WH Medicalization of Obesity

I added "WH" to the title because the original "Medicalization of Obesity" page got taken over by one of my classmates, hope there isn't any confusion! This page was created by Winnie Hyun'

Obesity as a disease

The Medicalization of Obesity

Terminologies

Medicalization describes a process by which human problems come to be defined and treated as medical problems The core process of medicalization is defining a condition in medical terms, describing using medical language, understanding through the medical framework, or treating with a medical intervention.

Obesity and overweight are defined as abnormal or excessive fat accumulation that may impair health. Obesity is associated with an increased risk for type 2 diabetes, hypertension, dyslipidemia, cardiovascular diseases, musculoskeletal disorders, certain types of cancer, and mortality For adults, WHO (World Health Organization) defines obesity as having BMI (body mass index) greater than or equal to 30.

Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2)

Stigmatization of obesity

Stigma and discrimination toward obese population impose numerous consequences for obese persons' psychological and physical health. Although numerous science documenting weight stigma are available, its public health implications are widely ignored. Instead, obese persons are accused of lacking self control of weight, with common perceptions that weight stigmatization is justifiable.

Obesity as a disease

American Medical Association (AMA) reclassified obesity from a condition to a disease as of May of 2013. The declaration may be the most profound act of medicalization in American medicine; population that got affected by this decision was significant. Instantly, approximately 30% of the US adult population got defined as suffering from a medical disease. Today, it is approximated that 67% of US adults fall under “obese” category, and 15% qualify as eligible recipient for government support to undergo surgery to overcome obesity. Despite mixed opinions on support for it, redefining obesity as a medical disease made government financially responsible for some treatments. Take note of Dr. Sharma's arguments'

Treatment

Non-surgical

The non-surgical treatment commonly takes a multicomponent approach including the following: behavioural therapy, dietary adjustments to reduce energy intake, increase of physical activity, and pharmacotherapies (medication). Some non-conventional treatments include Internet based weight loss programs. They accommodate individuals who cannot meet in-person treatment due to numerous barriers such as program availability, patient proximity, transportation concerns, and time constraints.

Surgical

Bariatric surgery is being accepted as a viable option for obesity treatment. The surgery collectively encompasses both open and laparoscopic procedures, including gastric banding, gastric bypass, and vertical banded gastroplasty Currently, individuals with a BMI >40 or >35 with serious comorbidities related to obesity are recommended to get evaluated for bariatric surgery. Bariatric surgery has been presenting successful results, reversing, eliminating, or significantly ameliorating numerous comorbidities associated with obesity, such as diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea. The surgery was also found to lower premature death rate, to improve quality of life, and to lower disability and health care costs.

Arguments

Benefits

Supporting arguments for medicalization of obesity include expanding access to bariatric surgery for those with comorbid conditions, reduction of stigma involving overweight individuals, and affordable obesity treatments due to expanded government funding.

Consequences

Greater government and private-based investments to develop and reimburse obesity treatments can increase Food and Drug Administration (FDA) approval of pharmaceutical interventions, use of these medications among the public, insurance coverage of obesity treatments, support for obesity public policy, and funding for obesity prevention programs. Weakening of public policy and prevention programs resulting from increased government-funded medical treatments was another concern raised. In short, overmedicalization (see link) is a huge concern; over-expansion of medicine's professional jurisdiction is a mechanism the pharmaceutical industry can increase markets, thus contributing to rising health care cost on government's end.

Medicalization and society

Government

Medicalization made a significant impact on the US health policy. It led the government to overemphasize medical care as a a primary policy lever, framing health vulnerability and health disparities that elide social and economic aspects focusing on improving access to individual health services.

Accepting bariatric surgery

As medicalization of obesity expanded the pool of eligible recipients to be covered by government’s health insurance coverage in their obesity treatment, bigger population is choosing to undergo bariatric surgery. Due to increased popularity of the surgery, the western culture is now perceiving the option as practical and long-term solution to obesity.

Weight-loss Industry

The reclassification of obesity benefited weight-loss industry. Weight-loss industry and industry-sponsored groups such as the American Obesity Association had missions of expanding the government’s role in funding obesity research, to increase coverage for weight-loss treatments, and to put diet drugs and weight-loss surgery on the same level as any other necessary medical procedure. Obesity being approached from medical perspective helped merge the weight-loss industry's interests with that of public health medical industry.

Cost

Based on statistical study, the estimate for direct medical cost for obesity (including bariatric surgery and weight loss medication, but not including medical visits), the estimated cost for obesity treatment after medicalization was 1341.1 million dollars in the United States.

References

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WHO http://www.who.int/mediacentre/factsheets/fs311/en/

Picot, J., Jones, J., Colquitt, J.L., Gospodarevskaya, E., Loveman, E., Baxter, L., et al. (2009).The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess (13)1-190, 215-357, iii-iv.

Sadler, J.Z. (2014). Risk Factor Medicalization, Hubris, and the Obesity Disease. Narrative Inquiry in Bioethics 4(2) 143-46.

Sales, M.S. (2013). AMA declares obesity a disease: Should we like this decision? American Society for Nutrition. https://www.nutrition.org/asn-blog/2013/08/ama-declares-obesity-a-disease-two-viewpoints/

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Centers for Medicare and Medicaid Services (2013.) CMS Manual System. CAG-00250R3:Proposed Decision Memo for Bariatric surgery for the treatment of morbid obesity-Facility Certification Requirement. [CMS Web site]. 27 June. Available at: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=57&ncdver=4&bc=AgAAgA AAAAAAAA%3d%3d&

Moynihan, R., & Cassels, A. (2005). Selling sickness: How the world’s biggest pharmaceutical companies are turning us all into patients. New York: Nation Books.

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