The health care system rethinks obesity

Illustration of measuring tape around medicine bottle.

Illustration: Shoshana Gordon/Axios

Physicians and medical professionals are leading a rapid cultural shift around obesity, viewing it as a disease rather than a lifestyle choice.

Why it matters: This shift has brought new treatments and better care—but also new controversies about who gets these treatments and how they are best used.

What are they saying: “Obesity is a very prevalent chronic disease characterized by excessive accumulation or distribution of fat, a health threat that requires lifelong care. Almost every system of the body is affected by obesity,” six obesity advocacy groups recently reported in read in a joint statement.

  • “Every obese patient should have access to evidence-based care.”

Push news: An existing class of diabetes drugs has shown great promise for weight loss, offering a glimmer of hope for the millions of Americans living with obesity.

Yes, but: Many insurance companies, including Medicare, will not cover these diet pills. They may not be able to afford it without insurance.

  • Wegovy, which is approved for weight loss under certain conditions, is priced at $1,349 for a one-month supply.
  • Veronica Johnson, an obesity specialist at Northwestern Medical Center in Chicago, told NBC News: “Most of my patients can't afford $1,300 a month, especially for medications that they need to take long-term.”

the other side: Kristine Grow, a spokeswoman for the American Health Insurance Plan, recently told Axios that these treatments have limitations, “have not been proven effective for long-term weight management, and may have complications and adverse effects for patients.”

  • The same class of drugs can also be abused. Some digital health startups are advertising and prescribing medications for people who are not overweight, The Wall Street Journal reported this week.

Between the lines: The treatment environment for children and adults is changing rapidly.

  • New guidelines released last month by the American Academy of Pediatrics advise against delaying obesity treatment in children and say doctors should be proactive with measures such as intensive health behavior and lifestyle treatments and, in some cases, prescription drugs or surgery.
  • But the guidelines have already met with resistance. For example, eating disorder experts warn that it could backfire, NPR reported this week.
  • “We run the risk of doing major harm to 6-year-olds or 8-year-olds by telling them they have a disease … just based on their weight status,” eating disorder expert Kim Dennis told NPR.

What are we looking at: one Unusual interest groups are already pushing for Medicare to cover obesity drugs, STAT reports.

  • More broadly, the existence of an effective treatment raises major questions about how to prevent widespread abuse of another prescription drug — and how to balance access to obesity treatment with the risk of perpetuating stigma.

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