A System of High Prices, Stigma, and Inequity in Obesity

Nope, says Dr. Alissa Chen. Medicare shouldn’t start covering obesity medicines. Her dad, 72, has obesity that began when he was in grad school and has persisted throughout his life. Now he has the cardiovascular disease that often results from untreated obesity. But no, she doesn’t want him to receive treatment with advanced medicines proven to reduce these complications. “I’d rather he try cutting back on late night snacking before taking repeat injections.” Friends, this is the flawed thinking that a system of high prices, stigma, and inequity produces.

High prices set up the presumption that treatment is unaffordable. Stigma gives people permission to think the disease could be cured simply by choosing to snack less. Inequity is the result. People with social and economic privilege opt out of stupid conversations about blame and get treatment. Everyone else goes to the back of the line.

The President Seeks Price Cuts

If Novo Nordisk and Lilly thought that the agitation would fade about prices for obesity medicines that range up to ten times higher in the U.S. compared to prices elsewhere in the world, they were terribly mistaken. Yesterday, the American President joined the chorus of people who say these drugs are no good if people cannot afford them. “Novo Nordisk is charging the American people unconscionably high prices for these prescription drugs.” He went on to say that Lilly is doing the same thing.

No, the price issue is not going away. These drugs came into a broken system for drug pricing that encourages high list prices so that pharmacy benefit managers can earn a big rebate for letting them into the drug plans they administer. Call it an incentive or call it a bribe. It’s how the system works.

But now, it’s clear that these drugs have benefits to offer a very large population and specialty drug pricing for them longer makes sense. Sound policy says the price should come down. Greed says not so fast.

Stigma Gives Implicit Permission

The stigma of obesity makes it possible for companies to drag their feet instead of embracing more equitable pricing quickly. Writing in the American Journal of Preventive Medicine, Rebecca Pearl and a long list of colleagues explain:

“Derogatory attitudes and beliefs contribute to the societal devaluation and mistreatment of
individuals with a high weight, or weight stigma. Weight stigma includes social exclusion,
derogation, discrimination, and overall unfair treatment due to weight or size.”

Senior author Fatima Cody Stanford explains how the harm of stigma in obesity adds to inequities:

“Obesity and related conditions have a greater impact on marginalized groups, leading to further
health disparities. The result is a staggering burden of disease and yet poor access to care.”

Fix the System

It will not be easy. But it certainly is possible and imperative to fix the system. Without correcting high prices, health stigma, and inequity, we cannot overcome the burden of obesity.

Click here the publication by Pearl et al and here for the commentary by the President. For further perspective on equity, stigma, and obesity, click here, here, and here.

Sky Blue, painting by Wassily Kandinsky / WikiArt

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July 3, 2024