Serious Stuff

A Modest Proposal: Treat Obesity Seriously

We have a chronic disease problem. It started in America. It’s spreading all around the world. And already in the U.S. it’s playing a major role in reversing long-term gains in life expectancy. Yet, the response has been tepid, says William Dietz with two commentaries published in the last month. Dietz is Director of the STOP Obesity Alliance at the George Washington University. He poses a key question. Isn’t it about time to treat obesity seriously?

Under-Treatment

Because obesity is a chronic disease, we don’t have cures. What we have are tools that can be effective for managing it like a chronic disease. But we’re not using those tools. Since 2012, four new, safe, and effective medications for obesity have gained approval by meeting the rigorous standards of FDA. However, a study published last month in Obesity tells us that these drugs get very little use.

Researchers looked at patient records for two million patients across eight large healthcare organizations who meet NIH criteria for treatment with these meds. But less than 30,000 of them ever got a prescription. If you look at candidates for bariatric surgery, you will find similarly low rates of utilization. Only about one percent of patients who might benefit from surgery get it.

Dietz says that this sad state of affairs comes from multiple factors converging. Providers often neglect to diagnose obesity. Patients don’t ask for treatment. Gaps in provider knowledge, attitudes, and skills for obesity care also get in the way. Finally, time and cost considerations get in the way. Coverage for obesity care is patchy. Resolving these problems will not be easy, says Dietz:

Resolution of the conundrum will require the integration of multiple strategies, including empowerment of people with obesity to demand appropriate and effective care, overcoming bias and stigmatization, documentation of obesity, shared decision‐making about care with competent providers, adherence to a standard of care, and inclusion of pharmacotherapy in health plan formularies.

The Broader View

Dietz takes a broader view with his commentary in The Hill. We simply have not responded seriously to the slow burn of this relentless epidemic. Yes, we need treatment, he says. But we need an investment in serious prevention for obesity, too. So far, the efforts have been weak and, too often, grounded in bias about what ought to work. When we begin to treat obesity seriously, we will demand prevention that really works with hard evidence to back it up. Presumptions aren’t good enough. Says Dietz:

The obesity epidemic is an epidemic of a long-term chronic disease, but this difference must not be allowed to temper the urgency of our response. Hundreds of thousands of lives are at stake.

Click here and here for the commentaries by Dietz. Click here for the utilization study of anti-obesity medicines.

Serious Stuff, photograph © Chris Bird / flickr

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December 2, 2019

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