Obesity is often seen as being a result of poor lifestyle choices, lack of motivation, or unhealthy habits – but experts say that isn't always the case. And it's stigma and assumptions like these that continue to create barriers that have limited better obesity care.
"Obesity has been recognized as a disease by the American Medical Association for nearly a decade. Despite this, we are still seeing most treatment approaches for obesity focus solely on behavioral therapy," said Nadia Nazir Ahmad, MD, MPH medical director, obesity product development, Eli Lilly and Company. "There are more than 650 million people living with obesity worldwide – including 40 percent of U.S. adults. Many of them have attempted lifestyle change, but not all have experienced adequate or sustainable results. Given this, it's important that we not only research and develop new antiobesity medicines but also uncover the barriers surrounding the broader use of them."
The Reality of Living with Obesity
Obesity is a chronic and progressive disease. People living with obesity have an increased risk of developing other health conditions such as cardiovascular disease, musculoskeletal disorders, diabetes and some cancers.
"Solely focusing on behavioral changes as a treatment for obesity can fuel the misperception that the responsibility largely rests with people living with the disease, which could be physically and mentally detrimental to them," said Joe Nadglowski, president and CEO of the Obesity Action Coalition. "Further, it also neglects individuals whose lifestyle choices aren't necessarily the underlying cause of their obesity and can ultimately drive up costs of care for obesity and related conditions."
According to the Center for Disease Control and Prevention, the estimated annual cost associated with obesity-related medical care in the United States alone was $147 billion in 2008. A 2019 study published in The New England Journal of Medicine also showed obesity disproportionately affects people of color and is predicted to become the most common BMI category among low-income adults.
"While behavioral therapy is an important aspect of developing an obesity treatment plan, it doesn't address the full picture," said Julia Dunn, senior medical advisor, Eli Lilly and Company. "It's important to recognize that obesity can also be treated effectively with drug therapy. Therefore, physicians must dive deeper to determine if individuals could benefit from antiobesity medicines, which may give them a better chance to improve overall health outcomes."
Collectively, the biases and misperceptions slow diagnosis and appropriate care. Coupled with comorbidities, delayed diagnosis, limited use of available evidence-based treatments and the progressive nature of the disease cause people with obesity to suffer premature mortality, lower quality of life, exposure to higher care costs and premature mortality. Accumulatively, according to one estimate, not treating obesity as a serious chronic disease results in total costs over a trillion dollars.
Improving Our Understanding of Obesity for a Better World
Currently, only one to three percent of people with obesity are being treated with antiobesity medicines. To better understand the reasons behind the slow uptake of these medicines to treat the disease and identify opportunities to improve obesity care, Lilly collaborated with Cerner Enviza to kick off the first nationwide study in the U.S. to comprehensively evaluate drivers and barriers of antiobesity medicines use within the community and medical field, called the OBSERVE study. Phase I qualitative results, which were presented at ObesityWeek 2021 in November of last year, revealed several underlying biases and misperceptions among people living with obesity, healthcare providers (HCPs) and employers who decide coverage. Phases II and III of the study will continue through 2022.
Data showed these biases and misperceptions often led to de-prioritization of antiobesity medicine consideration when evaluating foundational approaches to care. This was partially due to a lack of familiarity with obesity care guidelines and the evidence supporting appropriate use among primary care physicians, who are the first-responders for diagnosing and treating chronic diseases such as obesity. Findings also supported limited coverage in benefits packages as a barrier to the use of antiobesity medicine, with employers viewing wellness programs as an adequate solution to address obesity.
Lilly strongly believes the first step in creating change is to combat the existing biases and stigmas to drive broader awareness of obesity as a chronic disease and lift these unjust burdens from people living with obesity. From there, rapidly advancing science and evidence-based medicine in obesity care will move obesity toward treatment parity with other chronic diseases including needed insurance coverage. This includes collaboration toward passing legislation such as the Treat and Reduce Obesity Act, aimed at providing more treatment options for people living with obesity.
"While continued research on advancing antiobesity medicines is a big part of the solution, it's also important for pharmaceutical companies such as Lilly investing in the research and development of these medicines to form alliances with advocacy organizations," said Ahmad. "Through these collaborations, we can increase awareness of the need for more balanced approaches to treating obesity and create meaningful change."
"We're grateful for our collaboration with Lilly, among other companies, who are joining forces with us to provide people with obesity comprehensive access to high-quality and diversified care," said Nadglowski.