Obesity is often included in the litany of chronic diseases that plague six in 10 Americans — except by Medicare, which currently refuses to cover treatment for obesity until it causes significant health problems like diabetes or heart disease.
The growing number of Americans with obesity is helping drive the chronic disease crisis in the U.S. and deepening existing health inequities. The government’s failure to recognize and treat it like other diseases may be making matters worse. Policymakers need to treat obesity like the disease it is and give health care professionals and their patients access to the tools necessary to treat it.
I’ll focus on diabetes here because that is my specialty. But what I write also applies to cardiovascular disease, certain types of cancer, and hypertension.
More than 37 million Americans live with diabetes. The vast majority of them have type 2 diabetes, mainly caused by the body’s inability to use insulin well. The link between obesity and type 2 diabetes is clear, and it is the leading risk factor for the disease. More than 85% of people with diabetes are overweight or have obesity, and most new cases of type 2 diabetes every year are attributable to obesity. Well over 100 million Americans live with obesity, and the number is steadily climbing. In 1980, roughly 15% of American adults had obesity. Today, it’s nearly 42%, a 223% increase. By 2030, half of all Americans will have obesity.
Not surprisingly, the increase in obesity has coincided with the skyrocketing rate of diabetes, which has more than tripled since 2000.
The burden of obesity — and diabetes — is disproportionately borne by communities of color. Rates of obesity are 50% among non-Hispanic Black adults, nearly 46% among Hispanic adults, and 41% of non-Hispanic white adults. Black adults are 60% more likely than white adults to be diagnosed with diabetes and twice as likely to die from it.
Growing rates of obesity and diabetes represent an urgent public health crisis. Without action, this problem will continue to get worse, leading to more Americans developing other diseases related to these two, including cancer, cardiovascular disease, arthritis, and others.
In 2013, the American Medical Association declared obesity to be a disease. In its declaration, the AMA noted that obesity was “a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention.” Yet nearly a decade later, treatments for it like intensive behavioral therapy, medications, and surgery, remain out of reach for tens of millions of Medicare beneficiaries and most others, effectively denying them access to medically necessary, safe, and effective treatments.
Much has changed in the intervening years. As the medical and research communities come to better understand the causes and condition of obesity, new and safe treatments for obesity have come to market. While the FDA has approved several weight-loss medications, a new generation of obesity-treating drugs has been developed that mimic a hormone called glucagon-like peptide 1, which can signal the brain in ways that make people feel fuller. These new drugs can help people shed 15% to 20% of their body weight. In just the last year, one medication has been approved, and another is currently under review, and may be approved in 2023. New behavioral health and lifestyle management tools are available and, after 30 years, new guidelines suggest earlier surgical interventions to treat obesity. But although the science and options for intervening against obesity have changed, insurers and the U.S. health care system have yet to catch up.
In the U.S., individuals with diseases are provided access to specialized health care professionals, medical procedures, and pharmaceuticals. Not so for people with obesity: the system often forces them to wait and get sicker before their treatment is covered by insurance. Insurance forces health care providers to wait for patients to develop cardiovascular disease in order to prescribe medication and encourage weight loss, or for patients to develop type 2 diabetes before discussing behavioral therapy or medication aimed at weight loss.
This approach exacerbates the current health crisis, and is a huge disservice to people who require treatment for a disease — obesity — that is often ignored until it is too late.
Rather than waiting for people to develop obesity-related diseases, health care professionals should be able to treat obesity as the underlying root cause of what ails so many of their patients. But their hands are frequently tied: Medicare specifically prohibits covering reimbursement of obesity medications. As a result, health care professionals are left to treat patients without access to clinically proven and effective tools to promote weight loss, including FDA-approved pharmaceutical therapies to treat obesity.
The health care system and insurers need to take obesity seriously. To do so, they must start by ensuring patients and health care professionals have access to the full array of evidence-based, safe, and effective treatment protocols through comprehensive insurance coverage. This includes access to intensive behavioral therapy provided by a qualified professional, access to medical interventions necessary to improve metabolic health, and, of course, access to FDA-approved pharmaceutical options.
I urge policymakers to equip health care professionals with the tools they need to treat the more than 100 million Americans with obesity before they develop other serious health conditions.
Robert Gabbay is an endocrinologist and the chief science and medical officer for the American Diabetes Association. He serves as a clinical Advisor for Sweetch, Vida Health, and Lark Health, which work to support healthier lifestyles and management of chronic conditions.
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