Recognition and treatment of obesity as a disease – 60 minutesThank you for reading this post, don't forget to subscribe!
Nearly half of American adults are obese, a condition that was a fraction of that just 40 years ago, and scientists disagree about what has caused the dramatic increase. What everyone agrees on is that this is a major health crisis, as obesity can cause type 2 diabetes, hypertension, stroke and more than a dozen cancers.
Now there is a drug that leads to dramatic weight loss. But it’s terribly expensive. Hollywood celebrities take it to flatten their stomachs, but few can afford the thousands of dollars it costs annually.
And very few insurance companies will cover it, even though in 2013 the American Medical Association, some would say, finally recognized obesity as a disease.
Dr. Fatima Cody Stanford: It’s a brain disease.
Leslie Stahl: Is that right?
Dr. Fatima Cody Stanford: It’s a brain disease. And the brain tells us how much to eat and how much to store.
Dr. Fatima Cody Stanford, an obesity physician at Mass General Hospital and an associate professor at Harvard Medical School, says common beliefs about obesity are wrong.
And diet shows like The Biggest Loser snooker people.
Leslie Stahl: If you diet, you lose weight, right?
Dr. Fatima Cody Stanford: For many of us, we can go on a diet. Sort of like The Biggest Loser, right? You go and restrict people. You make them work out 10 hours a day and then you give them 500 calories. For most people, they will lose weight rapidly. But 96% of “The Biggest Loser” contestants regained their weight because their brains were working well. It had to bring them back to store what they needed or what the brain thought it needed.
Leslie Stahl: So willpower?
Dr. Fatima Cody Stanford: Throw that out the window. My last patient I saw today was a 39 year old young woman struggling with severe obesity. She works out 5 to 6 times a week, consistently. She eats very little. Her brain is protecting a certain set point.
The set point, Dr. Stanford says, is a weight range your brain needs to maintain by controlling how much food you eat and how much of it you store. One theory is that it’s an evolutionary survival mechanism that helped store fat during starvation.
Leslie Stahl: So we had COVID. Many, many people gained weight. Did these people have a new set point that is now higher?
Dr. Fatima Cody Stanford: Absolutely. So when you have chronic stress and you get to a certain weight and you maintain that weight for, say, at least 3 to 6 months, then you calibrate that set point to another set point.
Leslie Stahl: I’ve always heard it’s fast food. It’s Diet Coke, that thing, that’s the trigger. Is it true?
Dr. Fatima Cody Stanford: So I think we have to look at the different causes of obesity as a big pie. And this is one of the factors. But notice how I’m using this part of the pie, right?
Dr. Fatima Cody Stanford: But the number one cause of obesity is genetics. This means that if you are born to obese parents, you have a 50-85% chance that you will have the disease even with optimal diet, exercise, sleep management, stress management, so when people see obese families, the assumption is, ” Ugh. What are they feeding these kids? They’re doing something wrong.” Do you actually know this? 79-90% of doctors in the United States have a significant bias against overweight people. Now doctors listening to me might say, “Oh, it’s not me.” Hold on, because that patient came to you and said, “Look, doctor, I’m eating well.” “Look, Doc, I’m working out.” And the doctor says to them, “Are you sure? I don’t believe you’re really doing this.”
Leslie Stahl: Wait, you mean doctors don’t understand obesity? doctors?
Dr. Fatima Cody Stanford: Doctors don’t understand obesity.
In one of his published studies, Dr. Stanford found that most medical schools do not teach that obesity is a disease, and in fact do not even offer courses on it, even though it is the second leading cause of preventable death in the country after smoking.
Nicole Sams, a Rhode Island mother of five, spent years seeing doctors who all had the same message.
Nicole Sams: “Well, you just need to see a nutritionist.” And I did. I did everything they told me: I went to a nutritionist; you know, I was sitting, the gummy foods were coming in front of me, “Oh, you’re only going to eat this portion,” I’m like, “Oh.”
Maya Cohen went on her first diet when she was 13. At her heaviest, at 5 feet tall, she weighed 192 pounds.
Leslie Stahl: Did you feel like people were looking at you and saying, ‘Why doesn’t she stop eating? She ate her way to it’?
Maya Cohen: You know you look at somebody and you internalize, “Oh, they must think I’m eating too much.” So it’s just that after a while you personally think, “Okay. Everyone tells me that I am…that it is a flaw in my character;” therefore it must be true. And so you start to believe it.
Dr. Carolyn Apovian: Don’t you think that if people walking down the street obese, stigmatized as they are, shunned, don’t you think that if they could lose weight and keep it off, they would?
Dr. Carolyn Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston, who attended both Maya Cohen and Nicole Sams, is relieved to finally have a highly effective drug to offer patients si, which is safe, according to the FDA.
It’s part of a new generation of drugs that lead to an impressive average loss of 15% to 22% of a person’s weight and help keep it off. Drs. Apovian and Stanford advise companies developing obesity drugs, including the Danish company Novo Nordisk, an advertiser on this show. This makes the drug Wegovy, which you inject yourself once a week, kind of like an epipen. It’s not easy to get. The drug is currently in short supply. And it costs more than $1,300 a month.
Leslie Stahl: People in Hollywood can afford these expensive injections. And they take them.
Dr. Fatima Cody Stanford: Exactly.
Leslie Stahl: And they’re not necessarily obese people.
Dr. Fatima Cody Stanford: Yes. We have a national shortage of these drugs. If those who have the funds are able to get them, the people who really need them cannot. Then that creates a bigger disparity, doesn’t it? The haves and the have-nots.
The vast majority of people with obesity simply cannot afford Wegovy, and most insurance companies refuse to cover it in part because, as AHIP — the health insurance trade association — explained in a statement, these drugs “have not yet been proven to work well long-term weight management and may have complications and adverse effects on patients.”
Dr. Carolyn Apovian: What we’ve seen so far is really nausea, vomiting, you know that’s why these drugs are dosed slowly and started at low doses.
Leslie Stahl: Oh, and building?
Dr. Caroline Apovian: And upgrade.
Dr. Apovian says most of the side effects go away with time.
Dr. Carolyn Apovian: We’re frustrated every day when we see patients who are desperate for weight loss to reduce diabetes, hypertension, stroke, heart disease, and we can’t give them this amazing, powerful drug that’s very effective and safe. And we can’t give it to them because insurance doesn’t cover it. I get denial emails – stating that we are denying this because “the doctor did not counsel the patient about behavior modification as part of this.” This is where the obesity stigma comes in, the idea that the patient can do it with diet and exercise. You would never do that to a patient with hypertension or heart disease or type 2 diabetes, tell them, “Just don’t eat sugar, you’ll be fine.”
Novo Nordisk also makes a type 2 diabetes drug called Ozempic, which most insurers and employers cover. What disappoints doctors is that Ozempic and Wegovy are exactly the same drug, although Wegovy for obesity is usually prescribed in a higher dose.
When Maya Cohen asked for the obesity cure…
Maya Cohen: My insurance company told me they consider it a “vanity drug.”
Leslie Stahl: “Cure for Vanity.”
Leslie Stahl: This suggests that the insurance company does not consider obesity a disease–
Maya Cohen: Right.
Nicole was also denied coverage. On its website, her health plan, through the state of Rhode Island, places anti-obesity drugs in the same category as erectile dysfunction and cosmetic drugs.
There are about 110 million Americans eligible for the anti-obesity drug, making it an expensive investment for insurance, but if they covered it, overall government and private health care costs would likely decrease. Just take diabetes, which in many cases is caused by obesity. Diabetes costs more than $300 billion annually, most of which is covered by Medicare and Medicaid. But University of Chicago health economist Thomas Phillipson points out that there is actually a law that prevents Medicare from covering weight loss drugs.
Leslie Stahl: Would you think that this insurance program for the elderly would benefit enormously from these drugs?
Thomas Phillipson: Yeah, one-third of Medicare spending is diabetes, you know, which is strongly associated with obesity. And Medicare kind of sees all the health care costs when you get older, when you have heart disease, etc., from your obesity. I think what it will ultimately come down to is that they have evidence that it will actually reduce the overall cost of Medicare.
When Dr. Apovian told both Maya Cohen and Nicole Sams that their obesity was not a weakness of will, they were blown away.
Nicole Sams: I looked at her and said, “I don’t believe you. What do you mean, ‘It’s not my fault?’ It’s my fault.” Because that’s what I’ve heard my whole life.
Maya Cohen: I came home the other day feeling like a stone had been lifted off my shoulders. Like, “Okay, finally there is hope. There is hope.”
Leslie Stahl: Are you crying?
Maya Cohen: I did. A lot. (I laughed)
Dr. Caroline Apovian: All these years of thinking that somehow you don’t have willpower and that’s your moral flaw and that you’re a glutton and why did you eat so much and– feeling shame. That’s the shame.
Leslie Stahl: Yes, yes. That’s the shame.
Dr. Caroline Apovian: That’s the shame.
Maya was eventually able to get the medication covered by her insurance because she has type 2 diabetes. She has lost more than 50 pounds. Dr. Apovian says she must continue to diet and exercise and, like most patients, will take the drug indefinitely to maintain her weight. Nicole does not have type 2 diabetes.
Leslie Stahl: Nicole, we called your insurance company and they gave us a statement.
Nicole Sams: Okay.
Leslie Stahl: “Earlier this year, the State of Rhode Island, in consultation with the Pharmacy Manager, decided that Rhode Island State Employee Health Insurance would cover the entire class of anti-obesity drugs.”
Nicole Sams: Oh…really?
Leslie Stahl: “This coverage change goes into effect January”–
Nicole Sams: Okay.
Leslie Stahl: –“2023”
Maya Cohen: I’m so happy for you.
Nicole Sams: Yes. This is great. This is great. (SPLASH) Wow. Eha.
In its statement, the health insurance trade association said that “obesity is a complex disease, and the evidence and clinical guidelines related to the treatment of obesity … are evolving rapidly. Health insurance providers will continue to review the clinical evidence.’
Produced by Ayesha Siddiqi. Associate Producer, Kate Morris. Broadcast Associate, Wren Woodson. Edited by Craig Crawford.
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