Recognizing obesity as a disease, not a choice, is a step toward health equity

When the American Medical Association recognized obesity as a disease in 2013, doctors and other health care workers began to pay greater attention to a condition that is a cause of death for nearly one out of five adults in America. Eight years on, U.S. policies have failed to catch up with medical understanding in addressing this public health crisis.

Without the right kinds of policy interventions, nearly half of Americans will have obesity by 2030.

Communities of color will be hit hardest. Already, nearly 50% of Black adults and 45% of Hispanic adults have obesity — a body-mass index (BMI) of 30 or higher. But this condition is not just a matter of carrying extra pounds. It puts individuals at greater risk for many other chronic diseases, including cardiovascular diseases, metabolic diseases like diabetes, and many cancers, all of which disproportionately affect communities of color and perpetuate health disparities.

Treating obesity and related conditions costs the U.S. $1.4 trillion every year.

Congress has a historic opportunity to turn the tide for Medicare beneficiaries. The Treat and Reduce Obesity Act of 2021 would update Medicare’s 20-year-old rules by recognizing the disease as a treatable medical condition and expanding access to comprehensive, affordable, and clinically effective treatments for it. The bill would establish two provisions that empower people with obesity to take control of their health.

First, the act would ensure broader coverage for intensive behavioral therapy. This is an evidence-based approach to eating, exercise, and environment modification that promotes healthy behaviors to help people lose weight. Medicare currently reimburses only primary care physicians for conducting intensive behavioral therapy. The Treat and Reduce Obesity Act would expand that to include dieticians, mental health professionals, and other health care professionals who can safely guide individuals through this therapy.

Under current Medicare rules, individuals with obesity who do not have diabetes must pay out of pocket to see a dietician. If that person develops diabetes, Medicare will then cover visits to the dietician. This makes no sense from a public health perspective. Government policies should provide incentives to prevent diabetes and other diseases, not just treat them after they appear.

Second, the Treat and Reduce Obesity Act would modernize Medicare Part D by allowing it to cover FDA-approved weight loss medications. This is a profound opportunity to improve health and quality of life, especially with newly available medicines and those in the pipeline that make use of the body’s naturally occurring hormones to regulate insulin and decrease appetite.

The significance of these two advancements goes beyond treating individuals with obesity. They represent a decisive moment in shifting society away from viewing obesity as caused by individuals making poor choices and toward treating obesity as a manageable chronic disease like asthma or high blood pressure. This is a crucial step in eliminating bias against people with obesity, which has hobbled efforts to address this epidemic even as it fuels health inequity.

The Treat and Reduce Obesity Act has been introduced in every session of Congress since 2012 and gone nowhere, reflecting the profound systemic challenge of passing legislation to address this disease. But there is a palpable shift underway as more government leaders are adopting a mindset about obesity that is informed by science rather than by prejudice. Policymakers across the aisle are casting aside the old view that obesity is a matter of individual willpower and, like the American Medical Association and other leading health organizations, recognizing obesity as a disease. As a result, the act now has unprecedented bipartisan and bicameral support across the political spectrum.

A growing chorus of patient advocates back the bill, with more than 100 obesity and health advocacy organizations recently urging Congress to pass the act. This includes the National Urban League, National Black Nurses Association, League of Latin American Citizens, Black Women’s Health Imperative, National Hispanic Medical Association, and others, all of which see this legislation as the best opportunity for Congress to have an immediate impact on communities of color that are most affected by obesity.

There is a groundswell of public support too. A Morning Consult poll conducted in November on behalf of Obesity Care Now found that 70% of the 2,200 U.S. adults surveyed support Medicare recognizing obesity as a treatable medical condition. Among the same group, 73% support expanding Medicare coverage for preventing and treating obesity in adults.

Updating Medicare coverage to include more health professionals providing education and behavioral support for people with obesity and covering medications to treat obesity should not be controversial. We do this for every major disease, from asthma to diabetes to heart disease. It should be federal policy for obesity, too.

The obesity epidemic has reached a critical level, with Black and Hispanic Americans disproportionately bearing its impact. The U.S. can take a big step toward achieving health equity by improving care for people with obesity, starting with Medicare beneficiaries. Congress must lead the way.

Fatima Cody Stanford is an obesity medicine and nutrition physician and scientist at Massachusetts General Hospital and Harvard Medical School. Kelly Copes-Anderson is head of diversity, equity, and inclusion at Eli Lilly and Company.