Obesity is a chronic disease: instead of punishing patients, provide access to treatment

Weight-shaming entertainment first appealed to American audiences through reality TV shows that subjected obese people to extreme dieting and often dangerous exercise regimens. Viewership for these programs dwindled, but the weight-shaming entertainment persisted on television as it left the gym to find a new setting for its drama: the doctor’s office.

Recent shows have replaced personal trainers with professional-looking medical providers, but their tactics are much the same: publicly berate and humiliate patients facing life-threatening medical complications. Worse still, many of these patients also live in abject poverty and participate in these TV shows in exchange for access to free care.

This form of television entertainment would never be considered acceptable if it depicted the treatment of any other chronic disease, but society is so determined to punish obese people that it has become a hit entertainment.

Some would say these are extreme cases driven by television’s perpetual need to capitalize on the lowest human impulses. While that may be true, such toxic entertainment simply wouldn’t resonate with viewers (and advertisers) if it weren’t rooted in a broad, harsh reality: weight biases permeate all levels of the system. health. This fact has left potentially life-saving anti-obesity drugs underutilized and inaccessible to most patients.

Obesity has been recognized as a disease by the American Medical Association for nearly a decade. The National Institutes of Health, meanwhile, has recognized obesity as a disease since the late 1990s. Yet health care coverage for the treatment of obesity lags behind nearly all other chronic diseases – the use of anti-obesity drugs being one of the most neglected areas of obesity care.

Viable treatment options

Estimates suggest that only 3% of obese people use anti-obesity drug treatment. The neglect of a viable treatment option is absurd considering that the new generation of anti-obesity drugs are beginning to approach the weight loss achieved through bariatric surgery. In fact, two recent randomized clinical trials of new obesity drugs have been shown to be very effective in inducing weight loss. In the first trial, the average weight loss was nearly 15% of body weight, with 32% of participants losing more than 20% of their excess body weight. In the second study, the average weight loss was 22% of body weight, and 55% of participants lost more than 20% of their body weight.

The failure to adopt anti-obesity drugs by providers and the insurance industry, which in some circumstances have even gone so far as to classify anti-obesity drugs as “vanity drugs”, is rooted in a weight bias and the principle that obese people are solely responsible. to reverse their condition – taking medication is ‘the easy way out’. Imagine, for any other chronic illness, forgoing medications that could spare a patient the risks and complications of major surgery, increase mobility, improve mental health, relieve physical pain and financial burden, and begin to alleviate the harms of this disease – all because of a bias that is not supported by research or medical literature, but is present at all levels of society.

In this disreputable aspect of health care, the Office of Personnel Management (OPM) is an outlier. The OPM recently met with federal employee health insurance companies to outline their plans to address health equity. In this dossier, the agency has clearly defined its expectations for health benefit offers in 2023: carriers are not allowed to exclude anti-obesity drugs from coverage and their benefit proposals must indicate how care obesity are covered in children and adolescents.

The effects of this decision will be considerable. OPM offers more than 200 health plans across the United States and administers health insurance benefits for more than eight million federal employees, retirees and their families. Based on adult obesity rates in the United States, it is possible that more than 3 million obese people have access to these federal health benefits.

We have never been closer to seeing such a large workforce accessing this level of comprehensive care.

But we can’t stop there. Given that nearly half of Americans receive health insurance benefits through their employer, we need other employers to follow OPM’s lead by including obesity treatment as a health benefit. With nearly 43% of Americans age 60 or older affected by obesity, millions of Medicare beneficiaries also lack access to these drugs. Given the increased risk of more severe and deadly SARS-CoV-2 infections in this demographic, Medicare should also prioritize access to anti-obesity medications.

A global approach

Of course, pharmaceuticals are only one of many tools in this effort, and the high prevalence of obesity and its complications reminds us that we will not treat our way out of the obesity pandemic – we must also give prioritizing access to complementary and equitable community care. programs that prevent weight gain and maintain weight loss. These programs, like those of WW (formerly Weight Watchers) and the Y, are essential and should be prioritized as part of comprehensive obesity management plans.

Expanding access to obesity drugs won’t eliminate discrimination in health care and it would certainly make reality TV quite boring, but it has the potential to save and improve lives. And that should matter more than our prejudices.

Author’s note:

The author is a director of the STOP Obesity Alliance which maintains a steering committee, associate members and corporate members, and there are pharmaceutical companies that have partnered with STOP at the corporate member level: https://stop. publichealth.gwu.edu/members

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