The Rising Call to “Treat Obesity First” Starts to Resonate

We are witnessing something rare. It is a sweeping change in how people are looking at a whole spectrum of chronic diseases. They all tie back to obesity: hypertension, high cholesterol, diabetes, many cancers, liver disease, kidney disease, and joint disease come quickly to mind. Most of the time, the change in perspective comes in subtle increments. They point to a rising call to treat obesity first.

Today we see a strong signal in the Washington Post as Leana Wen, an emergency physician with no particular ties to the specialty of obesity, says it plainly for policymakers to hear:

“Health care is undergoing a major paradigm shift. Some clinicians are shifting away from treating chronic conditions such as hypertension, heart disease, diabetes, back pain and fatigue – long the bread and butter of primary-care medicine – and toward targeting their common root cause: obesity.”

Radical Change

If you want a reminder of how radical this shift in thinking really is, consider the words of Arthur Frank. He was an early pioneer of obesity medicine who wrote in JAMA:

“Twenty years ago, I changed course in my internal medicine practice and decided, rather deliberately, to work on the problem of obesity. My friends, my colleagues, and my family thought I was crazy. The warnings were clear. ‘Don’t risk your credibility and your career, don’t venture into a part of medicine that no one takes seriously, don’t move into the world of quacks and charlatans.’”

He wrote that 30 years ago. It’s barely been ten years since the American Board of Obesity Medicine formed for board certification in this field. Our own experiences with policy makers dismissing the idea of treating obesity are even fresher. Just a few years ago, bright young persons in Washington would push back on calls for access to care. They offered only platitudes about “personal responsibility” and “behavior change.” But now they are looking for ways to fund obesity care.

Can Health Policy Keep Up?

Wen closes by asking if health policy can keep up:

“The next part of this transformation is now happening. How much ‘obesity first’ will become the norm depends on whether effective treatments will be made widely available. In my view, how to pay for obesity medications is one of the biggest health policy challenges facing the United States.”

This implies a challenge for Pharma to provide adequate supplies at reasonable prices. It is a challenge to health insurers to catch up and stop looking for excuses to prevent the delivery of obesity care. They must clear the way and encourage providers to treat obesity first.

Preventable chronic diseases are crushing health systems all over the world. In large part, this is because they have been treating obesity last or not at all. Seeing movement toward reversing that mistake is truly exhilarating.

Click here for free access to Wen’s essay in the Post. For further perspective, click here and here.

First Train in Feodosia, painting by Ivan Aivazovsky / WikiArt

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October 2, 2024