Recognizing and Treating Obesity as a Disease

On Jan. 1, 2023, Dr. Fatima Cody Stanford sat down with Lesley Stahl of CBS News and 60 Minutes to discuss provider bias and roadblocks to effective management for patients with obesity.

 

One of Dr. Stanford’s studies found that most medical schools don’t teach that obesity is a disease and, in fact, don’t even offer courses on it, even though it’s the second leading cause of preventable death in the country, after smoking.

Dr. Stanford says that despite most people believing that people with obesity have a lack of willpower, the number one cause of obesity is actually genetics. That means individuals born to parents that have obesity will have a 50-85% likelihood of having the disease, even with an optimal diet, exercise, sleep, and stress management.

So, says Dr. Stanford, when people see families that have obesity, the assumption is, “Ugh. What are they feeding those kids? They’re doing something wrong.” When actually that line of thinking is not only false, it contributes to provider bias.

 

“Doctors do not understand obesity.”

 

In her interview, Dr. Stanford notes that 79-90% of physicians in the U.S. have significant bias towards individuals that are heavier. To doctors listening that say, “Oh, it’s not me,” Dr. Stanford says before making that claim, ask yourself if you’ve had a patient come to you and tell you, “Look, Doc, I’m eating well. Look Doc, I’m exercising.” But then you’ve said to them, “Are you sure? I don’t believe that that’s really what you’re doing.” That’s provider bias. A doctor who sees patients with heart failure wouldn’t hesitate to aggressively treat that disease, and obesity should be no different.

 

“We have a national shortage on these [obesity] medications. If those that have the means are able to get them, yet the people that really need them are unable to, then that creates a greater disparity, right? The haves and the have-nots.”

 

Commenting on the availability of weight-loss drugs for patients with obesity, Dr. Stanford and 60 Minutes explain that the 110 million Americans eligible for an anti-obesity medication make it a costly investment for insurance, yes. But if they did cover it, overall government and private health care spending would likely come down.

For instance, diabetes (commonly linked to obesity) costs more than $300 billion a year, most of which is covered through Medicare and Medicaid. Economists note there’s actually a law that prevents Medicare from covering weight-loss drugs, which some insurance companies list as “vanity” drugs in the same class as those used for erectile dysfunction and cosmetic purposes.

 

“That’s where the stigma of obesity comes in, the idea that the patient can do it with diet and exercise.”

 

Dr. Stanford and her colleagues are frustrated when they see patients daily who desperately need to lose weight to reduce their risk of diabetes, hypertension, stroke, or heart disease, but they aren’t able to receive effective and safe drugs because insurance won’t cover them. Denials point to the lack of physician counsel on behavior change as part of this.”  You would never do that to a patient with hypertension or heart disease or Type 2 diabetes; tell them that you “Just don’t eat sugar, you’ll be fine.”

 

In a statement to 60 Minutes in response to this piece, the health insurance trade association said, “obesity is a complex disease and the evidence and clinical guidelines related to obesity treatment… are evolving rapidly. Health insurance providers will continue to review the clinical evidence.”

 

For more insights from Dr. Stanford, watch her in the Cardiometabolic Beat Podcast episode, Addressing Disparities in Obesity Management:

 

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