Recently, media outlets and social media influencers have been on fire with stories about new “miracle” obesity drugs that promise a quick fix for people wanting to lose weight. Lost in this chatter are the life stories of millions of Americans struggling with obesity and its physical and emotional effects. A vital question is being ignored: how can we continue to allow money to determine access to treatment when many people with obesity already have difficulty getting the basic prevention and screening options they so desperately need?
As a practicing gastroenterologist and a patient living with obesity, we know the harmful effects of the false assumption that obesity is the result of poor lifestyle choices. Strangers, family members, and even some medical providers often assume that people with obesity are lazy or undisciplined about diet and exercise. This ill-informed perspective is harmful to people with obesity who receive hurtful comments, stares, and judgment when, in fact, obesity is a complex, chronic, life-threatening disease that damages mental and physical health.
To prevent the vicious cycle of generational obesity in our children, it is time to change how we view and manage the epidemic of obesity in America. Obesity is a long-term medical condition and should be treated as such: with a multidisciplinary approach to prevention and treatment.
Our goals of education, prevention, and breaking down barriers to accessing obesity treatment have inspired our collaboration and advocacy work with the American Gastroenterological Association. Together, we are encouraging Congress to advance and pass the Treat and Reduce Obesity Act (TROA). This legislation would expand Medicare coverage to include FDA-approved prescription drugs for chronic weight management, expand behavioral counseling, and allow additional qualified medical professionals to provide treatment. Because many private insurance companies model their covered health benefits to match that of Medicare, TROA’s passage could lead to increased obesity care coverage for all Americans who have insurance and improve access to care for Americans with lower incomes and those from racial and ethnic groups experiencing disproportionate obesity rates.
Nearly 42 percent of American adults have obesity — and the rate continues to increase rapidly — yet it remains widely misunderstood as a disease. Research has proven that obesity is a chronic medical condition that impacts multiple systems of the body — cardiovascular, endocrine, psychological, hepatic, and gastrointestinal, to name just a few. Every patient experiences the effects of obesity in a unique way, so health care providers must take ownership of managing this complex condition and breaking down barriers to treatment. Otherwise, if current trends continue, the World Obesity Federation estimates the economic impact of untreated disease could reach $4.32 trillion annually. Payers, providers, and patients must unite to ensure that the most up-to-date and effective treatments are available to those most in need.
Patients with obesity are often embarrassed and hesitant to talk to their providers about their condition. This challenge of bringing up obesity as a medical condition is often complicated by patients not knowing which providers to talk to. Patients may not fully grasp the vital connection between their obesity and its related health issues, such as gastroesophageal reflux disease, high blood pressure, metabolic dysfunction–associated steatotic liver disease (previously known as nonalcoholic fatty liver disease), and colorectal cancer. And since weight bias is well documented in many medical offices, patients with obesity might skip medical appointments and not learn that a broad spectrum of recommended treatments are available, ranging from lifestyle changes, behavioral therapy, and prescription medication to endoscopic and surgical procedures.
Obesity is a complex problem that requires a multidisciplinary team for successful treatment. In addition to primary care physicians and registered dieticians, other specialists trained in obesity medicine can play a significant role in a patient’s care team. For example, gastroenterologists frequently encounter patients with serious medical conditions caused by untreated obesity that could be treated or resolved with weight management. When providers can provide a multidisciplinary model of care, patients can have better access to the health care and treatment options that they need.
Patients with obesity should also feel confident that the treatment their provider recommends will be covered by their insurance plan. Unfortunately, many of the most effective obesity treatment options are not covered by insurance plans and current Medicare guidelines. Although Medicare recently extended Part D coverage for one obesity medication, that coverage is limited to instances when the medication is prescribed to treat cardiac disease. While this is a step in the right direction, tens of millions of Americans are still unable to access the care they vitally need to treat obesity. Patients should also feel empowered to ask for a referral to an obesity medicine specialist so they will know that their complex disease will be treated as seriously as other medical conditions.
We shouldn’t delay access to treatments that can improve the health and quality of life for millions of Americans. We all have friends and family who are affected by the disease of obesity. This legislation would be an important first step to increasing access to obesity treatments and ultimately reducing health care costs. It’s time for Congress to pass TROA. We urge everyone to join our efforts to spread awareness and education to support advocacy for essential treatments.
Pooja Singhal is a gastroenterologist. Patty Nece is a patient advocate.
