Under the Affordable Care Act, more insurance plans are expected to start covering the cost of obesity treatments, including counseling on diet and exercise as well as medications and surgery. These are treatments that most insurance companies don't cover now.
The move is a response to the increasing number of health advocates and medical groups that say obesity should be classified as a disease.
Not everyone thinks this is a good idea, but this summer, the American Medical Association determined that obesity is a disease. The organization followed in the footsteps of the Obesity Society, a health advocacy group that called obesity a disease back in 2008.
Many overweight or obese individuals are victims of their own genetic history, according to Dr. Lee Kaplan, an obesity specialist and director of the Massachusetts General Hospital Weight Center. "We're all wired in slightly different ways," he says, adding that those subtle differences are reflected in how the body deals with energy stores and fat.
There are thousands of genes in the body, and Kaplan says about 100 of them are involved in making some people more susceptible to weight gain.
Classifying obesity as a disease is long overdue, according to Dr. Osama Hamdy, who directs the Obesity Clinical Program at the Joslin Diabetes Center in Boston. "The reality is, if you have that genetic susceptibility to gain weight, you will gain weight easily, no matter what."
Genetic susceptibility has to do with hormones and chemical systems in the body that direct appetite, metabolism and the absorption of nutrients and fat.
One of those hormones is leptin. It's produced by fat cells and tells the body when it's eaten enough. Hamdy says the majority of people who are obese are resistant to leptin. "The brain is shielded from the information on how much fat you have in your body," he says. "The brain is under the assumption all the time that you need more fat."
Other hormones make some people get hungry more often than others.
Then there's another system of brain chemicals, the endocannabinoid system. If it's not functioning properly, it fails to tell the body to stop eating what it really likes. For example, if you've always loved the sugary flavorful taste of ice cream, you may end up eating way too much of it simply because an enzyme in your brain fails to halt the chemical that signals your brain to eat as much of the beloved food as you can.
A 2009 study on the genetic susceptibility of weight gain found that when 12 pairs of identical twins were overfed 1,000 calories a day for about three months, each set of twins gained a different amount of weight. Some only gained about 8 pounds, while others gained nearly 30 pounds. But within the pair of twins themselves, the weight gain was exactly the same.
But not everybody thinks calling obesity a disease will help make people healthier.
Classifying obesity as a disease "sets people who are heavier up to believe there's something wrong with them and they're going to get sick unless they do something about it," according to Linda Bacon, a professor of nutrition at City College of San Francisco and the author of the book Health at Every Size: The Surprising Truth About Your Weight.
That then is "used as justification for surgery to ward off the potential of future disease," she says, "but that future disease may never exist."
Indeed, research has shown that some people can be overweight or even obese and still fit, whereas their more slender counterparts may be at greater risk for heart disease.
Even so, Kaplan says obese individuals are still at greater risk of high blood pressure, high cholesterol, arthritis, sleep apnea, infertility, depression and diabetes.
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Today in Your Health, we're taking time to answer more questions that you have sent to us about the Affordable Care Act. That's the new healthcare law taking effect next month. But first, we're going to hear about treatments for obesity. Many insurance plans don't cover treatments, such as counseling on diet and exercise, medications and weight-loss surgery. But that might all change under the Affordable Care Act. This is largely due to a growing acceptance that obesity is a disease, not a lifestyle choice.
NPR's Patti Neighmond has more.
PATTI NEIGHMOND, BYLINE: When Melissa Merenda went to college, she didn't gain the Freshman 15. It was more like the Freshman 30.
MELISSA MERENDA: Just the way that I ate and the lifestyle and, you know, drinking in college didn't help.
NEIGHMOND: Merenda continued gaining even after college. At 5 foot 5, she was the heaviest she'd ever been: 216 pounds. She decided it was time to get serious. She started walking a lot. She joined a volleyball team and drastically changed her diet. Even so, after a few months, she'd only lost seven pounds. Merenda ended up going to the Massachusetts General Hospital Weight Clinic.
MERENDA: By the time I got there, I was kind of at wit's end. Nobody would listen to me and I was just like, well, what's the point of doing all of this if I'm just going to, you know, be fat. I might as well just eat cheesecake and be happy, not bust my butt trying to work out
NEIGHMOND: The obesity program is headed by Dr. Lee Kaplan, a firm believer that obesity is a disease which puts some people, like Merenda, at a disadvantage when it comes to gaining weight.
DR. LEE KAPLAN: We're all different. We're wired in slightly different ways. And those subtle differences are reflected in how the body deals with energy stores or how the body deals with its fat.
NEIGHMOND: And many of those differences are inherited. There are thousands of genes in the body and Kaplan says about 100 of them are involved in making some people more susceptible to weight gain.
Harvard Professor Dr. Osama Hamdy, directs the obesity program at the Joslin Diabetes Center in Boston. He says classifying obesity as a disease is long overdue.
DR. OSAMA HAMDY: The reality is if you have that genetic susceptibility to gain weight, you will gain weight easily no matter what
NEIGHMOND: Genetic susceptibility has to do with hormones and chemical systems in the body that direct appetite, metabolism and the absorption of nutrients and fat. One of those hormones is leptin. It tells the body when it's full. Hamdy says the majority of people who are obese are resistant to leptin.
HAMDY: The brain is shielded from the information on how much fat you have in your body. And the brain is under the assumption all the time that you need more fat because it cannot sense that leptin.
NEIGHMOND: Leptin tells the body when to stop eating. Other hormones make some people hungry more often than others. Then there's a system of brain chemicals that, if not functioning properly, fail to tell the body to stop eating what it likes. Instead they do the opposite.
HAMDY: This is exactly what you like, this is what you love, continue to eat it.
NEIGHMOND: Hamdy says defining obesity as a disease should encourage more doctors to offer treatments like gastric bypass surgery and medication. Two new obesity drugs were recently approved by the FDA. But not everybody thinks calling obesity a disease is a good idea.
Linda Bacon is a nutritionist in San Francisco.
LINDA BACON: It sets up people who are heavier up to believe there's something wrong with them and that they're going to get sick unless they do something about it. Then that gets used as justification: oh, I have to get weight loss surgery to ward off the potential of a future disease. But that future disease may never exist.
NEIGHMOND: Others worry that overweight people may just opt for medication, before even trying to seriously change their diet and exercise routine.
Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.