors are overweight. Do you think the AMA coming out and “diagnosing” people with the disease of obesity is going to make doctors focus their attentions more on overweight or obese patients if they haven’t been able to focus on addressing their own weight and/or wellness?

In regard to their second point, surgeries and drugs for weight loss have shown very little clinical evidence of long-term success. So who wins if the reimbursements and coverage for these procedures and pills change? Primarily drug and device manufacturers and facilities that provide the procedures. It follows that you run the risk of doing unnecessary procedures just because the insurance will pay for it.

And people like to talk about gastric bypass being a miracle for weight loss. But what no one realizes is that you actually have to eat a very restricted diet and show that you can stick to it for several months before most hospitals will clear you to have the surgery if your insurance pays for it. So if you have the ability to eat a restricted diet to get the surgery, shouldn’t you just restrict your diet to healthy foods in the first place and avoid the risk of (many) complications? Yes, there are some people that really do need the surgery. But it’s not the miracle that everyone believes it to be, and it requires an unbelievable amount of determination and hard work. (Just like living a healthy lifestyle.)

In regard to the third point, the AMA says that it will help the public understand that some people have no control over their weight. That is partially true. There are people who have weight gain due to circumstances out of their control, or their bodies severely limit their ability to lose, even under the ideal conditions (hello, thyroid disease). But the way we reduce the stigma surrounding obesity is to start focusing on health, not weight loss. We have to stop equating skinny with healthy.

This brings me to the AMA’s Council on Science and Public Health’s objection to this classification. BMI (body mass index, or a ratio of height and weight) is the only real tool that clinicians use to diagnose “obesity,” and it is widely known to be flawed. (You have extremely healthy people with high BMIs and extremely unhealthy people with low BMIs because health is multi-dimensional.) If the only tool for diagnosis of a “disease” is known to be flawed, how can you actually determine whether or not someone has that particular disease? A logical argument, which was flatly ignored by the larger body.

The Council also raised the point that people could be automatically diagnosed with a disease (that could affect their health insurance premiums) simply because of their BMI. I currently have a BMI of 27.9, but my bloodwork (like blood glucose and cholesterol) is super humanly awesome, I eat a clean and healthy diet, and I’m so active that I get up at 5 a.m. so I can run up and down hills in cemeteries. I challenge any doctor to tell me that I have the “disease” of being overweight. Do I still continue to watch my weight and work toward a weight that feels right for my body? Yes. But never at the expense of my health and certainly not to please the American Medical Association and put more money in the pockets of pharmaceutical companies. Keep in mind that pharmaceutical companies need people to be obese to sell them obesity drugs. They don't make money when people start eating salads and taking a walk.

It’s common knowledge that our health care system is broken. But we aren’t going to fix it by taking more pills and having more surgeries. We’ve allowed the professional societies for dieticians to take sponsorship money from companies that sell sugary soft drinks and garbage foods. And now we’re letting pharmaceutical companies and lobbyists decide what constitutes a disease instead of research and evidence-based practice.

We need our health care practitioners to focus on wellness, not just weight loss. Eat healthy foods and be active because those are healthy behaviors, clinically shown time and time again to reduce (actual) disease risk and increase quality and length of life. Don’t follow fads and eat fake diet foods just to drop the pounds because the AMA wants to fear monger about obesity being a killer disease. Obesity can be a side effect of an unhealthy lifestyle and it is a risk factor for chronic disease, but it isn’t a disease in and of itself, by any definition. 

The AMA should focus its wellness efforts on increasing people’s access to real and healthy foods and give them the opportunity to learn healthy behaviors, not cater to Big Pharmaceuticals. Makes you wonder if a drug company will sponsor the next AMA meeting. I guess we'll see. 

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