Missing the Human Dimension of Obesity

Yesterday, the Institute for Clinical and Economic Review conducted an impressive public hearing on the effectiveness and value of obesity medicines. ICER deserves credit for developing a complex and remarkably transparent model for objectively evaluating this. However, caution is necessary. This model is sufficiently complex to obscure two important facts about obesity and its treatment. First, the human dimension of obesity runs very deep. Second, though people like to imagine there’s a single best fix for this challenge, one size does not fit all.

Real People,
Not Economic Abstractions

Regarding the human dimension of obesity, ICER clearly reached out to advocates for people and communities living with this complex and chronic disease. They deserve credit. However, their model does not fully capture the human dimension of obesity and the profound effects of untreated obesity upon the lives of the people who have it. In fact, it seems that it primarily emphasizes cardiovascular events.

Anyone who is living with obesity will tell you that cardiovascular events are distant threats that do not match the daily effects of obesity on their lives. In reading the subjective narrative of the evidence report, it is not clear that its authors really understand this dimension, because it is not reflected in the report.

One Size for All

The other major factor to consider is that for obesity care, one size does not fit all. This is because of the heterogeneity of the disease, its response to treatment, and the great diversity of needs in the people living with it.

In contrast to that reality, the ICER report is written in such a way that summaries of it suggest the report “affirms Qsymia as the most cost-effective obesity treatment.” Here we quote the Associate Editor of Endpoints News. But his words are typical of most reports on this effort by ICER.

Limiting Options When More Are Needed

We agree strongly with the Black Women’s Health Imperative about this report. They have suggested that ICER should do much more to account for the under-treatment of obesity, its health impact, and the diverse needs of people and communities living with obesity. We need more, not fewer, options for coping with obesity. As written, many health plans and providers will use this report as an excuse for limiting those options.

This will be a tragic mistake.

Click here for more on this project from ICER and here for further perspective.

Numbers in Love, painting by Giacomo Balla / WikiArt

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September 17, 2022