A recent JAMA article (2014;174:615) that critiqued the FDA's decision to approve Belviq and Qsymia for weight loss included the following statement: "Although treatment options are limited, obesity is not an emergency - it is not even a disease, but rather a risk factor for disease." This statement has sparked a vigorous debate.

The statement detracts from what is an otherwise informed discussion of the risks of drug therapy. It is clear the authors have a firm understanding of obesity. They discuss obesity's prevalence and its contribution to heart disease, stroke, hypertension, diabetes, and the deaths of hundreds of thousands of Americans each year-and the billions of dollars it contributes to health care costs. Based on those data, it is difficult to understand how obesity could be categorized as anything but a public health emergency. 

The long-standing debate about whether obesity is a disease or a risk factor for disease has always seemed irrelevant to me. There are lots of health issues like birth defects or disabilities that most people would not label diseases, and yet would have no objection to their treatment. I think that how one categorizes obesity may have more to do with whether they think it is a consequence of personal choices or the result of underlying genetic, metabolic, or psychological determinants. Even those who would argue that obesity is a consequence of personal choices would likely agree that the consequences of obesity are diseases, like cardiovascular disease, type 2 diabetes or several types of cancer. So what is this debate really about? Does it reflect an attitude that only the diseases associated with obesity should be treated? Treating the consequences of obesity rather than preventing or mitigating the consequences through weight reduction means that the costs of obesity will continue. We know that to continue paying these costs is not sustainable. Furthermore, in my view, the stance that we should not treat obesity effectively with all the tools at our disposal reflects a bias against those with this disease.

The authors are concerned about the adverse effects of these drugs. We are too. That is why we argued in the Obesity Drug Outcomes Measures paper developed by the GW obesity research team that the risks of treatment, like drug therapy, needed to be balanced against the risks of continued obesity and its complications. Five percent weight loss reduces obesity-associated comorbidities and can be accomplished with the drugs the authors of the JAMA paper dismissed. When providers need more tools to treat obesity, it is hard to understand why effective FDA approved interventions would be so sharply criticized.

As a coalition, we've worked over the last seven years to help change the conversation and create an environment of understanding about what obesity is and what it isn't. I hope that we can continue to work together to foster more productive conversations surrounding prevention and treatment options for obesity, and I look forward to hearing your feedback at obesity@gwu.edu. 

Best wishes, 

 

Research-Based Evidence Often Lacking When Minnesota Lawmakers Decide Childhood Obesity Policies, U Study Finds 

August 18, 2014

MinnPost.com

By Susan Perry

A study published in the American Journal of Public Health found that less than half of all formal written materials, oral testimony, and discussions used by the Minnesota State Legislature to pass laws related to childhood obesity cited research based evidence. Study researchers noted that while most of the evidence involved statistics about the prevalence of obesity, none of the materials offered any information, whether evidence-based or not, that described racial, ethnic, or socioeconomic disparities.

August 15, 2014

The Wall Street Journal

By Jo Craven McGinty

The article highlights that while today's primary measure of obesity - the body mass index (BMI) - has been attacked as outdated and flawed, groups such as the World Health Organization and the CDC continue to use the BMI measure. In a paper published in the Journal of Chronic Diseases, study researchers tested the validity of several body-weight indexes and found that BMI was preferable to the alternatives. Researchers noted that despite its limitations, the BMI is simple, cheap, and accurate for assessing overall trends.

Croydon Law Firm Study Suggests Obese People Have Fat Chance of Getting a Job 

August 13, 2014

Croydon Advertiser

A law firm polled human relations and recruitment professionals across the country and over half admitted that they find obesity to be an undesirable trait in the hiring process. In addition, 56 percent of those polled said they thought obesity was a "valuable marker" when determining candidate character and predicted performance.

One Step to Combat Obesity: Make Stairs More Attractive 

August 4, 2014

NPR

By Flora Lichtman

Put Down the Cupcake: New Ban Hits School Bake Sales 

August 1, 2014

The Wall Street Journal

By Stephanie Armour

A federal law stemming from the 2010 Healthy, Hunger-Free Kids Act championed by First Lady Michelle Obama will require school bake sales to adhere to nutrition requirements in certain states beginning in the fall. The law aims to lower childhood obesity rates and will require the U.S. Department of Agriculture to set standards for all food and beverages sold during the school day, including vending machines, snack carts, and daytime fundraisers.

Body Mass Index and Death by Stroke: No Obesity Paradox 

August 2014

JAMA Neurology

A study published in JAMA Neurology found that there was no evidence of an obesity paradox in patients with stroke.  This conflicts with other recent studies that have identified an "obesity paradox," when people with obesity and other chronic diseases have a better chance of survival than normal weight individuals. Stroke occurred at a significantly younger age in patients with higher BMI, hence, patients with obesity that have are susceptible to stroke should continue to aim for a healthier weight.