The Goldfish

Obesity Care for the Few and the Wealthy

It’s nothing new. Overwhelmingly and for a long time it has been true that obesity care is mainly available to the few and the wealthy. This is the inevitable result of multiple forms of bias that collide in the chronic disease of obesity. Healthcare has a bias for serving the the wealthy. Health systems also have a well-documented and systemic racial and ethnic bias that denies a decent standard of care to Black, Hispanic, indigenous, and other disadvantaged groups. And then finally, weight bias is at work, amplifying these biases.

The result is that, for the most part, obesity care serves the few and wealthy.

Behavioral Interventions for People with Time and Money

For decades now, the mainstay of obesity treatment has been intensive behavioral therapy. In other words, highly structured programs coaching people to adopt a healthier lifestyle. This typically involves participating in roughly 22 to 26 sessions over a period of a year – weekly at first, then every other week, then monthly. For many people with limited time and money, participating in a program like this is a luxury they cannot afford.

Writing in the Journal of Racial and Ethnic Health Disparities, Loneke Blackman Carr, Caryn Bell, Candice Alick, and Keisha Bentley-Edwards describe it plainly:

“Behavioral weight loss interventions are an efficacious treatment for obesity, but consistently, Black men and women are minimally represented, and weight loss outcomes are less than clinically significant thresholds.”

For many people living with significant social and economic disadvantages, get a new lifestyle is not a terribly realistic option. It’s little wonder that disadvantaged groups rarely access these programs.

Advanced Treatment – for a Price

Writing in the Washington Post, Laurie McGinley and Lenny Bernstein explain that the availability of breakthrough drugs for obesity is putting a spotlight disparities in obesity care. They explain:

“The high costs [of new obesity meds] appear destined to increase the rampant disparities in weight-loss medicine, in which many drugs and services are available only to those who can pay out of pocket.”

Obesity medicine physician Robert Kushner says these new meds could be game-changers. But he calls out the overwhelming issue:

“The number one distressing and upsetting issue when it comes to these medications is that the population most in need are unable to afford or have access to it.”

This problem is not new. Leah Hecht and colleagues document disparities in bariatric surgery that pre-date the availability of advanced medicines for obesity.

But it’s wrong and it’s foolish. Because health systems are consumed with treating the complications of untreated obesity. And all this disparity, all this neglect of medical needs, results in a waste of human potential.

The question should not be can we afford to treat obesity? It should be can we afford the suffering and loss of productive lives that comes from denying people care?

Click here for the paper by Carr et al, here for the reporting of McGinley and Bernstein, and here for the Hecht research. For additional papers on this problem, click here, here, and here.

The Goldfish, painting by Paul Klee / WikiArt

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December 27, 2022