Obesity is a chronic condition that affects millions of Americans. It’s also a significant risk to cardiovascular diseases, a leading cause of mortality. Despite implementing state and local programs addressing the issue, the rates of obesity remain high.
Why? One reason is the restricted access to treatments. To build a healthier America, the government must partner with organizations and insurers to increase the availability of obesity medications and take an aggressive approach to controlling this epidemic.
Obesity Rates Are Rising
In 2023, the Centers for Disease Control and Prevention (CDC) estimated that more than one in three adults in 23 states lived with obesity. This is the first time since 2013 that the prevalence of obesity has reached 35%. At least one in five adults in every state lives with the condition.
What does this data suggest? It calls for advancing treatment and prevention strategies, starting with addressing the stigma and bias associated with obesity.
Obesity itself is a complex condition to manage, but it's also a precursor for numerous chronic ailments, like heart disease, stroke, Type 2 diabetes, cancers and respiratory illnesses. Comorbidities are prevalent, which results in even more expensive therapies. Robust prevention measures must be implemented to control the health issue.
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Causes of Soaring Obesity Rates
What factors drive the obesity trend? Here are some of them.
Poor Nutritional Decisions
A survey by the International Food Information Council (IFIC) found that although many Americans consider processed food unhealthy, 70% don't fully understand what processed food is. The survey also found that nutrition drives food purchasing decisions 20% less in low-income households than in high-income households.
The Western diet is another culprit. Despite knowing the benefits of good nutrition, many Americans consume pre-packaged foods because they're convenient. Fast food culture is firmly embedded in society, which increases obesity incidence.
Sedentary Lifestyles
More than one in five adults don't exercise. The rates of physical inactivity across U.S. territories range from 18% in Colorado to 49% in Puerto Rico.
Exercising could prevent one in 10 premature deaths. Despite physicians offering blanket advice to patients about getting more activity, many miss out on their fitness due to lack of time and limited access to safe areas.
Increased Rates of Mental Health Conditions
Depression and obesity tend to coexist, although researchers don't fully understand the complex link between mental health and weight. Individuals diagnosed with obesity had a 55% higher risk of developing depression. Alternatively, those with depression had a 58% higher risk of being obese.
Depression can prompt emotional eating behaviors, using food to cope with difficult emotions instead of satisfying hunger. Additionally, people who feel low and sad are less likely to adopt healthy lifestyles, like exercising. Poor mental health triggers negative habits, like stress eating, which elevates the risk of obesity.
One or a combination of these factors increases the risk of unhealthy weight gain.
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The Less Evident Causes
Some factors that contribute to obesity being an epidemic are less obvious.
Restricted Access to Insurance-Covered Drugs
Limited accessibility to medications that aid in weight loss prevents people from getting adequate treatment for obesity. Because most insurers don't cover many FDA-approved weight loss prescriptions, spending out-of-pocket discourages people from exploring pharmacological interventions to remedy their health problems. As a result, medications become available only to a few people who can afford them.
Some insurers may cover obesity treatments but for a higher premium, leaving others with no choice but to opt for less effective, cheaper alternatives. Others may also include coverage in their policy but require prior authorization and need the patient to meet specific eligibility requirements. All these restrictive layers prevent the availability of obesity treatments.
Counterproductive Diets
Popular culture promises quick-fix solutions to obesity, which can harm a person’s health. Fad diets lead to unsustainable consumption behaviors. Restrictive eating patterns are poor approaches to losing pounds because they contribute to increased body fat or eating disorders. Counterproductive diets may also lead to weight cycling, where body mass fluctuates between losing and regaining weight. These bouts of weight loss and increase are associated with diabetes and perpetuate obesity.
Employers Are Liable to Address Obesity Concerns
Under the Americans with Disabilities Act (ADA), a disability is a condition that limits a person’s ability to accomplish one or more significant activities. Obesity isn't considered a disability unless it coexists with a disabling disease, like diabetes. It’s an impairment and doesn't qualify a person for disability benefits.
However, this could change as more state and federal lawsuits challenge the coverage exclusions for obesity medications and treatments.
Employers are responsible for accommodating the needs of their employees living with obesity. Otherwise, they could face legal issues. Some solutions are providing access to wellness programs, modifying their job responsibilities and offering flexible scheduling for their medical appointments.
Employees can take legal action against the company if it fails to ensure their rights while on duty. For instance, denying a medical leave violates the Family and Medical Leave Act (FMLA). Employees discriminated against because of their weight may also file a legal action with the Equal Employment Opportunity Commission (EEOC).
What About Insurance Providers?
Insurers may or may not cover weight loss, depending on the type of plan. According to a recent study, 18% of larger companies cover glucagon-like peptide-1 (GLP-1) antagonists for weight loss. These injectables help treat obesity. Smaller organizations may exclude GLP-1 drugs because of cost considerations and the lack of evidence of their efficacy.
One reason insurers don't cover GLP-1 drugs is that using them to treat weight problems is considered off-label. Although they can reduce appetite and curb hunger, these IV drugs are FDA-approved only to treat Type 2 diabetes — not obesity.
Fortunately, the FDA recently approved injectables such as Wegovy (semaglutide), Zepbound (tirzepatide) and Saxenda (liraglutide) for chronic weight management. Some insurers cover them if employees meet certain eligibility requirements, such as being diagnosed with high blood pressure, high cholesterol and other obesity-related medical problems. An elevated BMI that classifies a person as obese may not suffice to get drug coverage.
If employees are denied services and treatments because of their obesity status, they may pursue legal action under the ADA. They may also file a breach of contract to court if their policy explicitly includes coverage for obesity drugs, but insurers reject the claims.
If their physicians recommend a medically necessary procedure but the provider refuses to cover it, employees may file an internal and external appeal.
Government Interventions to Decrease Obesity Rates
What does the government do to bring the numbers down? At the federal level, officials monitor obesity trends and related risk factors to understand the disease better. This approach opens up opportunities for novel interventions with a high chance of effectiveness. Additionally, programs like Federally Qualified Health Centers and WIC offer services to support children and families at high risk of obesity.
Meanwhile, state and local agencies prioritize two methods for addressing the issue. One is to promote good nutrition, exercise and breastfeeding in early care and education. Breastfeeding reduces the risk of obesity by 36%-52% during childhood and early adolescence. A second is to cement policies and activities that expand awareness of Family Healthy Weight Programs, which encompass safe and effective treatments for childhood obesity.
Medications Approved for Treating Obesity
The FDA has approved six drugs to remedy overweight and obesity. They are:
- Xenica and Alli (orlistat)
- Qsymia (phentermine-topiramate)
- Contrave (naltrexone-bupropion)
- Saxenda (liraglutide)
- Wegovy (semaglutide)
- Zepbound (tirzepatide)
These medications are typically prescribed in full doses for 12 weeks. If the patient doesn't lose at least 5% of their initial weight, the doctor may change the medications or suggest lifestyle modifications.
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The Pipeline for Future Obesity Treatments
The next generation of obesity remedies combines conventional weight loss drugs with entero-pancreatic hormone-based therapies, which are medications that target the hormones produced in the gut. This new formula aims to regulate metabolism, appetite and blood sugar levels to control weight.
In addition, new drugs like retatrutide, cagrisema, mazdutide and survodutide are in phase 3 trials as potential treatments for complicating metabolic dysfunctions. Scientists are also developing oral forms of GLP-1 as a substitute for injectables currently used to treat Type 2 diabetes.
These numerous therapy options with different mechanisms of action will empower healthcare providers to individualize treatment based on the patient's preference, comorbidities and response to medications. Tailored interventions have a higher probability of success than a universal approach. Let's hope these new drugs can finally curb the number of obesity cases.
Reducing Obesity Must Be a Priority
Obesity is linked with several chronic illnesses, like diabetes and heart disease, that can be fatal. Lowering the cases should be a priority. Advancements in pharmacotherapy will expand access to treatments. Timely FDA approval of these novel drugs will allow people to access the prescriptions sooner and address their health problems.
