IBM 360 Computer at the NSA in 1971

Can We Afford Optimism About Treating Obesity?

“Can’t never could.” This old bit of Southern American wisdom aptly describes one of the startling reactions to impressive progress in obesity treatment – “we can’t do this. It will cost too much.” This reaction has been part of the landscape of obesity care for some time, so it should not be startling. But when it comes from folks who are keenly intent on providing obesity care, it does startle us. Reacting to a editorial by John Morton, a number of folks responded with how would we ever pay for this? But let’s take this question seriously. Can we afford optimism about treating obesity?

Should we worry that obesity treatment will wind up costing us 1.7 trillion dollars annually in the U.S., as Dariush Mozaffarian suggested earlier this year?

A Moonshot for Obesity Treatment

Let’s be clear. We refuse to sign up for the no-we-can’t school of thinking about obesity care. Optimism about the future of medical care for obesity – including scalability and affordability – is not only reasonable, but also essential for progress. This is what a moonshot is all about and a moonshot for obesity treatment is what Morton suggested in his editorial:

“Treating obesity is our healthcare moonshot. If we accomplish this mission, our destination will be increased quantity and quality of life with less cancer, heart disease, diabetes, and even COVID-19 complications. To accomplish this goal, we need to treat obesity seriously.”

The Economics of Innovation

Assuming that innovation is unaffordable is a stealthy way of expressing indifference. With the original moonshot, we had no idea how we would do it or what it would cost. The commitment to do it came first.

But more important, the innovation that emerged eventually led to amazing advances in affordable and efficient computing power. The IBM 360 computer in 1971 cost two million dollars or more. Today, we have far more computing power in our smartphones than we had in one of those computers.

Back then, IBM had a stranglehold on the market for computing and kept those prices high. Both innovation and regulatory pressure brought them down. That’s why we now have massive computing power in our pockets.

Can’t Never Could

Without a doubt, we have issues in the U.S. market for healthcare and obesity treatment that give us high prices. But this is not our fate for all eternity – if we expect and work for something better. Right now, semaglutide for obesity costs ten times more in the U.S. than the U.K. This should not be.

Drug companies know that change is needed, though it’s no simple matter. Recently, the CEO of Eli Lilly responded to a fake tweet about making insulin available for free by saying:

“It probably highlights that we have more work to do to bring down the cost of insulin for more people.”

Can we make highly effective obesity care available and affordable? Yes, with commitment, persistence and optimism, we can.

Click here for the editorial by John Morton. For further perspective, click here.

IBM 360 Computer at the NSA in 1971, photograph by an unknown U.S. Government Agent / Wikimedia Commons

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November 25, 2022

4 Responses to “Can We Afford Optimism About Treating Obesity?”

  1. November 25, 2022 at 9:13 am, Allen Browne said:

    It has been shown that patients who control the disease of obesity with metabolic-bariatric surgery (MBS) and healthy living lower their health costs to below the health costs of those who do not control their obesity. Even with the up front cost of MBS the lines cross at about 3 years post op. And this ignores the increased economic productivity of those who control their obesity. And now we have a new generation of medications which can approach the power to control obesity of MBS. Any lack of optimism is bias and stigma.

    Let’s go! Obesity is just a disease and we can control it, improve the quality of life of those who have it, and it will be an economic win. Do the math – the cost of treating the over 230 obesity related diseases and the decreased economic productivity vs the cost of MBS or anti-obesity medications or combinations. It’s “no-brainer” held up by bias and stigma.


  2. November 27, 2022 at 7:55 am, John DiTraglia said:

    I agree we are really close and making obesity go away will make heart disease, stroke, type 2 diabetes, and hypertension mostly go away too and internists will have be uber drivers.
    There is another interesting quirk here. As complicated as obesity is, we still don’t even understand the cause or how the treatment works, but the cure is curiously and ridiculously simple.

    • November 27, 2022 at 12:35 pm, Ted said:

      While I agree we have some much better options, I’m skeptical about a “ridiculously simple” cure. What can seem simple for one person often turns out to be a bit more complicated or elusive for the next.

  3. November 29, 2022 at 10:58 am, Allen Browne Email said:

    Unfortunately there is no cure, control is complicated, and we are making control very elusive