The saying goes, “an ounce of prevention is worth a pound of cure.” But what happens when it’s too late to prevent a chronic disease? No amount of prevention is enough for the tens of millions across the country who already live with obesity.
If we want to support people with obesity, the weight loss debate must stop conflating obesity prevention with obesity treatment. Instead, we should focus on the tools that best solve the needs of people where they are – just as we would for cancer or diabetes – by making the most effective treatments possible available.
We can do this because the obesity medications dominating the zeitgeist (i.e. Wegovy) aren’t just headlines. They are truly remarkable treatments that can, for the first time, help huge numbers of people lose weight and improve their health. And there’s still more to come, as clinical trials continue to evaluate new obesity medications with results that are nothing short of mind-blowing.
Treating a disease doesn’t mean ignoring its root causes. Investment in both prevention and treatment are essential for public and individual health. Right now though, these advancements in treatment give us an incredible chance to do right by those who live with obesity and suffer from its consequences each day. Here’s how we can do that.
Be honest about the role and limitations of diet and exercise
Let’s be clear. Diet and exercise are irreplaceable contributors to someone’s overall health with wide-ranging positive effects – not limited to, improving heart health, preventing chronic disease, and supporting one’s mental health. A healthy diet and regular exercise are also good methods of maintaining a healthy weight – especially when combined together.
However, people often struggle to lose weight through these methods. This difficulty is due to both real-world and science-based factors At the population level, research shows that people struggle to sustain the high levels of physical activity and adherence to a calorically restrictive, yet still nutritious, diet over the long term. And even when they do, our bodies’ natural response can be to fight to maintain weight rather than lose it, creating a tug-of-war that negates progress.
To help more people with obesity lose weight and keep it off, we must educate them as well as their doctors about the best role for diet and exercise to play: as support, but not as a replacement for treatment. Unfortunately, providers are not immune from harboring weight bias, and often our training doesn’t include education on the science or treatment of obesity.
Diet and exercise should be part of a comprehensive approach to obesity treatment, inclusive of provider-led care and, when appropriate, prescription medication. They shouldn’t be the sole weight loss methods for people with obesity.
Expand insurance coverage of obesity treatment
Obesity may be formally recognized as a disease by the federal government as well as leading provider and clinical organizations, but that hasn’t ended widespread stigma and bias against it. Even someone who is fortunate enough to find a provider who is knowledgeable and available to deliver obesity care may face an uphill battle in getting their treatment covered by insurance.
Some insurers may misunderstand obesity – labeling it as a lifestyle problem and its treatments as ‘vanity drugs’. However, insurers are also worried about their bottom lines. Today, a minority of employer-sponsored health plans cover prescription obesity treatment. Similarly, only 10 states include broad coverage of prescription obesity treatment in their Medicaid plans, and Medicare is prohibited from covering weight loss medications entirely.
It’s time for this to change. The evidence shows that new prescription medications are the most effective treatment option aside from surgery, and medications are far easier to make available at scale. No other chronic disease – particularly one as prevalent, serious, and costly – would have to fight for coverage of such effective, potentially life-saving, treatments. Patients, providers, and policymakers alike should be in support of broad insurance coverage of obesity treatment.
Measure the true value of obesity treatment
The distinction between prevention and treatment is important to denote. But, it’s also true that obesity treatment can help prevent downstream health risks and complications.
More than 200 conditions have been linked to obesity – including many of the leading causes of preventable death. For instance, obesity contributes to up to half of new Type 2 diabetes cases in the U.S. annually. The immense human costs of obesity are matched by the financial costs. The CDC estimates $173 billion in direct medical costs of obesity annually plus up to $6.38 billion annually in additional productivity costs. Other sources point to these numbers as too conservative and state that the true cost is even higher.
Measuring obesity treatment in numbers on the scale shortchanges its value. People with obesity know this, their interest in weight loss and obesity treatment stems from a desire to improve their overall health and live longer, healthier lives. And new evidence shows that this is possible, as Novo Nordisk’s Wegovy showed a 20% reduction in risk for major cardiovascular events like heart attack and stroke – which are among the top causes of death. The healthcare system, too, should weigh the value of treating obesity for its ability to improve someone’s quality and quantity of life.
There’s no doubt lots of room for improvement in the ways in which we prevent and treat obesity in this country. We cannot afford to fall further behind on either front. Part of this improvement will come from distinguishing what effective prevention looks like, what effective treatment includes, and taking the opportunities presented to advance each. At the moment, that’s the chance we have to improve treatment for people with obesity – changing their health and lives for the better.
Photo: Peter Dazeley, Getty Images