美国医学会决议：肥胖是病

芝加哥——美国医学会(AMA)的主要政策制订机构明确表示，肥胖不仅应被视为疾病危险因素，而且还是一种真实的疾病状态，需将肥胖预防和治疗的所有方面都纳入保险范围。

在6月18日的AMA代表议会年会上，与会代表以276票对181票通过了数家专业机构提出的决议，该决议请求AMA“将肥胖认定为疾病状态，对其多个病理生理方面需采取一系列干预以促进肥胖治疗和预防。”

这一投票结果将确保该决议成为AMA正式政策。发起这项决议的机构包括美国临床内分泌医师协会(AACE)、美国心脏病学会(ACC)、内分泌学会(ES)、美国生殖医学会(ASRM)、心血管造影和介入学会(SCAI)、美国泌尿外科学会(AUA)和美国外科医师协会(ACS)。

从提交给代表的委员会报告来看，在议会表决前几天，有关该决议的初步表意结果还不统一。委员会建议采纳决议，但AMA的科学与公共卫生理事会在报告中表达了反对该决议的立场。


Jeffrey Cain博士

理事会成员Robert Gilchick博士对代表议会陈词：“我们认为尚无充分证据支持将肥胖认定为独立疾病状态。”Gilchick博士指出，虽然肥胖是危险因素，但不表明其本身是疾病。一些因体重指数偏高而被认为肥胖的人可能实际上是健康的，如果他们不一定患病，为什么要将其判断为病人呢？如果视肥胖为疾病，将可能带来药物干预凌驾于其他潜在干预措施(如调整生活方式、提倡改善营养和锻炼环境等)之上的风险。


Jonathan Leffert博士

AACE代表Jonathan D. Leffert博士表示，应通过该决议，因为肥胖像其他疾病一样由多种因素引起，并且可通过行为、内科和外科治疗予以处理。美国家庭医师学会主席Jeffrey Cain博士在投票后接受采访时表示，将肥胖称为疾病，医生将可获取更多资源用来帮助患者。希望AMA的行动号召将促使保险公司尽快扩大保险范围。

AACE在投票后立即发表了一份赞誉AMA代表行动的声明。AACE主席Jeffrey Mechanick在声明中指出：“AMA代表议会的行动表明，在直面肥胖和帮助患者获取其所需的适当干预、治疗方面迈出了重要一步。”

AACE指出，超重或肥胖可增加罹患乳腺癌、冠心病、2型糖尿病、胆囊疾病、骨关节炎、结肠癌、高血压和卒中的风险，并且超重或肥胖给美国造成的医疗费用负担高达2,100亿美元/年。

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By: ALICIA AULT, Cardiology News Digital Network

CHICAGO – The American Medical Association’s chief policy-making body has decided that obesity should be considered not just a disease risk factor, but an actual disease state that warrants insurance coverage for all aspects of prevention and treatment.

At the annual meeting of the AMA House of Delegates, it voted 276-181 on June 18 to support a resolution that was brought forward by several specialty organizations that called on the AMA to "recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention."
 
The vote ensures that the resolution becomes official AMA policy.

The resolution was sponsored by the American Association of Clinical Endocrinologists, the American College of Cardiology, the Endocrine Society, the American Society for Reproductive Medicine, the Society for Cardiovascular Angiography and Interventions, the American Urological Association, and the American College of Surgeons.

Preliminary testimony on the resolution a few days before the floor vote was "mixed," according to the committee report presented to the delegates. The committee recommended adopting the resolution, but the AMA’s Council on Science and Public Health had urged against it in its report to the delegates.

Speaking to the House of Delegates, Dr. Robert Gilchick, a member of the council, said, "We did not think the evidence rose to the level where obesity could be recognized as its own distinct medical disease state."

He noted that, although obesity is a risk factor, it may not in and of itself indicate illness. Some people who are considered obese by virtue of their body mass index might actually be healthy and fit, said Dr. Gilchick. "Why should a third of Americans be diagnosed with having a disease if they aren’t necessarily sick?" he asked.

Calling it a disease risks promoting medical interventions over other potential solutions, like lifestyle changes and advocating policies to improve nutrition and the exercise environment, Dr. Gilchick added.
 
Dr. Jonathan D. Leffert, a delegate from the AACE, said that the resolution should pass because obesity, like other diseases, has multifactorial causes and can be addressed through behavioral, medical, and surgical treatments. "The scientific evidence is overwhelming," he said.

"We know that it is a disease," Dr. Jeffrey Cain, president of the American Academy of Family Physicians, said in an interview after the vote. By calling obesity a disease, physicians will get more resources to help their patients. Hopefully, the AMA’s call to action will move insurers to improve coverage sooner rather than later, he said.

Immediately after the vote, the AACE issued a statement lauding the AMA delegates’ action. "The action by the AMA House of Delegates represents a major step in addressing obesity head-on and helping patients to get appropriate interventions and treatment they need," AACE President Jeffrey Mechanick said in the statement.

Being overweight or obese increases the risk of breast cancer, coronary heart disease, type 2 diabetes, gallbladder disease, osteoarthritis, colon cancer, hypertension, and stroke and contributes as much as $210 billion a year to the nation’s health costs, according to the AACE.