Struggling With Obesity

What is excessive weight? In medical terminology, the word excessive weight has come to be used as a noun (as in,”obesity and excessive weight”) as much as an adjective. Such usage has the effect of making clear that excessive weight and obesity are part of a disease process, more on that below. The medical definition for excessive weight is based on body mass index (BMI). BMI is measured in units of kg/m2, which means that it requires height and weight for the calculation. BMI calculators are readily available online, such as the one offered by the National Heart, Lung and Blood Institute ( NHLBI ). Excessive weight is defined as a BMI of 25.0 to 29.9 kg/m2. A normal BMI is defined as falling between 18.5 and 24.9. Having a BMI lower than 18.5 classifies one as being underweight.

What is Obesity? Just as for excessive weight, the medical definition for obesity hinge on the BMI calculation. To be classified as obese, a patient must have a BMI of 30.0 or greater. A BMI of 40.0 or greater is often referred to as “morbid obesity” and is recommended by national guide lines as the cut point for identifying highly muscular, may have a high BMI that is due to their greater muscle weight rather than to body fat. Thus, the BMI is intended to be part of a greater clinical assessment.

Why Does it Matter? Many studies have shown that the likelihood of poorer health out comes (in teams of such diseases as cancer, cardiovascular disease, obstructive sleep apnea, diabetes, high blood pressure, and others), as well as overall premature death, increases as BMI increases. And the clinical definition of obesity (BMI of 30.0 or greater) is used in many cases to determine appropriate treatment options. There are also implications for insurance coverage and what therapies would be considered medically necessary. In 2013, the American Medical Association (AMA) officially declared obesity to be a disease, acknowledging the “enormous humanitarian and economic impact of obesity as requiring the medical care, research and education attention of other major global medical diseases.”

In 2013, the American Heart Association, American College of Cardiology, and The Obesity Society released new long awaited obesity guide lines, which were published as the “2013 ACCF/AHA/TOS Guide line for the Management of excessive weight and Obesity in adults.” The impact of officially acknowledging obesity as a chronic disease is expected not only to raise awareness of the problem among the general public, but also to impact policy at all levels. Policymakers may feel greater need to fund and implement obesity treatment and intervention programs, while third-party payers may be more likely to reimburse physicians and other healthcare professionals for treatment and management of obesity as a recognized disease.

As for the centers for Medicare and Medicaid Services (CMS) are concerned, obesity has been categorized as a chronic illness since 2004. Since November 29, 2011, Medicare has covered the cost of behavioral therapy for patients with a diagnosis of obesity. This may consist of screening with BMI and midsection circumference, dietary assessment, and high-intensity behavioral interventions.