Why Are Obesity Treatments Hard to Get?

When Oprah Winfrey Announced At the end of 2023, when I was taking weight loss medications, many questions arose: What medication are you taking? How long will it take? What role should medications play in reducing obesity?

How to pay for the medication was probably not a concern for the billionaire media mogul. But for many Americans living with obesity, cost is a central concern when it comes to treatment.

The treatment of obesity has a long story, with a variety of options, from preventive services and nutritional counseling to medications and surgery. Insurance coverage for this full range of obesity treatments. varies by stateas are Medicaid benefits designed for people with lower incomes.

See: Obesity is a complex disease with a variety of treatments >>

What is behind the increase in obesity rates?

According to the most recent data from the CDC, 4 out of 10 Adults in the U.S. are living with obesity, a rate that is higher than 3 in 10 two decades ago.

The trends are even worse for some marginalized groups, such as people with lower incomes, people living in rural areas, and Black and Latino communities. In addition to genetics, social determinants of health play an important role in determining obesity risk.

“In underserved communities where chronic toxic stress and access to cheap, salty and sugary foods are high, whether or not they have access to these medications, addressing obesity is a challenge without policies that support healthier living in these neighborhoods,” according to Lisa Fitzpatrick, MD, MPH, MPAsenior professor at the Milken School of Public Health at George Washington University.

Read: Social determinants of health, health disparities and health equity >>

Food is medicine According to Fitzpatrick, policies designed to improve access to healthy foods and reduce food deserts are important and should be expanded. But she points to challenges including unequal access, limited awareness and a lack of structured, long-term ways to determine what the impact of these policies will be on chronic diseases like diabetes and heart disease.

“If people are provided with regular nutrition, is this enough to improve their health and keep them healthy?” Fitzpatrick asked.

Along with weight gain in the country, there is growing recognition among medical professionals that obesity is a medical condition that increases health risks such as heart disease, diabetes, liver disease and some cancers, among other conditions.

Concurrent with these changes, new anti-obesity drugs (AOMs) have attracted attention and gained FDA approval for use as a weight loss treatment, not just for the treatment of diabetes or other diseases. Combined with lifestyle changes, AOMs can reduce body weight as much as one third. And research has shown that AOMs combined with lifestyle changes result in more weight loss than just lifestyle changes.

But the promise of obesity drugs may hit a wall: health insurance.

Barriers to access to treatments for obesity

Health insurers do not always cover weight loss medications or other obesity treatments. When they do, they often impose limitations and obstacles, such as having to prove that other treatments have failed before a new drug is approved.

If you lose or change your health insurance due to a job change, you will likely have to start the process over again, which may prevent you from accessing medications or other necessary services. If you are eligible for Medicare at age 65, you may lose access entirely because Medicare does not cover weight-loss medications except when they are specifically prescribed to prevent specific conditions, a recent coverage change.

Even with coverage, patients typically have to pay a portion of the cost through copayments or coinsurance, which can be a few hundred per month. Without insurance coverage, AOMs can cost patients as much as $30,000 per year Out of your pocket.

Joy Tashjian, RN, BSN, has insurance but it does not cover weight loss medications.

He has lost 25 pounds (about 1.5 pounds a week) since he started taking tirzepatide last November. Tashjian pays $550 out of pocket each month for the medication.

“I’m very grateful to be able to afford it,” she said. “I can’t tell you what a difference the medication has made.”

Tashjian said he has been overweight since he was 5 years old. Since then, he has tried many diets, starting at age 7, but only lost about a pound a month. This medication allows you to lose weight without feeling intense hunger or experiencing a constant “eating noise.”

Although Tashjian does not have high blood pressure or cholesterol, diabetes or other physical health problems associated with obesity, he said he has complex post-traumatic stress disorder as a result of his weight.

“I was bullied and constantly received negative comments from adults, teachers and supervisors, also throughout my adult life,” she said. “I keep wondering how different my life would have been if this medication had been available when I was a child.”

Rachel*, 52, has health insurance coverage for her AOM because she is diagnosed with diabetes, a condition for which her medication is approved. She but she faces other challenges as a result of the insurance rules.

Rachel’s health plan will not allow her to reorder the medication until she uses the last injection. When she reorders, she runs into a supply shortage, causing weeks of delays between doses. She said she has regained weight after the initial losses, which her doctor believes is due to her unequal access to medication.

According experts, these medications are not designed for intermittent use. Once people stop taking an OMA, they can expect to regain the weight they had lost in a relatively short time.

Fitzgerald said he is concerned that it is unlikely that most people will be able to take OMA for life, which may be necessary to get the benefits. The risk of disrupted access to medications points to an even greater need to combine medications with strategies such as a healthy diet and exercise.

“Medicines should be seen as a [addition] to a lifestyle plan to prevent chronic diseases, not just obesity,” Fitzpatrick said. “My hope is that many of those who benefit from these medications will simultaneously adopt lifelong prevention strategies, which is certainly difficult to do in our society. “This way, if for some reason the medication is no longer available or tolerated, the person has a foundation to support continued healthy living.”

Another obstacle to obesity treatment is the shortage of healthcare providers. Not only are they specially trained obesity medicine specialists few and far between, more than 100 million Americans do not have access to a regular source of primary care.

“As with most health issues, primary care providers are the gateway to accessing healthcare, so [obesity treatment] “It can be added to a long list of services that people struggle to have inadequate access to,” Fitzpatrick said.

This educational resource was created with the support of Eli Lilly, a member of HealthyWomen’s Corporate Advisory Board.

*Name has been changed for privacy reasons.

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