My fat problem-and yours

This month the American Medical Association declared that obesity is a disease. The vote was controversial.

Labelling obesity as a disease fits right in with the medicalization of every fitful tic and annoyance in American life. Bummed out? Can’t sleep? Sexually tapped out? There’s a pill for that. Just recently psychiatrists-they’re doctors, too, they’d have you remember-declared caffeine withdrawal to be a mental illness, as one of a number of “caffeine-related disorders.”

What is this really about? Money. With the AMA hoping to “expand coverage for obesity-related services,” newly minted diet pills acquire a sudden legitimacy.

Right now Medicare, the nation’s largest insurer, doesn’t cover diet pills. That could change. A bipartisan group of congressmen wants Medicare to start shelling out for fat pills. Who’s going to pay for that, you ask? Do you have a mirror handy?

The AMA’s decision is also a potential windfall for the dubious field of bariatric surgery, aka stomach stapling, which is experiencing explosive growth. There are now over 200,000 bariatric surgeries a year, a 16-fold increase in 15 years. Stomach stapling is rapidly becoming a sub-category of plastic surgery for celebrities such as New Jersey Governor Chris Christie and weatherman Al Roker who want to slim down, but find dieting to be awfully hard work.

Medicare and some private insurers already cover bariatric surgery for people who are pretty darned fat-Body Mass Index of 35 and above-and also have an obesity-related disease. Now there will be pressure to cover stomach stapling for men and women with a BMI of 30 or more, i.e., people like me.

You could practically hear the corks popping over at the American Society of Metabolic and Bariatric Surgery. In a statement, the Society’s treasurer, Dr. John Morton, called the AMA decision a “tipping point,” adding that “now coverage policy must catch up to that consensus.” Who’s going to pay for that, you ask? Don’t put that mirror away!

Yes, losing weight is hard, and how very American to outsource that struggle to Big Pharma and the stomach staplers. AMA board member Dr. Patrice Harris suggests that I may have a simplistic view of obesity. “It’s not just a behavorial issue, it’s much more complex than that,” she says. “It’s multifactorial in its etiology, with behavioral, environmental, and genetic causes. Yes, personal responsibility is a piece of the puzzle, but we can’t say we won’t treat people just because they can’t push back fromthe table.”

I’m going to outsource my conclusion to Dr. Elliot Berry, a nutrition expert at Hebrew University in Jerusalem. “The AMA statement is dangerous, counterproductive, not useful or constructive,” Berry told the Jerusalem Post.

“There is no magic bullet-no medicine-for obesity,” he added. “The way out of obesity is to eat less and better and to move your body.”