Millions of Americans are more worried than ever about obesity. And millions are willing to consider weight-loss methods they never had before, including metabolic and bariatric surgery and anti-obesity medications. The reason: a pandemic that put those with obesity in its crosshairs. These are among the findings from a recent survey from the American Society for Metabolic and Bariatric Surgery (ASMBS) and NORC, an independent research organization.
Fears over excess weight rose during the pandemic for nearly a third of Americans and prompted nearly 6.4 million to consider having either bariatric surgery or taking prescription anti-obesity drugs for the first time. This is particularly notable given that only about 200,000 people get bariatric surgery in any given year, only about 1% of the surgically eligible population. Another 1% to 3% turn to medication.
New thinking on obesity is warranted. More than 40% of Americans, an all-time high, have the disease that in addition to COVID-19, is linked to heart disease, type 2 diabetes, sleep apnea and scores of other diseases. For too long, patients and even the medical community, have been much more willing to treat the consequences of obesity rather than treat it at its source. COVID-19 may have helped to change that calculus.
Obesity quickly emerged as a major clinically significant risk factor for serious illness, hospitalization, and death from COVID-19. According to CDC, more than half of patients hospitalized with COVID-19 in 2020 had obesity, which weakens the body’s immune system, causes chronic inflammation and increases the risk for other diseases, including type 2 diabetes, another independent risk factor for COVID-19.
The dangers of obesity are not lost on the American public. The survey found that more than 80% of adults think obesity is the biggest health threat facing the country, as big as cancer (82%), and even more significant than heart disease (77%), diabetes (76%), and COVID-19 (68%).
But when it comes to treatment and the nature of the disease, some misperceptions persist.
Nearly three-quarters (73%) believe diet and exercise is the most effective way to lose weight, even more effective than involving a doctor (65%) or bariatric surgery (56%), the latter of which has been shown to produce the greatest and most durable weight loss and health benefits among individuals with obesity.
Most view obesity as a risk factor (61%) for other diseases rather than a disease itself. On the other hand, the American Medical Association, the nation’s largest physician group, back in 2013, declared obesity a disease caused by a combination of biological, genetic, social, and environmental factors. However, nearly three-quarters of those (73%) who struggled to lose weight in the past believe obesity is simply due to a lack of willpower. This may be why only 41% report having spoken to their doctor about their weight.
We are seemingly in the final throes of the pandemic and hopefully the lessons learned and the greater attention to obesity treatment will not be lost. After a big drop in procedures in 2020 due to COVID restrictions on surgery, my bariatric surgery colleagues and I are seeing a rebound to pre-pandemic levels. This is welcome news, but even so, bariatric surgery remains one of the most underutilized treatments in medicine, currently serving only about 1% of the eligible patient population.
Clearly, we can’t operate our way out of the obesity crisis, but neither can we ignore that obesity is both a disease and a modifiable risk factor for other diseases that few succeed in addressing in the long term with diet and exercise alone. At over 40%, obesity rates in the U.S. are at an all-time high and are only projected to grow higher. Half the population is forecast to have obesity by 2030 and another 25% will have severe obesity.
COVID-19 lit the match for many people to get healthier and protect themselves from severe disease. Treating the disease of obesity itself — the source of so many other diseases — is the best way to do that. Medical practice, public education, and public health policy need to adapt to reality — pandemic or not.
Shanu N. Kothari is a surgeon.
