Report 4 of the Council on Scientific Affairs (A-05)

Recommendations for Physician and Community Collaboration on the Management of Obesity

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Summary

Objective.  To review the findings and recommendations of the American Medical Association (AMA) National Summit on Obesity to identify additional interventions to confront the obesity epidemic.  Special attention is also directed to childhood obesity and potential anti-obesity efforts in schools.  Additionally, this report briefly evaluates the concept of obesity as a disease and considers the issue of designating the measurement of body mass index (BMI) and waist circumference as a Joint Commission on Accreditation of Healthcare Organizations (JCAHO)-sixth vital sign. Finally, the report offers recommendations for specific AMA and collaborative Federation actions targeting the obesity epidemic. 

Methods. An informational review of current literature was conducted using PubMed to identify articles on the concept of obesity as a disease.  The Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) Web sites were also searched for pertinent information.  Proceedings of the AMA National Summit on Obesity were consulted for potential interventions established in breakout sessions. For the discussion of BMI, the CDC and the National Heart, Lung and Blood Institutes’ Web sites were searched using the terms body mass index, and waist circumference. For the discussion of obesity and schools, published studies from the years 1998 through 2005 were identified through a PubMed search of English-language articles, using the key words coordinated school health, obesity and school, overweight and school, vending and school, soda and school, nutrition and school, competitive food and school, physical education and school, and physical activity and school.  Additional publications were identified by review of references in the above noted articles.  In addition, current state legislative initiatives related to physical education and nutrition in schools were reviewed.

Results.  The AMA currently has extensive policy addressing the public health burden of obesity.  Several potential interventions involving the community, schools, employers and worksites, and physician practices have been identified.  Arguments exist both for and against classifying obesity as a disease.  Measurement of BMI and waist circumference are helpful in the diagnosis of overweight and obesity, and in stratifying relative risk.  Because children spend a considerable amount of their weekly awake and productive hours in schools, this site should be a primary area of focus in the fight against obesity.

Conclusion.  The war on obesity cannot be fought only on the clinical front.  It requires a collaborative and coordinated effort by many groups, and physicians (as natural leaders) are in the unique position of being able to negotiate many of those arenas.  More attention to both prevention and treatment is needed.  Focusing on schools is logical since that is where children spend a large amount of their time, eat many of their meals, and have many opportunities for physical and nutritional education.  Physicians can be advocates for development of this “medium” so that its value and ability to contribute to treating and preventing obesity can be strengthened.  It is important to recognize that even within this area of focus, the best results can be obtained when physicians, families, and communities work together to support our schools and children.   Several areas for collaboration between the AMA and other stakeholders are apparent.

RECOMMENDATIONS

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA directives at the 2005 AMA Annual Meeting:

The AMA:

1. Will work with the Centers for Disease Control and Prevention to convene relevant stakeholders to evaluate the issue of obesity as a disease, using a systematic, evidence-based approach. (Directive)
2. Continues to actively pursue measures to treat obesity as an urgent chronic condition, raise the public’s awareness of the significance of obesity and its related disorders, and encourage health industries to make appropriate care available for the prevention and treatment of obese patients, as well as those who have co-morbid disorders. (Directive)
3. Encourages physicians to incorporate body mass index (BMI) and waist circumference as a component measurement in the routine adult physical examination, and BMI percentiles in children recognizing ethnic sensitivities and its relationship to stature, and the need to implement appropriate treatment or preventive measures. (Directive)
4. Will promote use of the AMA’s Roadmaps for Clinical Practice: Assessment and Management of Adult Obesity primer in physician education and the clinical management of adult obesity. (Directive)
5. Will develop a school health advocacy agenda that includes funding for school health programs, physical education and physical activity  with limits on declining participation, alternative policies for vending machines that promote healthier diets, and standards for healthy a la carte meal offerings.  The AMA will work with a broad partnership to implement this agenda. (Directive)
6. Will collaborate with the Centers for Disease Control and Prevention, the Department of Education, and other appropriate agencies and organizations to consider the feasibility of convening school health education, nutrition, and exercise representatives, parents, teachers and education organizations, as well as other national experts to review existing frameworks for school health, identify basic tenets for promoting school nutrition and physical activity (using a coordinated school health model), and create recommendations for a certificate program to recognize schools that meet a minimum of the tenets. (Directive)

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