The American Medical Association recently declared obesity a disease that requires a wide range of treatments.
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The decision generated a lot of controversy, but on one point everyone agrees: With more than 35 percent of U.S. adults and 17 percent of children and teens struggling with weight, the burgeoning statistics have troubling implications for America’s health care system.
For more insight, we turned to Dr. John Alverdy, a national authority on the surgical treatment of obesity at University of Chicago Medicine. He performs a variety of complex, minimally invasive and open gastrointestinal surgical procedures and has 25 years of experience in the field. Here’s an edited transcript of what he had to say:
Q: What does the AMA’s recent decision mean?
A: There’s no question that we are at a point in human progress where the U.S. and many other countries are discovering health problems that elude our understanding and thus our ability to treat and prevent them. I can imagine that there is significant pressure for large regulatory bodies within the medical community to address these issues and provide some answers. Regarding obesity, it is simply not enough for a medical doctor to prescribe, “Eat less and get off the couch.”
Governing bodies such as the AMA are compelled to provide the public more complete answers and real guidance. Much is at risk since the costs of obesity are rising at a pace that is, frankly, frightening. Thus the question is: Is this a disease that can be defined because it has a fundamental biological basis, or is it simply a matter of volition and personal responsibility? In certain cases, and perhaps in the context of a health epidemic, the AMA has declared that obesity is a disease.
Q: Why is obesity such a challenge for us to solve?
A: Like other problems that have contemporaneously developed with human progress, cases of extreme obesity may result from the body’s inability to regulate food intake and energy output so that weight is maintained within a normal range. While the general public bias is that the obese are simply eating too much relative to the amount they are burning off, and that this is always under voluntary control, the evidence to support this assertion is weak at best.
Q: Can you explain more about some of the factors that might explain why being overweight is not a matter of too much pizza and not enough gym time?
A: What precisely drives a human to overeat to the ultimate peril of their own health is complicated. Researchers have been trying for decades to pin this problem on a human gene, with some success, but not enough to explain each individual case of obesity or the epidemic.
Advances in genetics, ecology and evolution have taught us that the environment can have a major impact on the expression pattern of genes, and these genes can assemble into functional biologic networks that can express complex behaviors.
And it is not just our own inherited genes that can be influenced by the environment, but also the microbial (bacteria, viruses) genes in our intestine that respond to processed foods, antibiotics, stress.
Q: Will the AMA’s decision empower doctors to bring up this touchy subject with patients?
A: It could help. Perhaps in the same way we have learned to separate reactive depression (brought on by) a particularly stressful event from depression that has a strong genetic and chemical basis, doctors can approach obesity using knowledge generated by functional genomics and personalized medicine. The AMA’s position is a brave one, and it sends the message that we as physicians do not want to be dismissive of a problem that may have a fundamental biological explanation, especially one that has a huge impact on our nation’s well-being.
Q: You are an expert in gastrointestinal surgery. Is this the answer to the nation’s obesity epidemic?
A: Surgery has an important place in the obesity problem, but it is not a panacea. In properly identified patients it is safe, cost effective and life saving. But the real advance in medicine will come when this surgery becomes obsolete because we have treated the problem as a disease, worked hard to understand its biological basis and developed treatment and prevention measures that really work to achieve sustained and permanent weight loss.
Q: What about TV shows like “The Biggest Loser” that demonstrate it can be done if you are just willing to work hard enough?
A: The point of “The Biggest Loser” is a mixed one. It sends the message that it is all up to you; that you can do it on willpower alone. It supports the public bias that weight gain and weight loss is purely volitional. On the other hand it reinforces that if you cannot changes your genes, you might as well try to change your behavior.
Personally, I feel sad watching people who have struggled their whole lives with their weight being told by others and feeling themselves that it is their fault, when there may be some strong biological drive to overeat. This does not excuse patients from spiraling out of control. … Most thin people take credit for being thin; most overweight people take the blame.
The truth remains to be discovered, but my hunch, and the preponderance of evidence to date, suggests that we are missing some critical environmental gene interactions that explain the profound shift in weight we are seeing worldwide.
Q: What would you like to see happen in the war on weight?
A: My greatest joy would be that we apply science and systems biology to this problem and come up with a real understanding that leads to effective treatments and prevention strategies that eliminate the need for surgery, blame, embarrassment and the suffering that comes with obesity.
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