It’s always a successful day at the office for Fatima Cody Stanford, M.D., M.P.H.,M.P.A., when she can look at a patient’s chart, see a diagnosis of diabetes, high cholesterol or hypertension, and see progress in their health or resolution of a health concern.
Shanna Tucker, M.D., an obesity medicine specialist at NYU Langone Health, has a similar standard. If she can reduce the dosage or stop prescribing medication for one of these diseases, she knows her patient is on the right track.
When obesity medicine specialists help patients with weight loss, their overall goal is far greater than achieving lower numbers on the scale. By treating a patient’s obesity, specialists are also helping patients manage and resolve other chronic conditions that threaten their overall health.
“Most of my patients have been with me for a decade or longer, so this is a lifetime commitment to their chronic disease that is obesity,” said Stanford, an associate professor of medicine at Massachusetts General Hospital and an obesity medicine physician-scientist. “I want to help them delete diagnoses from their chart — from their obesity itself to diseases associated with their obesity.”
Obesity can reduce life expectancy because it generally increases the risk of other conditions and chronic diseases, including diabetes, heart disease, kidney disease and liver disease. And it can also contribute to sleep problems, joint pain, mental health issues and some cancers. It was also found to be a top risk factor for Covid-related hospitalization and death.
Growing rates of obesity have created a significant public health issue in the U.S. More than 1 in 3 adults and 1 in 5 children are living with obesity, and the U.S. spends more than $147 billion a year on obesity-related healthcare.
Tucker said many patients come to her in frustration because they’re already eating well and exercising. They’ve lost some weight, but they can’t seem to lose any more or their weight has started climbing. They’re also struggling with chronic health conditions made worse by obesity.
“Not enough medical providers may understand that sometimes additional treatment is necessary for many patients,” Tucker said.
The benefits of anti-obesity medications
Obesity medicine specialists tailor plans for patients that can include a combination of lifestyle management, medication and, in some cases, surgery.
Anti-obesity medications (AOMs) have been getting a lot of attention in the media, with many public figures attributing their weight loss to the use of these medicines. While anti-obesity medications aren’t new — the FDA first began approving them in 1959 — the current class of GLP-1 medications like semaglutide have become household names (Ozempic/Wegovy and Mounjaro/Zepbound) for their ability to help people achieve significant weight loss.
While the weight loss achieved through GLP-1 medications makes headlines, obesity medicine specialists have a broader view of the medications’ benefits and see how they can offer quicker resolution to chronic diseases. A meta-analysis (a review of many studies) shows that anti-obesity medications can contribute to a significant reduction in cardiovascular events, like heart attacks and strokes, and hospital admission for heart failure in people with Type 2 diabetes.
Tucker said people living with obesity don’t have to lose a lot of weight to see results. Even just a 5%–10% drop in weight can help improve high cholesterol or high blood pressure. Weight loss can also be important for quality-of-life improvements, such as allowing people to move more easily, sleep better, experience less joint pain and have more energy.
“I know a lot of people don’t want to start a new medication, but by treating obesity, I’ve had patients who’ve had a significant amount of weight loss and were able to start decreasing the dose of their diabetes medication or even stop their high blood pressure or high cholesterol medications,” Tucker said. “I say to keep the big picture in mind about the potential benefits of anti-obesity medication.”
Barriers to obesity treatment
Although effective obesity treatment can improve health outcomes and yield substantial savings for the nation’s healthcare system, many Americans don’t have access to obesity care.
Not enough healthcare providers are trained in obesity medicine, Tucker said, and the cost of the medications themselves can prevent patients from being able to get them. There’s also no guarantee that the medication will be covered by insurance or available to Medicaid and Medicare recipients.
“I think we’re really doing a disservice to these patients,” Tucker said. “They’ve already sought help and have made an appointment and come into my office. To get that far and not be able to prescribe a medication because of insurance is very disappointing.”
Since each state Medicaid plan has its own policies for obesity treatment coverage, many people don’t have access to anti-obesity medications. And, at the federal level, Medicare Part D still prohibits coverage of AOMs for most patients, even though people covered under the Veterans Affairs/Department of Defense and Federal Employee Health Benefits plans do have access to the full continuum of care for obesity. Stanford said she’s hoping the Treat and Reduce Obesity Act, first introduced in Congress in 2012 and reintroduced each session since, will become federal law to help expand coverage for Medicaid and Medicare patients.
Watch: Congressional Briefing: Ensuring Patient Access to Effective Treatments for Obesity >>
Stanford said she’s seen older adults who’ve made significant progress getting rid of chronic conditions through treatment lose all of their progress when they enroll in Medicare and can no longer afford their medication if they lose coverage for their medication.
Stanford also pointed out other disparities in who’s most likely to have access to treatment.
“The populations most likely to benefit, particularly racial and ethnic minority populations here in the U.S., are struggling to get these meds,” Stanford said. “We have to get past the idea that people just need to eat less and exercise more, which is founded not on science. I want to change that narrative. We can do better to help those who need it.”
Still, for people who are struggling with obesity and other chronic health conditions, Tucker said it’s worth talking to your healthcare provider to see if some type of obesity treatment can help.
“I know some patients may want to avoid the topic, and I can understand why for many reasons,” Tucker said. “There’s a lot of obesity bias or weight bias in the medical community. I do encourage people to at least ask their [healthcare provider] what resources are available if they’re interested in losing weight so they have all the information and resources to help them make the best next step.”
Help Us Increase Access to Obesity Treatment >>
This educational resource was created with support from Novo Nordisk, a HealthyWomen Corporate Advisory Council member.
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