The numbers are staggering. According to the Centers for Disease Control and Prevention (CDC), two out of every five adult Americans are obese. The CDC defines obesity as having a body mass index (BMI) of>30. To put this into perspective, a 5’9” male weighing 203 pounds or a 5’6” woman weighing 186 pounds has a BMI in excess of 30. Forty percent of us exceed this threshold.
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Unfortunately, this is an under-appreciated health crisis. Obesity drives blood pressure higher and impacts atherosclerosis resulting in heart attacks, strokes and heart failure. Heart disease remains the leading cause of death in the U.S. But this is just the tip of the iceberg. Obesity can lead to type 2 diabetes, which itself can cause kidney disease, amputations and blindness. Thanks to obesity, the prevalence of type 2 diabetes in states like West Virginia, Alabama, Mississippi and Louisiana is now an astounding 15%.
If these metabolic effects of obesity weren’t enough, we are now finding that obese patients are more vulnerable to Covid-19, more likely to be hospitalized due to Covid-19, and more likely to die from it than lean patients. Furthermore, obesity increases the risk of getting cancer. Thirteen different cancers, including breast, pancreas, thyroid and liver are linked with obesity.
The cost of obesity to the healthcare system in the U.S. is estimated to be on the order of $260 BILLION. Here is a disease that has reached epidemic proportions and needs urgent attention. But one has to wonder if it is even on anyone’s radar screen. It is as if we are all simply accepting this situation despite the fact that obesity underlies many diseases that are the leading causes of preventable death.
But there are things that can be done now to attack this problem. First of all, insurers need to step up and universally cover nutritional counseling and pharmacotherapy. Right now, such coverage is inconsistent across a wide variety of payers. Even when coverage exists, such as with Medicare patients for whom intensive behavioral counseling is available, fewer than 1% of qualified beneficiaries receive this intervention. Healthcare providers need to drive such counseling far more than is currently done.
Also, obesity is a multifactorial disease and more research needs to be done to better understand the root causes of this disease. The 2022 budget for the National Institutes of Health (NIH) allocates $1.23 billion to obesity research. This might sound like a lot, but it represents only 2.7% of its $45 billion. Surely, a crisis of this scope merits far more money for research. A doubling of this budget is certainly warranted.
The FDA can also play a major role. During the Covid-19 pandemic, this agency has demonstrated remarkable flexibility in working with the biopharmaceutical industry to provide vaccines and therapeutants as quickly as possible. The same attention should be paid to treat new therapies for obesity. This is not to say that safety standards should be lowered. However, drugs to treat obesity should not be looked at as “cosmetic” treatments. Rather, new medicines will have an impact on heart disease, cancer and diabetes and thus should be dealt with accordingly.
This is not a problem that will go away any time soon. Within the next decade, it is likely that 50% of Americans will be obese and 20% will be diabetic. More and more people will be more susceptible to cancer and whatever new virus traverses the globe. We need to deal with this now and with a sense of urgency.
