Government policy needs to catch up with obesity treatments

New therapeutics offer the potential to help a large percentage of the population, but Medicare regulations limit access

As medical experts on the front lines of the treatment of obesity, we are deeply aware of the growing public health crisis that obesity and its complications pose for Oregon. 

According to data from the Centers for Disease Control and Prevention (CDC), the most recent U.S. obesity prevalence rate has risen to 41.9%, with equal numbers of men and women affected for the first time. CDC data shows Oregon’s obesity prevalence in 2022 sits at 30.9%. In 1990, Oregon’s adult obesity rate was 10.7%.

Obesity directly causes type 2 diabetes; is a major risk factor for heart disease, heart failure, stroke, and cancer (especially breast and uterine cancers); and is the second leading cause of preventable death in the U.S. According to data released by the Oregon Health Authority (OHA) in 2019, obesity is also the second leading cause of preventable death in Oregon, causing an estimated 1,500 deaths each year. Oregonians with obesity were estimated to have annual medical costs that are $1,429 higher than those patients without obesity. 

While obesity is now a recognized disease by primary and specialty care societies (including the American Medical Association) and the CDC has highlighted the importance of equitable access to prevention and treatment, current Medicare regulations prevent access to safe and highly-effective therapeutics to treat obesity, known as anti-obesity medications (AOMs). 

It is common knowledge that obesity is a target of stigma and bias by our society. This Medicare exclusion speaks to the additional bias against medical therapy within the governmental regulatory communities. Imagine that the federal government only allowed your provider to treat your diabetes by having you see a dietician and excluded coverage for diabetes medications. Your next visit would be to the ophthalmologist as you start losing your eyesight or for renal dialysis when your kidneys fail.

The viewpoint that lifestyle plays the primary role in obesity treatment and those that struggle “are just not trying hard enough” remains prevalent. This is a historic and inaccurate view that has not kept up with the last 20 years of research and discovery — a “blame the victim” mentality similar to how hypertension once was perceived. Like obesity, hypertension onset is influenced by diet and exercise. Unlike obesity, however, if improvements in lifestyle (e.g., salt intake or exercise for hypertension) are not sufficient, we do not withhold or exclude medical therapy as a next step. 

While bariatric surgery is a highly effective means to achieve durable weight loss, it is not feasible for the entire eligible population and remains appropriate for a narrow slice of the most affected patients. This leaves an enormous gap (30% or more of the population) in need of treatment for their obesity and its complications. 

In addition to the positive health outcomes that can be gained by expanding access to proven obesity treatments, real savings can be realized if Congress or the Biden administration takes the steps necessary to ensure AOM coverage. A recently released white paper from the University of Southern California shows coverage for new obesity treatments could generate approximately $175 billion in cost offsets to Medicare in the first 10 years alone. 

A necessary step to increase access to effective obesity treatments is to ensure that AOMs are covered under Medicare. We encourage our federal delegation to lead this charge. For the past several sessions of Congress, a bipartisan bill to allow for Medicare coverage of AOMs has been introduced called the Treat and Reduce Obesity Act. The bill has just been reintroduced and we hope our delegation will add its support. We would also encourage the Biden administration to explore the Centers for Medicare & Medicaid Services use of its regulatory authority to implement the provisions of the legislation. 

Representatives of The Obesity Society and the American Society for Metabolic and Bariatric Surgery are prepared to provide input regarding establishment of coverage policy. We ask for parity in our ability to treat obesity as a chronic disease and to give our patients access to these essential tools.

Jonathan Q Purnell, MD, Preventive Cardiology and Obesity Medicine, Portland, Oregon  

Nancy Puzziferri, MD, Metabolic-Bariatric Surgery and Obesity Medicine, Portland, Oregon  

Andrea Stroud, MD, Metabolic-Bariatric Surgery and Obesity Medicine, Portland, Oregon  

Bruce Wolfe, MD, Metabolic-Bariatric Surgery and Obesity Medicine, Portland, Oregon