[Author Affiliation]David L. Katz. Editor-in-Chief, Childhood Obesity; Director, Yale University Prevention Research Center, Griffin Hospital, Derby, CT.Address correspondence to: David L. Katz, MD, MPH, FACPM, FACP, Editor-in-Chief, Childhood Obesity, Director, Yale University Prevention Research Center, Griffin Hospital, 2nd Floor, 130 Division Street, Derby, CT 06418, E-mail: david.katz@yale.eduWere childhood obesity not among the most salient of modern public health concerns,1 this journal clearly would not exist. The indications we have that obesity rates may be leveling off in children2 as well as adults3 merely translate the status of obesity from epidemic to hyperendemic, for the prevalence remains very high.4 Combine this with evidence that rates of severe obesity continue to rise steeply in children5 and adults alike, as well as recent evidence that the mortality toll of obesity may be greater than previously recognized and increasing for successive birth cohorts,6 and there is no debating the respect this scourge demands now and for the foreseeable future.Predictably, then, obesity is much respected, by journals such as this, wholly devoted to its causes, consequences, and potential cures, by the signature efforts of the First Lady of the United States,7 and in innumerable other ways. As of 2013, that list of homages includes the declaration by the American Medical Association (AMA) that obesity is a disease.8Ostensibly, the AMA's position is indeed about respecting obesity and conferring on it a status of medical legitimacy. This is important, and timely, for several reasons. First, the primary constituency of the AMA--physicians--has historically neglected effective obesity management in any of several ways. Either we have ignored it entirely,9 expressed bias against it,10 or invoked personal responsibility and wagged an admonishing finger. I have long joked, ruefully, that the wagging finger approach to obesity tends to make patients feel about an inch tall and that by reducing our patients' height while doing nothing constructive about their weight, we physicians have caused BMI to go up. Talk about counterproductive.The AMA, apparently, is on a mission to redress just such transgressions by establishing obesity as a clinical issue that physicians and, by extension, other professionals cannot ignore and must address with the same basic level of compassionate competency expected for other diseases. The matter is timely, given recent changes in reimbursement policies that make weight management counseling a billable enterprise.11Although the AMA's declaration was made with some fanfare and reverberated through popular culture with mostly favorable reaction, I see cause for grave concern. Making obesity medically legitimate involves two components: making it legitimate and making it medical. The former, to the extent it needs to be done, is, if anything, overdue. The latter, however, is worrisome. If we simply connect the points in the paragraphs above, we arrive ineluctably at this: Obesity is hyperendemic in our children, and obesity is a disease. Therefore, legions of our children are, by AMA fiat, diseased. Do we truly believe this?Obesity, in children as in adults, is on the causal pathway to an impressive array of adverse health outcomes.12 However, it is well established that some people can be heavy without being sick. Such a child, overfed, underexercised, and obese, but otherwise vital, is now, apparently, cataloged as sick. This concerns me.What concerns me far more are the therapeutic implications of obesity as disease. If anything, our culture is prone to overmedicalization,13 for reasons we might readily suppose. Even the currently massive societal preoccupation with so-called healthcare reform14 is principally about access to care for the treatment of illness and much less about building health at its origins in daily living. …
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Jan 1, 2016
Kallol Set 
Open Access
