The AMA Says Obesity Is a Disease. Now Can We Talk About Prevention?

We can approach the health problems that stem from unhealthy eating and physical activity as individual concerns requiring individual treatment. Or that there are social influences that affect what we eat, how we live and how healthy we end up.
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The American Medical Association sparked headlines last month when it voted to officially classify obesity as a disease. The AMA's action highlights the different directions we can take in trying to improve health and prevent chronic illness. We can approach the health problems that stem from unhealthy eating and physical activity simply as individual concerns requiring individual treatment. Or we also can recognize that there are social influences that affect what we eat, how we live and how healthy we end up -- long before we enter the doctor's office.

After the AMA's announcement, some members of Congress introduced a bill to expand Medicare reimbursements for weight-loss drugs and weight-reduction treatment. Yet while doctors, drugs and surgical procedures have a role to play in caring for these patients, prevention is the most important tool we have in the quest to improve health and prevent illness. We know from years of experience that the best prevention happens on the ground, in our communities, with support from policymakers. It's how we got lead out of paint, cigarettes out of the workplace and child seats into cars.

In California, a couple of efforts now underway could help prevent some of the health conditions the AMA is concerned with. We know breastfed babies are less likely to develop unhealthy weights, to suffer from SIDS or to develop diabetes. A proposed law, Senate Bill 402, would help new mothers breastfeed their babies by ensuring that all California hospitals where babies are born offer a basic level of support for breastfeeding. The bill won unanimous approval in the Senate, has cleared all committees in the state Assembly and is headed for a floor vote next month. It should be passed and signed by Gov. Brown.

In another area, California may move backward. Since 1999, the state and federal governments have supported a program, Safe Routes to School, that helps children walk or ride bicycles to school safely by helping counties and schools establish bike and pedestrian paths. Last year, about $46 million in state and federal money went to the program. Yet last month, despite a greatly improved revenue picture, the legislature froze funding for the Safe Routes to School program. Caltrans and other agencies are now deciding how state and federal transportation money will get used -- and Safe Routes to Schools will be competing with other projects for funding. Children across the state will be the losers if the program can't continue.

Slowly, the need to change the food and health environment is beginning to register with the broader public. Diet, physical activity and health are not just matters of individual character but are influenced by a host of factors.

When high-fat, high-sugar junk food is cheaper and more available than fresh fruits and vegetables -- not to mention more aggressively advertised -- then many people will go with the unhealthy option.

When it's easier, safer and more convenient to drive a car to work -- rather than walk or bike to the bus or train -- more people will drive and lose out on the chance to exercise.

When communities are plagued by violence, parents will keep their children indoors, where they may watch TV and play video games instead of being physically active outside.

For too long, there's been an artificial barrier between healthcare and policies that impact people's health. If Californians want to improve health and drive down medical spending, we need policies that incentivize the growing and marketing of healthy foods. We need transportation policy that encourages people to get out of their cars and walk. And we need regulations that limit junk-food advertising to children, discourage smoking and reduce outdoor pollution and the respiratory diseases it causes. Policy wonks like me even have a term for this approach -- "health in all policies" -- and it makes a lot of sense.

The AMA's decision to define obesity as a disease has brought needed attention to a crucial public health issue. How we respond will go a long way toward determining our approach to health, here in California and across the country.

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