On Tuesday, the American Medical Association declared obesity a disease. My mouth liked this fact, but my stomach is still making up its mind. Does this make it easier to get treatment, or does this just further stigmatize people battling the condition?
As the L. A. Times points out, “The AMA’s decision essentially makes diagnosis and treatment of obesity a physician’s professional obligation. As such, it should encourage primary care physicians to get over their discomfort about raising weight concerns with obese patients. Studies have found that more than half of obese patients have never been told by a medical professional they need to lose weight — a result not only of some doctors’ reluctance to offend but of their unwillingness to open a lengthy consultation for which they might not be reimbursed.”
One thing that obesity does not have in common with other life-threatening conditions is that it is really, really awkward to mention it to people, even if those people are your patients.
“Hey,” no one ever has trouble saying, “your foot is on fire. You should probably extinguish that if you want to live.” It’s not considered rude.
“Dude, you appear to have a giant chest wound, should I call someone?”
“I feel really weird mentioning this and it might not be your fault at all and it’s probably a genetic thing, but it really looks like you’re drowning.”
Never does your office decide that “This Summer, We’re All Going To Work Really Hard To Not Have Bubonic Plague.”
You can’t call into work obese. You can try, but it seldom works. “We can tell you’re not obese,” the people on the other end of the line say. “We saw you yesterday. Also you just posted a picture of yourself on Facebook jogging around with kale.”
Obesity resembles a disease in the sense that it shortens your life, but unlike, say, mumps, it’s deeply entangled with your self-image. Your boyfriend never telephones hosts to say, “Hey is there any way you could not serve cowpox germs at your wedding reception, because Carol is working really hard on this?” If your mother points out that you have an abnormally shaped mole on your shoulder, you don’t run screaming from the room crying, “there go 25 years of hard-earned self esteem!”
It’s similar, but different.
That, of course, is why the AMA decided this in the first place — to force that awkward conversation.
It’s the elephant in the room. But like an elephant, once you notice it’s in the room, it takes some effort to get it to leave. You don’t just say, “Shoo, elephant,” and expect it to wander merrily away. If that were the case, it would not be in the room, casting an elephant-shaped pall over things, to begin with. And equally that means that it’s hard not to notice it. “There’s an elephant here,” your doctor says.
“My God, an ELEPHANT? You’re KIDDING!” And by the same token, some might be rolling their eyes at the idea that being told by a medical professional to lose weight was the missing piece of the equation. (“My God! It wouldn’t have occurred to me that this was called for! I thought — well, I don’t know what I thought.”)
Is this going to change how fast food is advertised? If obesity is a disease, then surely things that can contribute to it, if you’re not careful, need to be packaged differently. After all, you never see other ads for disease agents. “You know what makes a house a home? Deer ticks.” “These salad bar eggs are a little iffy, but we urge you to sample them. And hey, no one in this commercial has salmonella!” So why flog the Big Mac and the Frostee? Viewed from the disease perspective, surely Paula Deen is engaged in the equivalent of germ warfare.
Then again, alcoholism and liver disease are real, and that hasn’t stopped those advertisers.
But it’s time we did something. More than one-third of adults and 17 percent of children are struggling with obesity. Is naming it a disease the way to go? We’ll soon find out. And if it discourages Paula Deen, it might find some support.