Access to Obesity Care: The View from Australia

It’s not just America. The emergence of a highly effective medical treatment for obesity is scrambling the usual approach to obesity all over the world. Because of the disconnect between the biological reality of obesity and popular misconceptions of this disease, healthcare systems typically put people off from getting medical care for it. That approach, though less than optimal, worked when the only highly effective option was daunting – bariatric surgery. But the experience with semaglutide in Australia offers a vivid picture to explain why poor access to obesity care simply will not work when good medical treatments are available.

Prioritizing Diabetes Care Over Obesity Care

People have a hard time wrapping their heads around the idea that obesity is a complex chronic disease. It’s not a behavior. Nor is it a choice that people make. Behaviors and choices can have effects for better or worse, but they don’t drive the pathophysiology of this disease. What drives it is the function of bodies to regulate fat tissue. Type 2 diabetes is a closely related disease that’s all about regulating glucose metabolism.

One hundred years after the discovery of insulin, medical systems and the general public understand that diabetes is a disease. Not so with obesity. It’s been less than 30 years since the discovery of leptin, a key link in the metabolic chain that regulates fat tissue. So the public understanding of obesity is still very much tied to issues of behavior and food. Medical care for obesity gets far less resource than care for complications arising from untreated obesity – like type 2 diabetes.

People with obesity had to deal with it on a DIY basis, while a diagnosis of diabetes would get people to the front of the line in medical care.

Demand for Semaglutide in Australia

Neglecting obesity doesn’t make the medical need for care of it go away, though. So the emergence of semaglutide as highly effective option for obesity care has people seeking it in Australia. Even though it’s not yet approved for obesity there.

That’s a problem for the medical system in Australia. It has always said diabetes care must come first. So obesity care has had to wait. But people whose lives are severely affected by obesity are not content to wait. Many of them are lining up for semaglutide and the demand for this very helpful and versatile drug is outpacing the ability of Novo Nordisk to supply it.

Thus, the Australian government is warning doctors to back off. It’s asking them to stop using semaglutide for obesity while the supply is short. Otherwise, patients who need it for diabetes won’t have enough.

The order of things will have to change, as endocrinologist Priya Sumithran explains:

“The last few years have seen a huge change and optimism in the field of diabetes and obesity in what is available and what is going to be possible. We now have several good treatment options imminent. However, the big question now is whether patients will be able to afford to access them.

“The way we fund or reimburse these medicines will need to change if people are going to be able to benefit from them equitably.”

Unmet Medical Need

In Australia and all over the world, medical systems have long ignored the unmet need for obesity care. The options weren’t great, so bias that patients are at fault and undeserving carried the day.

Now that better options are available and more are coming, the order of things will have to change. Health systems will have to step up to provide better access to obesity care.

Click here and here for further insight.

Sketches of Figures for ‘The Founding of Australia’, painting by Algernon Talmage / WikiArt

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July 1, 2022