CHICAGO – Is obesity a chronic disease on par with diabetes and rheumatoid arthritis that warrants separate coding and reimbursement? That was one question the American Medical Association House of Delegates grappled with at its annual meeting.
The AMA’s policy-making body approached obesity from several different angles, from physical education to soda taxes to physician counseling.
The Illinois delegation put forward a resolution urging the AMA to "recognize obesity and overweight as a chronic medical condition (de facto disease state) and urgent public health problem." As such, the resolution said, the AMA should also recommend that insurers and government agencies pay appropriately for obesity intervention services and develop an ICD code for managing and treating obese and overweight patients.
In committee debates, most delegates agreed that physicians should be paid for managing obesity, but there was a difference of opinion as to whether it should be classified as a disease. Current AMA policy labels obesity a major health problem; the group previously has called for better coding and payment for obesity-related treatment.
When the measure came to the floor for a vote, the delegates voted to study further whether obesity should be classified as a disease.
The House also agreed to a report written by the AMA Council on Science and Public Health that found that taxes on sugar-sweetened beverages are a potentially effective way to reduce consumption. This would be a new policy for the AMA. But the report found that the beverages are a contributing factor to the obesity epidemic. The report also said that the tax revenue should be used to fund programs to prevent obesity.
The new policy was not without its detractors. Dr. Daniel Koretz, an alternate from New York, wanted to amend the report so that the word tax was removed.
"I would hate to see the headline that the AMA is in favor of increased taxes," he said. He also said he felt that taxes should not be used as a method to induce people to act in their best interests. "This is a question of individuals’ freedom to make their own choices about health free of government coercion," he said.
Dr. Russell Kridel, a member of the Council on Science and Public Health, noted that the report merely explored whether a tax would reduce consumption.
"Our council looked at the science. We don’t advocate yes or no on taxes," said Dr. Kridel, a Houston plastic surgeon.
In the end, the House agreed to the Council report as written.
The House also delved into whether enough was being done in the schools to combat obesity. It approved a resolution that would back legislation or new policies to have "meaningful yearly instruction in nutrition, including instruction in the causes, consequences, and prevention of obesity, in grades 1 through 12 in public schools."
The delegates also considered a measure urging the AMA to create a checklist or guidelines for patients who wanted to resume physical activity after an illness or surgery. Delegates agreed that physical activity was important for quality of life and to combat obesity, but some were concerned that physicians might face liability – or be challenged outside their scope of knowledge – when signing off on a return to physical activity.
The House referred the idea for further study.