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Despite AMA saying obesity a disease, Samoa Air says ticket policy will stand

The American Medical Association (AMA) has declared obesity a disease, which could turn the tables on Samoa Air’s pay-by-weight ticket policy, pointing to discrimination — and, possibly not “the fairest way for you to travel”.


The news hits home as American Samoa, according to, ranks fourth in the world in obesity, with 90.8% of its population (ages 15 years old and older) being overweight or obese.


Waistlines across the globe are expanding and the rapid increase in the number of obese people has become a growing concern among members of the medical community, with some health experts coining a term for the epidemic: “globesity.“


American Samoa was ranked #1 on a list of the Top 10 Fattest Countries in the World, based on national health surveys compiled by the WHO between 2000 and 2008. At the time, 93.5% of the Territory’s population was overweight.


During its annual meeting in Chicago last week, the AMA decided to classify obesity as a disease, in what ABC News says is perhaps the group’s “biggest policy change on weight and health to date.“


According to “The decision overrode a recommendation by an AMA committee that had studied the matter for more than a year. While committee members weren't authorized to speak to the media, their final report pointed out that obesity was typically diagnosed using body mass index, a measure that is imprecise and not always associated with poor health outcomes.”


The World Health Organization (WHO) defines “overweight” as an individual with a Body Mass Index (BMI) of 25 or more and “obese” as someone with a BMI of 30 or more. (BMI is a calculation based on a person‘s height and weight).


ABC News reported, “someone with a body mass index higher than 30 – the Centers for Disease Control and Prevention's definition of obese – might be perfectly healthy, while someone below that threshold might be sick. Classifying obesity as a disease, the committee argued, might cause confusion because it's difficult to link excess weight to health problems, such as heart disease and type 2 diabetes.”


Obesity researcher James O. Hill, executive director of the Anschutz Health and Wellness Center at the University of Colorado, is quoted as saying that most professionals who diagnose, treat, and research obesity are in agreement that a BMI higher than 30 spells trouble. Hill told ABC News, he welcomed the AMA's new classification of obesity.


Dr. Nikhil Dhurandhar, an obesity researcher at the Pennington Biomedical Research Center in Baton Rouge, La., and vice president of the Obesity Society, is in agreement, telling ABC News that "The recognition of obesity as a disease is an extremely important milestone. Obesity has been a disease. It is now recognized to be so. We recognize that over a third of the population has a disease. Now we can start getting some standardization for reimbursements and treatments," he said.


But Dr. Richard Besser, the chief health and medical correspondent for ABC News, said he thought the AMA's declaration was much ado about nothing.


"I think it matters little whether we call obesity a disease, a condition or a disorder. We are already talking about the obesity epidemic. It matters less what we call it than what we do to prevent it," he said.


"We need to get physical activity back into everyone's lives, starting with our kids. We need to get them moving in school and after school. We need to get them eating healthy foods in appropriate amounts. That is where the conversation should be focused, not on whether this is a disease."


According to Yahoo News, while research suggests that a sedentary lifestyle and genetics play roles in causing obesity, a large body of scientific evidence points toward overeating as the main culprit.


Dr. Mitchell Roslin, chief of weight-loss surgery at Lenox Hill Hospital in New York told Yahoo News that "We define ourselves by what we do — as writers, doctors, firemen — but we each only have one body. We must start defining ourselves by our health." He added, "Obesity is very complex. There is no one personality type.”




On the local scene, Samoa News asked Samoa Air whether this AMA declaration would affect Samoa Air’s pay-by-weight ticket policy, seeing that it could now be viewed by some as biased — discriminatory — against people who have a certain type of disease.


Samoa Air made headlines around the globe earlier this year by being the first airline in the world to sell tickets on their flights by the kilo weight of their passengers. Local residents told Samoa News at the time of its inception that it was a “wait and see” situation. Samoa Air’s first flight to Pago was a sellout, according to the airline.


In an email correspondence to Samoa News on Sunday evening, Samoa Air Chief Executive Officer (CEO) Chris Langton wrote: “Everyone needs to understand that an aircraft on any sector of flight has a maximum available payload with which to pay for the flight and to return a dividend sufficient to keep the operation in business. The item for sale is weight and weight only. The aircraft can only carry that available payload and not a kilo more. How do you get to know what that weight is and how can you guarantee that it’s correct — simple, you weigh everything. Airlines do not weigh everything. They do not weigh passengers. We do.”


(Actually, Samoa News has observed that the two other airlines which also serve Pago — Polynesian Air and Inter Island Airways — do weigh their passengers during check-in, but their ticket prices are not based on this weigh-in, unlike Samoa Air.)


Langton, a pilot with over 50 years of international flying under his belt, said he “always knew we had the bull by the horns.” He said he brought the pay-by-weight idea to execs many times in the past, but “no one wanted to go in an area which was becoming an increasingly diverse topic, given that weight was becoming personal and was often a health issue.”


He continued, “Remember that there is a strong public belief that not all excess weight is beyond the individual’s means to address.”


Langton said, “Claims of discrimination under this system have no base whatsoever..”


However, he said, “the current system is full of discrimination and no one comes out a winner. Everyone is being discriminated at this moment and you only have to spend five minutes on any flight to recognize why the pay by seat system fails and even more so, when all the airlines have to admit that they simply do not know what the weight of their passengers is.


“The authorities around the world have been just as remiss in recognizing that the ‘standard weight’ principle is not good enough and that all objects carried on to an aircraft must be weighed and must be accounted for,” the CEO stated.


He continued, “We will always do that. So any suggestion that the industry (i.e. carriage of people and goods by air), under a pay by weight system somehow suggests discrimination of any sort is an entirely unsustainable argument, but is definitely an argument to be presented to any other system to defend.”


Langton concluded, “This has nothing to do with those who are unwell for any reason. We carry people who are medically classified as ambulatory or need to travel with a medical attendant or require a special medical environment such as life port systems and — under special conditions — infectious diseased patients can be transported. These are situations requiring specialized medical provisions, including medical certificates but still, the principles annunciated apply and in all respects, we only have weight to sell.” quoted Langton earlier this year as saying “There is no doubt in my mind that this is the concept of the future. This is the fairest way of you traveling with your family, or yourself.”


Earlier this year in March, Representatives Larry Sanitoa and Taotasi Archie Soliai — who are members of the Non-Communicable Disease (NCD) Coalition and also members of the cancer and diabetes coalitions — wrote a letter to Director of Health Motusa Tuileama Nua regarding the Territorial NCD Plan.


The lawmakers referred to statistics submitted by PIMA, an organization that was contracted by DOH to work on a comprehensive plan.


The data showed that 60% of all deaths in the territory are caused by NCDs, and significantly, American Samoans are dying much younger. What is scary, according to the faipule, is the number of youth now being diagnosed as young as 11 years old with Type II “lifestyle” diabetes.


“Reports confirm the top five causes for death in American Samoa are non-communicable disease-related, which also account for more than half of all the deaths from 2008-2010,” the faipule wrote.


“Aside from health, the social and economic impact of NCDs to individual families, to our government, and future economic growth, is devastating. The numbers are frightening and overwhelming,” they concluded.


Just last month, a US study conducted by Brown University found that 800 babies born in American Samoa (not including the independent state of Samoa) between 2001and 2008 were obese by the time they were 15 months of age. Of that number, 23.3% were boys and 16.7% were girls. The study of the babies carried in the womb to around 37-42 weeks also found a further 16.1% of boys and 14% of girls were overweight.