New packaging

Marketing consultants have known it for years. Packaging sells the product. Putting it in the right color box can make the difference between a top seller and a flop. The truth is that most of us select wine by the appearance of the label and books by the design on the jacket.

In medicine, we package signs and symptoms in diagnoses and syndromes, and sometimes add an extra label that says "disease" in bold letters. But, what qualifies a particular constellation of physical findings and patients’ complaints as a "disease"?

This is not a trivial question. For the unfortunate victims, having a "disease" may allow them to tell their friends, "See, I’m not just a whiner. I actually have something. I have a disease." Diseases sometimes have their own specialists. Some have support groups, fund-raising foundations, and spokespersons.

In June 2013, the American Medical Association took the bold step of labeling obesity a "multimetabolic and hormonal disease state." This was the next logical step in an evolution that began with parents being told that their children would outgrow their baby fat if they adjusted their diets. Now we know that the seeds of obesity may be planted well before birth, and have certainly taken firm root before age 3 years to persist as a chronic condition with a myriad of life-altering ramifications. Sounds like a "disease" to me.

In an article in a New York Times Sunday Review, two psychologists from the University of Richmond discuss the dilemmas associated with this repackaging of obesity as a "disease" ("Should Obesity Be a Disease?" Crystal L. Hoyt and Jeni L. Burnette. Feb. 21, 2014). With a colleague from the University of Minnesota, these researchers performed three studies with 700 subjects who were divided into two groups. One group was given an article from a family magazine that included the standard advice on setting weight management goals. The other was provided an article clearly stating that obesity is a disease.

Surveys of the two groups revealed that for the obese individuals, reading the obesity is a disease article improved their "body satisfaction." Not a surprise. Nor is the observation that the same message made attempts at change seem futile. Another of their studies showed that this attitude of futility was correlated with less-healthy, higher-calorie food choices.

So it appears that in labeling obesity as a disease, the AMA has handed us a double-edged sword. We can use the new packaging to help our obese patients feel better about themselves. But, we must be prepared to address a sense of futility that may accompany their acceptance of a disease for which we currently don’t have a cure. Faced with this dilemma, we may need to adopt the style of successful chronic disease specialists. Sharing our frustration, we must remind our obese patients that while we don’t have a cure, we can help them manage their disease in a way that minimizes its ill effects.

While the disease label can cut both ways for our current patients, we should seize the opportunity to use it as a potent weapon in prevention for our patients yet to be born or even conceived. And, now we understand that prevention means taking aggressive steps prenatally and in the first 2 years of life before it’s too late. Armed with the new label, it is time to mount a serious campaign with the slogan, "Baby Fat is a Preventable Disease!"

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at [email protected].

Marketing consultants have known it for years. Packaging sells the product. Putting it in the right color box can make the difference between a top seller and a flop. The truth is that most of us select wine by the appearance of the label and books by the design on the jacket.

In medicine, we package signs and symptoms in diagnoses and syndromes, and sometimes add an extra label that says "disease" in bold letters. But, what qualifies a particular constellation of physical findings and patients’ complaints as a "disease"?

This is not a trivial question. For the unfortunate victims, having a "disease" may allow them to tell their friends, "See, I’m not just a whiner. I actually have something. I have a disease." Diseases sometimes have their own specialists. Some have support groups, fund-raising foundations, and spokespersons.

In June 2013, the American Medical Association took the bold step of labeling obesity a "multimetabolic and hormonal disease state." This was the next logical step in an evolution that began with parents being told that their children would outgrow their baby fat if they adjusted their diets. Now we know that the seeds of obesity may be planted well before birth, and have certainly taken firm root before age 3 years to persist as a chronic condition with a myriad of life-altering ramifications. Sounds like a "disease" to me.

In an article in a New York Times Sunday Review, two psychologists from the University of Richmond discuss the dilemmas associated with this repackaging of obesity as a "disease" ("Should Obesity Be a Disease?" Crystal L. Hoyt and Jeni L. Burnette. Feb. 21, 2014). With a colleague from the University of Minnesota, these researchers performed three studies with 700 subjects who were divided into two groups. One group was given an article from a family magazine that included the standard advice on setting weight management goals. The other was provided an article clearly stating that obesity is a disease.

Surveys of the two groups revealed that for the obese individuals, reading the obesity is a disease article improved their "body satisfaction." Not a surprise. Nor is the observation that the same message made attempts at change seem futile. Another of their studies showed that this attitude of futility was correlated with less-healthy, higher-calorie food choices.

So it appears that in labeling obesity as a disease, the AMA has handed us a double-edged sword. We can use the new packaging to help our obese patients feel better about themselves. But, we must be prepared to address a sense of futility that may accompany their acceptance of a disease for which we currently don’t have a cure. Faced with this dilemma, we may need to adopt the style of successful chronic disease specialists. Sharing our frustration, we must remind our obese patients that while we don’t have a cure, we can help them manage their disease in a way that minimizes its ill effects.

While the disease label can cut both ways for our current patients, we should seize the opportunity to use it as a potent weapon in prevention for our patients yet to be born or even conceived. And, now we understand that prevention means taking aggressive steps prenatally and in the first 2 years of life before it’s too late. Armed with the new label, it is time to mount a serious campaign with the slogan, "Baby Fat is a Preventable Disease!"

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at [email protected].

Marketing consultants have known it for years. Packaging sells the product. Putting it in the right color box can make the difference between a top seller and a flop. The truth is that most of us select wine by the appearance of the label and books by the design on the jacket.

In medicine, we package signs and symptoms in diagnoses and syndromes, and sometimes add an extra label that says "disease" in bold letters. But, what qualifies a particular constellation of physical findings and patients’ complaints as a "disease"?

This is not a trivial question. For the unfortunate victims, having a "disease" may allow them to tell their friends, "See, I’m not just a whiner. I actually have something. I have a disease." Diseases sometimes have their own specialists. Some have support groups, fund-raising foundations, and spokespersons.

In June 2013, the American Medical Association took the bold step of labeling obesity a "multimetabolic and hormonal disease state." This was the next logical step in an evolution that began with parents being told that their children would outgrow their baby fat if they adjusted their diets. Now we know that the seeds of obesity may be planted well before birth, and have certainly taken firm root before age 3 years to persist as a chronic condition with a myriad of life-altering ramifications. Sounds like a "disease" to me.

In an article in a New York Times Sunday Review, two psychologists from the University of Richmond discuss the dilemmas associated with this repackaging of obesity as a "disease" ("Should Obesity Be a Disease?" Crystal L. Hoyt and Jeni L. Burnette. Feb. 21, 2014). With a colleague from the University of Minnesota, these researchers performed three studies with 700 subjects who were divided into two groups. One group was given an article from a family magazine that included the standard advice on setting weight management goals. The other was provided an article clearly stating that obesity is a disease.

Surveys of the two groups revealed that for the obese individuals, reading the obesity is a disease article improved their "body satisfaction." Not a surprise. Nor is the observation that the same message made attempts at change seem futile. Another of their studies showed that this attitude of futility was correlated with less-healthy, higher-calorie food choices.

So it appears that in labeling obesity as a disease, the AMA has handed us a double-edged sword. We can use the new packaging to help our obese patients feel better about themselves. But, we must be prepared to address a sense of futility that may accompany their acceptance of a disease for which we currently don’t have a cure. Faced with this dilemma, we may need to adopt the style of successful chronic disease specialists. Sharing our frustration, we must remind our obese patients that while we don’t have a cure, we can help them manage their disease in a way that minimizes its ill effects.

While the disease label can cut both ways for our current patients, we should seize the opportunity to use it as a potent weapon in prevention for our patients yet to be born or even conceived. And, now we understand that prevention means taking aggressive steps prenatally and in the first 2 years of life before it’s too late. Armed with the new label, it is time to mount a serious campaign with the slogan, "Baby Fat is a Preventable Disease!"

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at [email protected].