OPINION:
Believe it or not, and despite what you’re hearing, when it comes to addressing the American epidemic of obesity, there is no magic pill. The good news, however, is that for the first time, there are new medicines that seem to be magic — because they work.
The new group of medicines called GLP-1 receptor agonists are headline news. Why? Because they are more effective than any previous class of drugs in getting patients to lose weight and, equally important (and in combination with diet and exercise), keep it off. Initially approved by the Food and Drug Administration for patients with diabetes, they have become so popular among people who want to lose weight that the companies that manufacture them can’t keep up with demand.
And many insurance providers (most notably Uncle Sam) are worried that helping America successfully combat obesity will break the national health care piggy bank. Nothing could be more incorrect and shortsighted. Let’s make one thing crystal clear — helping America slim down must be a national priority lest we allow obesity and the diseases that often come with it (heart disease, stroke, diabetes, osteoarthritis, and some cancers, to name a few) to bury us both financially and literally.
Obesity affects 44% of American adults. According to a new article in the New England Journal of Medicine, if 10% of Medicare beneficiaries with obesity used a GLP-1 receptor agonist, the annual cost to Medicare could be as much as $26.8 billion. But payers are talking about the costs while remaining silent on the benefits. In 2023, according to the U.S. Joint Economic Committee, obesity caused $5,155 in average excess medical costs per person diagnosed as obese. That’s $520 billion in preventable health care costs — an impressive return on investment.
New, better medications are the best and swiftest way for this country to cut down on our health care expenses. By more effectively combating disease and improving patients’ lives, drugs reduce long-term medical costs and bolster the overall economy. But as they say in our nation’s capital, where you stand depends on where you sit.
When payers (most notably Medicare) look at GLP-1 receptor agonists, they see only the cost. That’s like the FDA reviewing risks while ignoring benefits when considering new medicines. It has to be about value. And when it comes to measuring value, we must embrace a comprehensive view of cost and benefit. Regarding GLP-1 receptor agonists, the proper denominator isn’t cost; it’s value. Choosing only to only discuss costs without context is dishonest and deleterious to public health.
Kudos, therefore, to Rep. Mike Burgess, Texas Republican and a physician himself, who has introduced the Preventive Health Savings Act, which would permit Congress to ask the Congressional Budget Office to provide estimates on long-term health savings made possible from preventive health initiatives, such as significant reductions in our national obesity rate.
This is especially important because obesity rates are higher for lower-income people and in communities of color. Minus a more comprehensive view of costs and benefits relative to new medical technologies such as GLP-1 receptor agonists, we are redlining these populations out of safe and effective treatment options. That’s the opposite of health equity.
Focusing on short-term costs while ignoring long-term benefits (to patients and our national treasury) is ignoring reality. It’s worth remembering the wise words of President John Adams, who said, “Facts are stubborn things.”
• Peter J. Pitts, a former associate commissioner at the Food and Drug Administration, is president of the Center for Medicine in the Public Interest, a visiting professor at the University of Paris School of Medicine, and a visiting scholar at the New York University School of Medicine, Division of Medical Ethics.
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