The wrong prescription for obesity

With one decision last week, about 20 percent of Coloradans were presumed dis- eased.

This was the handiwork of the American Medical Association, which voted to designate obesity a disease.

The good doctors have the best intentions. They want people who are dangerously fat to drop some weight.

But the simple truth is that the answer to obesity for a lot of people isn’t terribly complicated. Eat less and exercise more.

Not judging here, but except for the relatively small number of people with specific underlying medical conditions, that’s the deal. It’s basic science.

Of course, the realities of the modern lives we’ve constructed for ourselves make it more problematic than that.

Seductive video games keep kids tethered to screens instead of playing in the yard. And after a long day at work, it’s easier to put some relatively cheap carb- and -fat-laden frozen thing in the microwave instead of cooking a real meal.

Food is relatively cheap, plentiful and marketed to make us want seconds, even thirds. Dessert? You bet. On top of that, neighborhoods have sidewalks that go nowhere and lousy bike paths that don’t provide safe passage to school, work and stores.

But is any of that a disease? And does the AMA designation change it?

The answer is no. What I suspect it will do, fear it will do, is to more fully engage Big Pharma— and that will spell expense and trouble.

The most likely outcome of obesity being declared a disease is going to be a growing reliance on new weightloss drugs and procedures at great expense and questionable efficacy.

As always, this will be about money and using the designation as leverage to get private and public health care plans to underwrite a broader range of drugs and surgeries.

Just this year, two new prescription obesity drugs have been introduced: Qsymia from Vivus, and Belviq from Arena Pharmaceuticals and Eisai.

A spin through the listed potential side effects is pretty off-putting. For Qsymia, they include suicidal thoughts and the potential that a pregnant woman taking the drug might have a baby with birth defects.

Shouldn’t we be focusing first on having safe, walkable neighborhoods and bringing daily gym classes back to schools that have dropped them?

I concede that even with those sorts of changes, at some point individuals have to take charge of their own health destinies. It can be tremendously diffi- cult, and temptation looms large. Add to the individual challenge the sheer scope of obesity. It’s daunting.

Nearly 36 percent of adults were obese in 2011, according to the Centers for Disease Control and Prevention. The medical costs of treating obesity were $147 billion in 2008.

While Colorado’s rate is the lowest in the nation, it’s still a considerable 20.7 percent.

The biggest health risks of obesity are heart disease, type 2 diabetes, stroke and certain cancers.

Obesity is dangerous, and I can’t imagine you don’t already know that. Anyone who has been paying even a little attention knows it. Yet, we as a society carry on undeterred.

These must be frustrating days for those who care about public health. Still, I’m not convinced calling obesity a disease is the answer.

One of the gateway problems with the AMA vote is that there is significant disagreement in the medical community over what even consti- tutes a disease.

The good folks at the AMA very well may have been shooting for an end— increased focus on an issue they rightfully see as devastating to the health of many Americans.

But how do you call obesity a disease when a significant number of people considered to be obese actually turn out to be pretty healthy?

It’s contradictory, confusing and highlights the complexities of the debate.

So where does all of this leave us? Unfortunately, right back where we started.

Branding obesity a disease might unleash a few more expensive tools to fight the nation’s growing waistline, but at the end of the day it’s a battle won when common sense and self-discipline prevail.