ADA2024: How Big Is the Problem with Scale for Obesity Care?

One thing is plain to us in the huge showing of interest in obesity at the American Diabetes Association Scientific Sessions (ADA2024). The scale of opportunity is large because the unmet medical need is great. And yet we face a tremendous problem of scale for coping with the need for obesity care. We have problems with scale in four dimensions: systems for care, pricing, supply, and access.

Daniel Drucker, whose research research on GLP-1 provided an important spark for the progress we’re seeing, sums up the challenge we face in a new review:

“For the full benefits of these medicines to be realized on a global scale, considerable ongoing investment in and attention to cost-effective manufacturing and improving the supply chain are required to increase equitable access and lower cost. It would be shameful to conclude, once the final story of GLP-1 medicines is written, that their potential to improve global health remained unfulfilled, due to persistent challenges with equitable pricing and universal affordability.”

Systems for Care

Let’s start by saying it plainly. The systems are rigged for inequity in obesity care. This has many reasons. First of all, healthcare is notoriously inequitable. People with the greatest need often get the least access to care. For the most prevalent chronic disease in the world – obesity – it would be surprising if this were not true as well.

But in fact, the systems are rigged even more for people living with obesity. In his presentation on the merits of behavioral programs for obesity at ADA2024, professor David Marrero articulated the prevailing bias about obesity and its treatment with new obesity medicines:

“This became the drug du jour. We’ve all heard the stories of the famous people who are stars and wealthy folks in Hollywood. They discovered this and said, ‘oh yeah, I want this drug. I don’t want to have to work at a lifestyle intervention. I just want to knock the weight off.’”

This is a perfect distillation of the weight bias in healthcare. People seeking medical care for obesity are like lazy Hollywood stars who don’t want to work at lifestyle changes. It is pernicious. Because of this attitude, the system is rigged against people who need medical care for obesity.

Pricing

The rigging begins with pricing that ensures only wealthy and well insured people have a shot at receiving medical care for obesity. Pharma sets a high list price on obesity medicines – a premium for the versions they sell for an obesity indication. This is exploitation, plain and simple.

Supply

An inadequate capacity to produce these drugs reinforces the constraint of high price. Both Lilly and Novo Nordisk claim to be investing billions to scale up production. Perhaps this is a “best effort,” but the fact is that they are falling far short of meeting demand – even at extraordinarily high prices.

So then we see compounding pharmacies step up to fill the gap – but more often than not with sketchy products of dubious quality and safety.

Access

Thus we have a situation where the scale of systems for obesity care is so inadequate that access to care is unavailable for the overwhelming majority of people who need it.

It is unmistakable. The top three challenges for obesity care are scale, scale, and scale.

Click here for Drucker’s review article and here for more on the problem of access to care for obesity.

The Letter Scale, painting by Gosta Adrian-Nilsson / WikiArt

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June 24, 2024