Samuel Beckett Bridge and the Convention Centre Dublin

ECO2023: Obesity Care Advances Meet Reality

It is impossible to miss. At ECO2023, we are seeing tremendous excitement about advances in obesity care – mixed with concern about what happens when those advances meet with reality.

As ECO2023 unfolds, we’re hearing more about the advances that new obesity medicines are offering, but we’re also hearing reminders about the gap between the potential of those medicines and the reality of systems for providing obesity care. It is very constrained.

Getting from Zero to 100 for Youth and Adults

Just yesterday, Aaron Kelly and colleagues published a new analysis of data on semaglutide in adolescents. He’s presenting it today at the meeting. They found that it cut the number of teens with obesity almost in half after 68 weeks of treatment. Among teens with obesity receiving semaglutide, 45 percent fell into the categories of overweight or normal weight at 68 weeks. For those who received only placebo plus diet and exercise, only 12 percent reached that status. The number with class 3 (severe) obesity came down from 37 percent to just 14 percent. On placebo, that number actually grew.

Kelly summed it up saying, “Semaglutide is transformative for many children who are able to get access. It can be life-changing.” Also yesterday, we learned the the European Medicines Agency has quietly added use in adolescents to the approved indications for semaglutide.

But the rub comes when we look to the reality of how few youth can get access. Right now, costs are high, coverage is low, and resources for delivering care is limited. Parents and pediatricians alike are struggling to get used to the idea that obesity really is a complex chronic disease. Not to mention the problems Novo Nordisk is having with delivering an adequate supply of this advanced obesity medicine.

The problems are similar for adults with obesity, though perhaps slightly less extreme.

Closing or Widening Disparities?

Perhaps the most vexing problem with the intersection of these advances with reality is the problem of disparities in obesity. We’ve noted before that access to obesity care is most likely only for the few and the wealthy. For the poor and the marginalized, the unfortunate impulse is to inflict cruelty all too often. So access to care is poor and payers obsess about costs while scheming to deny access with increasingly bizarre rationales.

In the opening plenary Michael Marmot gave a compelling account of how much work we must do to close these disparities. “To tackle obesity, we must tackle inequality,” he said. “Don’t blame their diet, blame their poverty.”

And yet we hear voices persist in claiming that if we sufficiently tax the food that poor people eat (adding to financial stress), it will surely solve the problem. We can only shake our head.

The challenge is great, but every one of us has a role to play in overcoming it. Obesity medicine physician and advocate Fatima Cody Stanford tells us:

“We have to be advocates for those with less access. More than a third of my patients have low socioeconomic position. It takes an effort, but I am able to get them almost everything.”

Let’s resolve to be better humans.

Click here for Kelly’s new paper on semaglutide in teens and here for more from Marmot on the heath gap of inequality.

Samuel Beckett Bridge and the Convention Centre Dublin, photograph by Ted Kyle / ConscienHealth

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May 18, 2023