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The burden of obesity isn't measured just in pounds


New anti-obesity drugs are a new tool in fight against overweight, but more accessibility is needed.

© nito - stock.adobe.com

physician obesity card: © nito - stock.adobe.com

Each new year, millions of Americans resolve to lose weight. But the overwhelming majority of them will fail – and not due to a lack of willpower.

While obesity is too often depicted as a personal failing or the result of lifestyle choices, public health experts increasingly recognize that it's a distinct medical condition caused, at least in part, by genetic and metabolic factors beyond individuals' control.

The World Health Organization has aptly likened obesity to a "slow-motion disaster," one that affects people of all ages and ethnicities. More than 70% of Americans have obesity or are overweight. Among white Americans, 41% have obesity, a figure that rises to over 45% for Hispanics and nearly 50% for Blacks. Obesity is also becoming more prevalent among the young, affecting nearly 20% of children – who are far more likely to have obesity as adults.

© Rollins School of Public Health, Emory University

Kenneth E. Thorpe, PhD
© Rollins School of Public Health, Emory University

Fortunately, we now have evidence-based medical interventions that can enable those with obesity to lose weight and improve their overall health. Large employers are now using the YMCA's diabetes prevention program and other broadly accessible health platforms to promote dietary and lifestyle changes. These programs are already helping countless individuals across the country successfully attain a healthy weight.

And for the first time, the Food and Drug Administration has approved medications, known as GLP-1 agonists, that help people lose excess weight and reduce the risk for other conditions associated with obesity.

In clinical trials of various GLP-1 drugs, patients lost anywhere between 10% to 22% of their body weight on average in their first year. Combined with policies that promote healthier living, these anti-obesity medicines could help solve the obesity epidemic – but only if people can get coverage and access to them when prescribed.

Our failure to effectively treat obesity has had a wide range of negative ramifications. Obesity is both a disease itself and a major contributor to many other costly chronic conditions. It's now the second leading cause of preventable death in the United States and is associated with 236 different comorbidities, including diabetes, heart disease, and many cancers. It's also a key driver of soaring U.S. health care costs, with the annual total estimated at $173 billion.

All Americans bear the excess costs associated with our high obesity rate. Combined, Medicare and Medicaid spend roughly $93 billion each year on obesity-related medical claims. According to the Milken Institute, the economic impact of obesity in the United States exceeds a staggering $1.4 trillion each year. Obesity even affects U.S. military readiness; its incidence among active-duty service members has more than doubled over the past 10 years.

As these statistics make clear, obesity is a societal challenge that requires a sweeping national response. Encouraging people to eat healthier and exercise more is important, but simply hasn't been enough. If we are going to stem rising rates of obesity, we must address its physiological causes.

New drugs aimed at treating obesity can be a powerful tool in this fight. But that's only if they become more widely covered by insurance. Currently, most private insurers cover the drugs only if they are prescribed for diabetes. The Centers for Medicare & Medicaid Services (CMS), relying on an antiquated interpretation of a federal statute banning coverage of drugs used for weight loss or weight gain, doesn't cover them at all. However, by recognizing obesity as a chronic illness, the Medicare program has the ability to alter this interpretation and cover anti-obesity medicines.
Helping people attain a healthy weight can have an outsized impact. In a study I led, we estimated the cost savings associated with weight loss for adults with chronic disease. Just a 5% reduction in body mass index (BMI) could save a patient with hypertension almost $1,000 a year in medical costs. A person living with diabetes could save even more – nearly $2,000 annually. The greater the reduction in BMI, the greater the savings. Improved coverage and access to anti-obesity medicines could also ultimately improve overall health as people age into Medicare and substantially reduce Medicare spending.
Medical authorities, including the American Medical Association, have urged broader coverage for these drugs. And even many private insurers are beginning to recognize the cost efficacy of better treatments for obesity. Nearly half already cover bariatric surgery, and 22% now pay for anti-obesity medications. Medicare already covers bariatric surgery.
CMS can help millions of Americans make good on their New Year's resolutions by establishing coverage for anti-obesity medicines without delay. Congress and the Biden administration should further support programs and policies that better address obesity as a chronic disease and prevent the related complications that accompany it. Rather than setting Americans up for more failure, we can empower them to lose weight and improve their overall health.

Kenneth E. Thorpe, PhD, is chair of the Department of Health Policy and Management at the Rollins School of Public Health, Emory University. He is also chairman of the Partnership to Fight Chronic Disease.

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