Absurdity Flying

Absurd Arguments About Cost of Obesity Care

Recently, we have written much about the high cost of obesity medicines, limited coverage under health plans, and the need for change. This is a very real problem and glaciers melt faster (sad to say) than policy makers make progress on this. But absurd arguments about the cost of obesity care do not help.

In the New England Journal of Medicine this week, we have one such absurd argument set forth. Khrysta Baig and colleagues tell us that if 100 percent of Medicare beneficiaries with any degree of obesity took advanced obesity medicines continuously for the rest of their lives at current prices, the cost would be unacceptably high.

The only problem with that logic is that the scenario is wildly unrealistic. The prevalence of use, the duration of that use, and the persistence of high prices are all disconnected from reality. So let’s talk about those wild assumptions.

100 Percent Utilization

Among the assumptions in this viewpoint, this is certainly the wildest – the most radically disconnected from reality. There is no way ever that anything approaching 100 percent utilization of obesity medicines by everyone with any degree of obesity could ever come to pass.

For one thing, most people with obesity will quickly tell you that obesity is not a condition that they have. They just want to lose a little weight, preferably by cutting back on food and heading to the gym more often. So, far less than 100 percent of people with obesity even think about stepping up to consider taking an obesity med.

Then there are the pervasive systemic biases against providing obesity care. Providers don’t want to spend time on this subject because it’s tricky and time consuming. On top of that, payment for delivering this care is often poor.

For these and many other reasons, the utilization of obesity care is most often closer to one percent than one hundred. In fact, Medicare currently is already supposed to pay 100 percent for intensive behavioral therapy for obesity to prevent diabetes. But less than one percent of the people who need it, get it. The system is rigged to keep people from getting obesity care.

So no, nothing close to 100 percent of people with every degree of obesity will ever take these meds.

Most People Don’t Keep Taking These Meds

The second huge problem with these utilization numbers is the presumption that everyone will take them all the time, forever. Not gonna happen. The average duration of use for obesity meds is 81 days.

Among the many reasons for this, two stand out. First, people don’t like taking these drugs. So unless they’re getting noticeable benefits and negligible side effects, they stop. Second, people have a hard time recognizing that obesity is a chronic disease. Thus, many people lose weight and falsely expect that it should never come back, even if they stop taking the meds. They talk themselves into believing that all they have to do is be careful and they can keep the weight off.

Competition Must Bring Costs Down

The third problem is the assumption that costs of these advanced meds will stay high forever. Now admittedly, there are big problems with drug prices in the U.S., so high prices can be sticky. But over time, policy makers and market forces can bring these costs down. They’ve done it before. They can and will do it again. Many new drugs are coming into this market. Generic equivalents (biosimilars) will start appearing next year.

Doing Nothing Is Easy, But Unacceptable

The viewpoint by Baig et al adds up to an argument for doing nothing. That’s easy. But business as usual for obesity care means that only the few and the wealthy have access. Status quo is unacceptable. The cost of untreated obesity and its complications is too great.

Click here for that NEJM viewpoint.

Absurdity Flying, etching by Francisco Goya / WikiArt

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March 14, 2023

2 Responses to “Absurd Arguments About Cost of Obesity Care”

  1. March 14, 2023 at 6:33 am, Joe Gitchell said:

    Ted – I appreciate that even you can’t do everything, but you should consider posting either a link to this conscienhealth post or copy/paste this critique in (or both) to PubPeer (link below)

    Your points seem like the kind of issues that could’ve arisen in peer review, but at least now there are ways to provide these criticisms post-publication and so other readers can consider them, too.



    • March 14, 2023 at 7:18 am, Ted said:

      Thank you, Joe. Good suggestion.