At the recent White House Conference on Hunger, Nutrition, and Health, the Biden administration laid out its vision to end hunger as well as increase healthy eating and physical activity by 2030. Their goal is for fewer Americans to experience diet-related diseases like type 2 diabetes, obesity and hypertension. The national strategy to achieve this goal calls for a whole-of-government and whole-of-America approach to confront a broad array of food- and health-related challenges as well as the structural inequalities that create and exacerbate them.
As an obesity medicine physician and an expert in obesity pharmacotherapy, I applaud the White House for referring to obesity as the diet-related disease that it is, and I wholeheartedly support all efforts to enable Americans to eat more nutritious foods and engage in more physical activity. However, the strategy fails to address a key piece of the puzzle: obesity treatment.
Prevention is critical, and the ideas put forth in the White House’s proposal will likely help many Americans—particularly children—avoid weight gain as well as the downstream effects of obesity and its comorbidities. But more than 42% of U.S. adults already have obesity, and they need help now. Although healthy diets and adequate exercise are necessary to support weight loss and weight maintenance, they are rarely enough – without medical intervention – to tackle the complexities of excess weight and our bodies’ extreme resistance to weight loss.
It’s not just lifestyle
Our bodies have evolved a variety of metabolic, hormonal and neurobehavioral mechanisms to fight against weight loss, and it’s tremendously difficult to overcome these physiological responses through diet and exercise alone. It’s not a matter of willpower; it’s biology.
What’s more, decades of clinical practice and research have shown that obesity is a complex, relapsing, chronic disease with many contributing factors beyond lifestyle — such as genetics, environment, sleep patterns, stress, medications, hormonal imbalances, and other health conditions. These factors all influence each other in complicated ways and must all be taken into account for any weight management program to be successful long-term.
Thus, the vast majority of people with obesity need expert medical guidance and support to overcome the many barriers to weight loss. Telling these individuals to just eat less and exercise more doesn’t work.
Effective treatment does exist
Despite the high incidence of obesity in America, only 2% of those eligible receive medical treatment according to guidelines. This means that most individuals with excess weight continue to lose weight through diet and exercise and then regain it – over and over and over again. It’s a discouraging cycle. Worse, losing and regaining weight — which is too often the result of simple calorie-reduction diets — can exacerbate the metabolic conditions that lead to or worsen obesity.
When we actually treat obesity like the disease that it is — developing a comprehensive personalized plan that addresses all the contributing factors, providing ongoing expert support to respond to the inevitable setbacks, and incorporating pharmacotherapy when diet and exercise have been optimized — we see sustainable improvements in health and well-being. Losing weight is not easy, but it is possible. Clinically proven solutions do exist for those who need them.
It’s also important to remember that obesity is associated with more than 200 other health conditions, many of which can be significantly improved if not entirely reversed by treating the underlying obesity. Thus, obesity treatment plays a crucial preventive role in reducing a person’s risk of developing other health problems, including the diet-related diseases of type 2 diabetes and hypertension targeted by the White House strategy, as well as other ailments as diverse as osteoarthritis, nonalcoholic fatty liver disease, and obstructive sleep apnea.
It’s time to invest in treatment
Preventing obesity is absolutely a worthy goal, as is combating the disparities in nutrition and health that contribute to higher levels of obesity among disadvantaged communities. But we also desperately need to increase access to proven models of obesity care. To do so, we must take four steps:
- Train more healthcare providers to manage obesity. In relation to the scale of the obesity epidemic, there are alarmingly few obesity medicine specialists in the U.S. Most medical schools and other training programs devote surprisingly little attention to a disease that is both extremely common and has a major impact on virtually every system in the body. As a result, many providers are unsure how to address obesity beyond recommending basic lifestyle changes.
- Combat the stigma surrounding obesity, so that all providers and patients understand that obesity is a disease, not a character flaw. Individuals with obesity are more willing to seek care if they recognize that their inability to lose weight is not their fault and if their providers approach them with empathy rather than judgment.
- Embrace technology. The pandemic confirmed that digital technologies can significantly expand access through telehealth consultations and remote patient monitoring, while at the same time enhancing providers’ access to data and continuing education. New developments will further accelerate this trend.
- Expand insurance coverage for obesity treatment. Many health plans exclude obesity care, leaving individuals to pay out of pocket or, in most cases, forgo treatment. However, insurers are beginning to recognize that it’s more cost-effective to treat obesity early rather than wait until additional complications develop. The recent introduction of several highly effective new anti-obesity medications has also helped to strengthen the case for treating obesity as a chronic disease, but only as much as people can afford them.
The White House initiative to end hunger as well as increase healthy eating and physical activity deserves our support, but the strategy won’t eliminate obesity or the diet-related health complications that accompany it. To help individuals who are currently living with obesity — and those who fall through the cracks of our future prevention efforts — we also need to improve access to comprehensive medical treatment. The health of more than four in ten Americans is at stake.
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