By STEPHANIE TILENIUS
Well over a third of Americans are obese — and the percentage keeps growing at a staggering rate. Over the last twenty years, obesity prevalence grew from 30% to 42% of the US population and rates of severe obesity nearly doubled. If we don’t make serious changes to our healthcare system, it’s scary to think where we’re headed in a few short years.
The fact is, obesity is far from a cosmetic condition. It can be a devastating disease and was classified as such by the American Medical Association in 2013. Obesity is the leading risk factor for deadly diseases like type 2 diabetes, heart disease, stroke, and at least 13 types of cancer.
If we don’t stop the obesity epidemic in its tracks now, we’re in for a world of hurt. People’s lives, the healthcare system, and, by extension, the US economy could be headed for collapse if we continue to ignore it. Cardiometabolic conditions like obesity, heart disease, stroke, and diabetes cost the US healthcare system upwards of $500 billion a year in healthcare costs and another $147 billion in lost workforce productivity for heart disease and stroke alone.
And yet private and government-sponsored health plans are dragging their feet to address obesity head on. They know most people jump from health plan to health plan every few years, so they’re willing to take the chance that their members with obesity won’t develop high-cost complications soon enough to justify treatment now. And yet treatment could reverse the effects of obesity and downstream chronic disease, saving lives and billions of dollars in the long run.
Referring to how most people with diseases in the US get access to specialized health professionals and treatment, Chief Medical Officer for the American Diabetes Association Robert Gabbay said “Not so for people with obesity: the system forces them to wait and get sicker before their treatment is covered by insurance.”
Forward-thinking employers and pharmacy benefit managers, on the other hand, are taking note of new obesity therapies like GLP-1s. Employers will soon start covering GLP-1s and other weight loss medications because people have longer tenure with employers than insurers and employers recognize that obesity treatment reduces healthcare costs, increases worker productivity, and has the potential to attract and retain talent.
While the cost of many weight loss drugs is steep right now, it’s inevitable that we’ll see prices come down eventually. Just like we saw insulin prices come down to $35 a month, patient advocates and lawmakers will pressure drug companies to lower the cost of weight loss drugs to more reasonable amounts. Too many people need these medications who can’t afford them at their startling price point now. And no one wants to live in a world where lifesaving drugs for the masses are only priced for celebrities to use.
As exciting as they are, however, GLP-1s aren’t going to solve obesity alone.
Healthy food should really be the premier medicine to treat obesity. The trick is how to actually integrate food into medical practice. As of now, the best way to integrate food is through Medical Nutrition Therapy prescribed by registered dietitians. Dietitians can personalize eating plans to help people with obesity make healthy food choices that will impact not just their obesity, but also co-occurring conditions like diabetes, hypertension, and cancer. Some nutritious food delivery systems and SNAP benefits show promise too.
We can’t forget that obesity is also strongly linked to depression and other mental health disorders. The mind-body connection is real with obesity sometimes causing grave changes in brain function and cognitive impairment. Conversely, depression is often thought to be an underlying cause of weight gain. Research physicians like Chris Palmer, MD, argue that “mental disorders are metabolic disorders of the brain.”
People with obesity need more mental health support in order to combat the disease and make effective behavioral changes. Studies show that treating depression and obesity together can bring greater improvements for both conditions.
Initiating and sustaining weight loss often requires a nearly herculean effort for many people. It necessitates learning new coping mechanisms and changing lifelong habits — and even still, genetics and other biological markers can work against those efforts. Nevertheless, no surgery or drug alone can fully cure someone of obesity. Experts agree that weight loss medications (GLP-1s and others) and surgery must be coupled with behavior change for sustained results.
People with obesity need the supportive care of provider teams who can prescribe Medical Nutrition Therapy, weight loss medications, and antidepressants alongside mental health coaching and cognitive behavioral therapy when necessary.
Fighting the obesity epidemic will require wholesale change. We can’t keep dismissing obesity as a personal problem of willpower. Not only is that assumption hopelessly defeating, it’s patently false. Obesity is a medical disease that’s reached epidemic proportions and our healthcare system must directly address it with evidence-based treatments like Medical Nutrition Therapy, weight loss medications, and behavioral health coaching for lasting outcomes. If we tackle obesity with our full arsenal, we have the potential to save millions of lives and billions of downstream healthcare costs.
Stephanie Tilenius is the Founder and CEO of Vida Health