Last week’s American Medical Association (AMA) statement recognizing obesity as “a disease” aroused controversy and concern among some top nutrition experts but apathy in the Health Ministry on Sunday.
The AMA announcement last week resulted in turning serious overweight into a disease that requires giving medical care to some 30 percent of American adults (or nearly 80 million people) and 17% of children (12 million).
Although some senior AMA doctors thought the change would stigmatize fat people of all ages, in addition to the existing stigma they suffer, others thought it improve their medical treatment and voted in favor of the change.
Asked to comment, Health Ministry associate director-general Dr. Boaz Lev told The Jerusalem Post he thought “it doesn’t matter so much who is responsible for treating obesity. The healthcare system there is different than in Israel. The change could force the health maintenance organizations to pay for interventions. Here we have a universal national health insurance system, so it is not so relevant to us,” Lev said, “even though we have to fight obesity better.”
But Prof. Elliiot Berry, a veteran nutrition and metabolism expert at the Hebrew University and former dean of the Braun School of Public Health and Community Medicine said that calling obesity a “disease” takes responsibility away from the individual and puts it on the shoulders of the healthcare system. “The AMA statement is dangerous, counterproductive, not useful or constructive, and it stigmatizes the obese. It is not a medical disease but a societal problem.”
Berry said: “We have to get people and society to take their responsibility for obesity. There is no magic bullet -- no medicine -- for obesity. All the drugs originally put on the market have been taken off the market because of side effects. There is bariatric surgery [shortening the stomach so the obese have less room to digest food], but there are risks and complications. Education is needed -- and it should begin during their mother’s pregnancy, because things eaten then can lead to obesity in the baby. People have to take more responsibility for their health and lifestyles, and they have to be educated in schools as children.”
Berry noted that only a minuscule amount of obesity results from physiological and metabolic problems; the vast majority comes from a lack of education that leads to little or no exercise and poor diet. Calling obesity a disease, he added, “just stigmatizes them more. Obesity is a normal response to an abnormal environment.”
The HU nutritional expert said that as a result of the AMA decision, the onus is put on the American health maintenance organizations that will have to pay for interventions. They’ll have to pay for personal trainers. Do you need somebody to tell you to move? The way out of obesity is to eat less and better and to move your body,” Berry said. “There is no shortage of recommendations. The government has to work with the food industry to produce better food, with restaurants to give smaller portions. People have been talking of the obesity pandemic for 13 years, but nothing much is being done, there or here.”
Dorit Adler, the chief clinical dietitian of the Hadassah University Medical Center in Jerusalem’s Ein Kerem, agreed that obesity is a “social disease. It is crucial that primary physicians relate to obesity -- and the sooner the better. However, obesity is first and foremost a result of the obesogenic environment that we are surrounded with. Treating obesity should focus on prevention in each window of opportunity and has to be a long-term intervention. It is crucial to relate to the quality of the food and not only the calories, since the nutrition quality of the food has major effects on disease development or prevention,” Adler concluded.
She called for “collaborative efforts to lower the prices of the healthy basic basket of food, regulation of the food environment in public facilities and major involvement of dietitians in food policies and long-term programs.”