60 Minutes: Obesity Care in a Broken Health System

On 60 Minutes last night, Lesley Stahl reported in vivid detail just how hard it is to get good obesity care in our broken system for healthcare. She had help. Two of the world’s top obesity medicine physicians – Fatima Cody Stanford and Caroline Apovian – took viewers into their clinics. Two of Apovian’s patients – Maya Cohen and Nicole Sams – brought their experiences of living with obesity and seeking care into focus. All of this in just a little more than 13 minutes.

The bottom line on all of this is frustration. We have new knowledge and clinical tools to improve the health and the lives of people with obesity. Yet we have health systems calibrated to deny people care.

Misunderstanding and Bias

Stanford pointed out that obesity is a disease that starts in the brain, where the body regulates appetite, metabolism, and fat storage. But most health professionals don’t understand this because medical schools often neglect the subject. So they implicitly blame the patient with obesity. Stanford explains:

“The number one cause of obesity is genetics. That means if you were born to parents that have obesity, you have a 50-85% likelihood of having the disease yourself even with optimal diet, exercise, sleep management, stress management. So when people see families that have obesity, the assumption is, ‘Ugh. What are they feeding those kids? They’re doing something wrong.’”

That bias is so pervasive that even people living with obesity come to blame themselves. Sams describes her reaction when Apovian told her that it was physiology, not willpower, that is responsible for obesity:

“I looked at her and I said, ‘I don’t believe you. What do you mean, it’s not my fault? It is my fault.’ Because it’s what I heard for my entire life.”

Systems to Deny Care

With the default being to assume patients must bear the blame, health insurers can easily get by with denying real medical care for obesity. Apovian describes the excuses she receives from insurers for denying coverage:

“I receive emails about denials that state that we’re denying this because ‘the doctor has not counseled the patient on behavior change as part of this.’ That’s where the stigma of obesity comes in with the idea that the patient can do it with diet and exercise. You would never do that to a patient with hypertension or heart disease or Type 2 diabetes. You would never tell them ‘Just don’t eat sugar, you’ll be fine.’”

Denying coverage for obesity might hurt a patient, but it provides an immediate benefit to the health insurer – financial profit.

Wildly Expensive in Short Supply

Stahl describes these new drugs as “wildly expensive.” She says without insurance coverage, few of the people who need them most can receive them. Stanford explains:

“We have a national shortage on these medications. Those that have the means are able to get them. Yet people who really need them are unable to. That creates a greater disparity.”

We’re grateful for every person who put the time and effort into this concise report. For a wide and diverse audience, it captures both the promise of advances in obesity medicine and the frustration of health systems that can’t deal with it.

You can find this 60 Minutes segment here, along with additional segments on the science of new obesity meds here and the shortage of semaglutide here. For further perspective on how health systems skew obesity care for the few and the wealthy, click here.

Obesity, Leslie Stahl on 60 Minutes / CBS News

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January 2, 2023