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WBEN Extra: Obesity A Disease



More than 35 percent of U.S. adults and 17 percent of children and teens now have a disease, after the American Medical Association formally voted Tuesday to classify "obesity as a disease requiring a range of medical interventions."

  What does this mean for patients?



The AMA's new stance could have a "tremendous impact on [obesity] legislation in Washington [and] with insurance companies," says  Dr. Louis Aronne, an obesity specialist at New York-Presbyterian Hospital in New York City

Bariatric surgeries including Lap-band procedures or gastric bypass surgeries may now be covered by more insurers based on the AMA's reclassification, he said.

There are also two recently-approved obesity drugs, Qsymia and Belviq, that can be prescribed to obese patients.

Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital in New York City, says that the new shift could help doctors address patients who are obese earlier and get them into treatment

Before, a doctor who offered treatment for obesity might have been considered offensive by the patient because of the condition's connotation with an unhealthy lifestyle choice, he said.

"It's something that we have to do," he said of the new classification.

In April, Johns Hopkins Medicine researchers conducted a small study of primary care doctors, and found they were less likely to build an emotional rapport with overweight and obese patients than they were with normal weight ones.

The researchers pointed out that empathy is essential for patient care, making them more likely to adhere to medical recommendations.

Obesity's new disease-peg may also make more Americans realize what unhealthy eating and inactivity could be doing to their health.

  A January 2013 survey showed that while 70 percent of Americans know heart disease and diabetes are health risks tied to obesity, only 7 percent of respondents knew cancer was a risk and 5 percent knew asthma and sleep apnea could be helped by shedding pounds.
 

The shift is aimed in part to get doctors to tackle obesity as if they were treating a disease instead of a lifestyle condition in need of modification.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans," Dr. Patrice Harris of the AMA said in a statement.

"The AMA is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and Type 2 diabetes, which are often linked to obesity."


In Studio, In-Depth:
Hear John & Susan with BariatricSurgeon Aaron Hoffman MD
Medical Director at Kaleida's Center for Minimally invasive surgery at Buffalo General Medical Center.

An in-depth conversation in three parts, from Buffalo's Early News Thursday








 


Do you agree with classifying obesity as a disease?
Yes
( 13% )
Only in some cases
( 36% )
No
( 52% )
 

Obesity is defined as a body mass index (BMI)  -- a ratio of height over weight -- of 30 or higher. People are considered normal weight if they have a BMI between 18.5 and 24.9

While obesity may not have formally been considered a disease by doctors until now, the health condition has certainly been linked to diseases by growing bodies of research.

Studies have linked obesity to risk increases for heart disease, Type 2 diabetes, stroke, liver disease, sleep apnea, breathing problems, osteoarthritis and joint pain, infertility, sexual side effects and cancers of the breast, colon, esophagus, pancreas and kidneys


Exclusive WBEN Audio
On The WBEN Liveline

"Greg", a bariatric surgery patient
shares story
of having his stomach "stapled"



The 2013 "Annual Report to the Nation on the Status of Cancer" found significant rises in obesity-related cancers over the past three decades.

Heart disease in particular is the leading cause of death in the United States for men and women. The American Heart Association says  that too much fat around the waist can  contribute to heart problems by lowering HDL "good" cholesterol  and raising "bad" LDL cholesterol, blood pressure, and triglyceride levels.
 


CBS VIDEO:
AMA re-classifies Obesity as a Disease


 

from the US Centers for Disease Control

Obesity ....
Is common, serious & costly

  • More than one-third of U.S. adults (35.7%) are obese.
  • Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.
  • In 2008, medical costs associated with obesity were estimated at $147 billion; the medical costs for people who are obese were $1,429 higher than those of normal weight.

...Affects some groups more

  • Non-Hispanic blacks have the highest age-adjusted rates of obesity (49.5%) compared with Mexican Americans (40.4%), all Hispanics (39.1%) and non-Hispanic whites (34.3%) [See JAMA. 2012;307(5):491-497. doi:10.1001/jama.2012.39].
  • Among non-Hispanic black and Mexican-American men, those with higher incomes are more likely to be obese than those with low income.
  • Higher income women are less likely to be obese than low-income women.
  • There is no significant relationship between obesity and education among men. Among women, however, there is a trend—those with college degrees are less likely to be obese compared with less educated women.
  • Between 1988–1994 and 2007–2008 the prevalence of obesity increased in adults at all income and education levels.
 
CHICAGO (AP) — Obesity surgery worked much better at reducing and even reversing diabetes than medication and lifestyle changes in one of the most rigorous studies of its kind. But the researchers and others warn that possible serious complications need to be considered.

The yearlong study indicates that the most common weight-loss surgery, gastric bypass, can effectively treat diabetes in patients with mild to moderate obesity — about 50 to 70 pounds overweight, the researchers reported Tuesday in the Journal of the American Medical Association.

Other studies have shown the operation can reverse diabetes in severely obese patients, although sometimes the disease comes back.

About a third of the 60 adults who got bypass surgery in the new study developed serious problems within a year of the operation, though some cases were not clearly linked with the surgery. That rate is similar to what's been seen in previous studies.

But for the most serious complications — infections, intestinal blockages and bleeding — the rate was 6 percent, slightly higher than in earlier research.

The most dangerous complication occurred in one patient when stomach contents leaked from the surgery site, leading to an overwhelming infection, leg amputation and brain injury. Lead author Dr. Sayeed Ikramuddin, an obesity surgeon at the University of Minnesota, called that case "a fluke."

A journal editorial says such devastating complications are rare, but that "the frequency and severity of complications ... is problematic" in the study and that the best way to treat patients with both obesity and diabetes "remains unknown."

A research review in the journal said more long-term evidence on risks and benefits is needed to determine if obesity surgery is an appropriate way to treat diabetes in patients who aren't severely obese — at least 100 pounds overweight.

More than 20 million Americans have Type 2 diabetes; most are overweight or obese. Diabetics face increased risks for heart disease and strokes, and poorly controlled diabetes can damage the kidneys, eyes and blood vessels.

About 160,000 people nationwide undergo various types of obesity surgery each year. Bypass surgery, the type studied, involves stapling the stomach to create a small pouch and attaching it to a lower part of the intestines.

The American Society for Metabolic & Bariatric Surgery says obesity surgery is safe and that the death rate is less than 1 percent, lower than for gallbladder and hip replacement surgery.

The study involved 120 patients at five hospitals in New York, Minnesota and Taiwan. All patients got medicines for diabetes, obesity, cholesterol and/or high blood pressure. They all were advised to cut calories and increase physical activity.

Sixty patients also had surgery, and the two groups were compared after one year.

The surgery group lost on average nearly 60 pounds and 75 percent lowered blood sugar levels to normal or near normal levels. The non-surgery group lost an average 17 pounds and just 30 percent reached the blood-sugar goal. The surgery group also needed less medication after the operation.

The researchers say the diabetes changes were likely due to the weight loss but that hormonal changes affecting blood sugar may have contributed.

The surgery group showed a trend toward having less high blood pressure and elevated cholesterol — both major risk factors for heart disease, although those between-group differences could have been due to chance.

Ikramuddin, the lead author, said the study results don't mean that all mildly obese diabetics should have obesity surgery, but that "in the correct patient, surgery might be an important thing to consider."


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