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SA should follow US example by declaring obesity a disease

10 April 2014 Dr Dominique Stott, PPS
Dr Dominique Stott, Executive: Medical Standards and Services at PPS.

Dr Dominique Stott, Executive: Medical Standards and Services at PPS.

The United States of America (USA) recently made the bold move to declare war on obesity by classifying it as a disease. Locally, data from the Medical Research Council (MRC) has found that two-thirds of women and one-third of men are considered overweight or obese in South Africa, resulting in a steady rise in non-communicable diseases that add to the already over-burdened healthcare system.

According to Dr Dominique Stott, Executive: Medical Standards and Services at PPS, the development by the American Medical Association (AMA) could mean a complete mind shift in the way obesity is treated in South Africa. "Currently, a disease implies that there is a malfunction in a body part or body function. By declaring obesity a disease, health control and monitoring authorities are effectively ensuring that obesity itself is treated as an illness, and not just the resulting long term complications.”
 
The move to declare obesity a disease by the AMA now effectively defines 78 million American adults and 12 million children as having a medical condition requiring treatment.
 
Dr Stott says that the added advantage of a similar development in South Africa would mean that medical practitioners and government clinics would be able to receive adequate funding to help combat and manage this ever growing health problem.
 
She says that this would assist in the development of improved treatment outcomes for the condition, ultimately reducing any long term complications. "The resulting effect could also mean a reduction in both life and medical aid insurance premiums. Life insurance companies give better terms to applicants of normal weight, and load premiums or even decline cover for obese individuals due to the long term predictability of higher mortality and morbidity.”
 
Dr Stott further added that medical schemes would be able to reduce member premiums due to lower incidences of expensive long term complications. "This could mean that medical schemes would routinely consider covering medical treatments for obesity to prevent these long term complications. Bariatric surgery and similar procedures, which is increasing worldwide as a treatment for obesity, would assist in the long term success of weight reduction.”
 
Currently, a person has to have reached a specific weight or have tried weight loss programmes before being even being considered for bariatric surgery. Weight loss programmes are notorious for their short term efficacy in achieving weight loss, but not maintaining it. By stipulating a specific target weight before being considered for surgery implies a patient must eat themselves up to that weight.
 
According to the World Health Organisation (WHO), obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres). A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight. Once considered a problem only in high income countries, overweight and obese people are now dramatically on the rise in low- and middle-income countries, particularly in urban settings.
 
The long term effects of obesity range from strokes, blindness and kidney disease, hypertension and diabetes, heart disease, cancers and arthritis, says Dr Stott. "These are all managed as medical conditions when they occur, but no preventative measures and treatment protocols are in place for obesity specifically targeting it as a disease.”
 
Obesity is a highly complex disorder with a number of factors that can affect the development of the condition, points out Dr Stott. "Hormonal, behavioural (lack of exercise, sedentary occupation, overeating), genetics and family history, education (not knowing which foods lead to obesity), and economic (not being able to afford healthier food options) all play a role. The existence of an obesity genetic profile adds weight to the argument that obesity should be seen as a disease and not a disorder of overindulgence.”
 
She adds that the ‘obesity genes’ have received a large amount of attention from the medical research community. "Variations in how these genes control an individual’s ability to capture, store and use energy is part of the reason why some people are able to eat substantially more than others without gaining weight. Research into identifying and moderating these genes will hopefully improve obesity prevention measures available.”
 
"By far the most common cause of obesity is a genetic tendency, inherited from parents, towards obesity as well as behaviour patterns of overeating and sedentary lifestyle choices. By declaring obesity a disease, more focus would be placed on prevention and treatment, ultimately benefiting the overall health of the country’s population,” concludes Dr Stott.

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