Updated Feb 18, 2023 - Axios Events

The health care system rethinks obesity

Illustration of a measuring tape around a pill bottle.

Illustration: Shoshana Gordon/Axios

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

Why it matters: That shift is opening new treatments and better care — but also new controversies over who can access those treatments and how best to use them.

What they're saying: "Obesity is a highly prevalent chronic disease characterized by excessive fat accumulation or distribution that presents a risk to health and requires life-long care. Virtually every system in the body is affected by obesity," six obesity advocacy organizations recently wrote in a joint statement.

  • "Every person with obesity should have access to evidence-based treatment."

Driving the news: An existing class of diabetes drugs has shown enormous promise for weight loss, offering a ray of hope to the millions of Americans with obesity.

Yes, but: Many insurers, including Medicare, won't cover those drugs for weight loss. And they can be unaffordable without insurance coverage.

  • Wegovy, which is approved for weight loss under certain conditions, has a list price of $1,349 for a month's supply.
  • "A majority of my patients can't afford to pay $1,300 a month, especially for a medication that they need to be on long term," Veronica Johnson, an obesity specialist at Northwestern Medicine in Chicago, told NBC News.

The other side: Kristine Grow, a spokesperson for America's Health Insurance Plans, recently told Axios that the therapies have limitations and "have not yet been proven to work well for long-term weight management and can have complications and adverse impacts on patients."

  • The same class of drugs also can be misused. Some digital health startups are advertising and prescribing the drugs to people who aren't overweight, the Wall Street Journal reported this week.

Between the lines: The treatment landscape is changing rapidly for children as well as adults.

  • New guidance released last month by the American Academy of Pediatrics recommends against delaying obesity treatment for children, and argues that doctors should be proactive about approaches like intensive health behavior and lifestyle treatment and, in some cases, prescription drugs or surgery.
  • But the guidance is already drawing pushback. Eating disorder specialists, for example, are warning that it could backfire, NPR reported this week.
  • "We run the risk of doing significant harm to kids who are 6 or 8 by telling them that they have a disease ... simply based on their weight status," Kim Dennis, an eating disorder specialist, told NPR.

What we're watching: An unusual array of interest groups is already pushing for Medicare to cover the drugs for obesity, STAT reports.

  • And more broadly, the existence of an effective treatment raises big questions about how to prevent yet another prescription drug from becoming commonly misused — and how to balance access to obesity treatment against the risks of perpetuating a stigma.
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