Alarm bells should be ringing in Congress: A disease that is already one of the most common causes of death among Americans is expected to affect almost half of all adults within the next eight years.
The disease is obesity. For decades, it was considered a personal moral failure. Science has proven that this was wrong, just as chemistry has shown that substance abuse is insensitive to “simply saying no.” Congress must act because body shaming cannot be a substitute for national health policy.
Today, more than 4 out of 10 adults in the US have obesity, compared to 3 in 10 in 2000, and those defined as severe obesity gained even faster, from around 1 in 20 to 1 in 10.
Obesity kills 300,000 Americans annually, and poor nutrition is the most common risk factor for mortality in the US. Obesity is also an underlying disease in almost a third of COVID-19 hospital stays. It damages almost every system in the human body and leads to diabetes, heart disease, stroke, various types of cancer, mental illness, physical dysfunction, and many other diseases.
is striking is that in 2020, the medical institution spent nearly a quarter of a million dollars treating conditions for which obesity was a driving cause, but spent alarmingly little on preventing or treating obesity itself. Preventing obesity and obesity-related diseases not only prevents unnecessary suffering and death, it also makes financial sense. A 2022 Bipartisan Policy Center report we co-authored concluded that obesity (2020) costs 248 billion US dollars annually in medical expenses, 6.2 percent of total spending. A health microsimulation model from the USC Schaeffer Center found that obesity poses a greater risk to public finances than smoking.
Still, Medicare and private insurers cover only a few treatments for obesity. Currently, insurance coverage is limited to primary care behavioral counseling and weight-loss surgery for people with severe obesity and other associated conditions, leaving too few effective options available to most people with obesity.
More intensive behavioral counseling could help combat obesity, but Medicare is unable to limit insurance coverage to primary care providers who are rarely fully trained in weight management and don’t have the time for lengthy interventions. Intensive behavioral counseling could be delivered more effectively — and possibly at a lower cost — by specialist providers, including registered dieticians and psychologists. Medicare coverage for medical nutrition therapy — a type of dietary advice offered by a registered dietitian — is also limited to people with diabetes or kidney disease, omitting care for those with obesity and numerous other diet-related conditions.
When the drug Medicare was introduced almost 20 years ago, Congress banned reporting on weight-loss therapies on the grounds that they were cosmetic, not health treatments. As usual, private insurers followed this example: Fewer than 10 percent of people have commercial health insurance that covers weight-loss medications.
Despite a lack of incentives from Medicare, five drugs have come onto the market that can reduce weight by 6 to 16 percent within 52 to 68 weeks. Reducing just 5 percent of body weight improves blood sugar, blood pressure, triglycerides, HDL cholesterol, sleep apnea, and other chronic conditions. The drugs are safe and important tools for Americans’ health, but they cannot make a significant contribution to fighting obesity without insurance coverage.
Bipartisan bills in Congress aim to solve the problem.
The Obesity Treatment and Reduction Act (TROA) was introduced by scythes Tom Carper (D-Del.) and Bill Cassidy (R-La.), Rep. Ron Kind (D-Wis.), Raul Ruiz (D-Calif.), Brad Wenstrup (R-Ohio), and former Representative Tom Reed (R-N.Y.). It would expand Medicare’s insurance coverage to include FDA-approved prescription drugs for chronic weight management and intensive behavioral counseling from registered dietitians and other specialists.
Another bipartisan bill, the Medical Nutrition Therapy Act, was introduced by Sens Susan Collins (R-Maine) and Gary Peters (D-Mich.), as well as Rep. Robin Kelly (D-Ill.) and Fred Upton (R-Ill.). This bill would extend Medicare for Medical Nutrition Therapy (MNT) insurance coverage to obesity and other diet-related illnesses and would allow a range of professionals to avail the service.
In addition to access to medicines and nutrition advice, bipartisan political leadership is needed to push ahead with measures to improve food security for all. In the United States, childhood obesity is more common than hunger among children, even in low-income households. The reauthorization for child nutrition, which includes the National School Lunch Program and the specific complementary nutrition program for women, infants and children, should be adopted to combat childhood obesity by improving nutrition and food security. In addition, the reapproval of the Farm Bill by the upcoming 118th Congress provides an opportunity to improve nutritional quality as part of the Supplemental Nutrition Assistance Program (SNAP), the so-called “Food Stamp” program.
Medicare and private insurers pay for diabetes, heart disease, and high blood pressure treatments. If the goal is to save lives, then logic, clinical evidence, and compassion dictate that they should also pay for obesity prevention and treatment from now on.
Anand Parekh is a board-certified physician in internal medicine, senior medical advisor at the Bipartisan Policy Center, and former Deputy Deputy Deputy Secretary of Health at the U.S. Department of Health and Human Services. Dana Goldman is dean of the Price School of Public Policy and co-director of the Schaeffer Center for Health Policy & Economics at the University of Southern California.