How the AMA got it Wrong

September 27th, 2009 by LHill Leave a reply »

June 18, 2009 :: By Morgan Downey

The Associated Press reported on June 17, 2009 that the American Medical Association has adopted a new policy to oppose defining obesity as a disability. According to the report, “Doctors fear using that definition makes them vulnerable under disability laws to lawsuits from obese patients who don’t want their doctors to discuss their weight.”

What’s wrong with this? Well, nearly everything.

First, doctors do not discuss weight with their patients now. A new study confirms previous papers on physician visits found that BMI and obesity status could not be computed in half of office visits because of missing height or weight data. 70% of persons with obesity did not receive a diagnosis of obesity from the physician and 63% of those with obesity received no counseling for diet, exercise or weight reduction. Rates were even low for obesity patients with related co morbid conditions.1

Second, disability statutes don’t just list diseases and call them disabilities. Disability status is decided on a case by case basis depending on a combination of the medical factors and the applicant’s ability to carry on their normal work activities. At the federal level, the Social Security Administration has extensive procedures which basically require morbid or severe obesity and cardiovascular, respiratory or musculoskeletal problems. 2 Few would assert that obesity as a Body Mass Index level of 30 in itself is a disability. But higher BMI levels, with accompanying functional limitations, certainly do or should qualify.

Third, when I look at a statement like the AMA’s I find a quick test helpful: When I see “obesity”, substitute another disease such as “cancer,” “diabetes,” “arthritis,” or “sexually transmitted diseases” and see how it reads. It is impossible to imagine the AMA, which after all submitted an amicus brief to the Supreme Court in a 1998 to uphold the Americans with Disabilities Act against a dentist who would not treat a patient with HIV-positive patient3, as making such a statement about any other disease or condition.

All the AMA policy will do is to likely turn more physicians away from counseling patients with obesity, adding to the stigmatizing views of persons with obesity not only as ‘lacking self control’ but, now, ‘litigious’. It will support administrative judges deciding cases of who qualifies for disability in making negative decisions about an obese persons disability, cutting them off from perhaps their last economic support.

Too bad. On the gravest health issue of our time the AMA is AWOL. Whatever happended to ‘first, do no harm?’

1. Ma J et al Adult Obesity and office-based quality of care in the United States Obesity 2009, 17; 1077-1085

2. Social Security Administration policy on obesity as a disability http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2002-01-di-01.html

3. http://www.ama-assn.org/ama/no-index/physician-resources/18680.shtml