As a physician, I am thankful that my colleagues and public health collaborators took a laser-focused approach to the COVID-19 pandemic, with the intention to save as many lives as possible. It is within this context that I consider with curiosity why our nation’s urgency to bend the curve on obesity pales in comparison to our dedication to eradicating COVID-19.
For three decades now, obesity has been proven to be a complex, chronic disease and not a character flaw, choice or lack of discipline, as some areas of society might have us believe. It has cost the lives of our loved ones, with a particular set of consequences for communities of color.
Nearly half of non-Hispanic Black adults and Hispanic adults live with obesity, according to the Centers for Disease Control and Prevention. The public health community now asserts that reducing obesity rates years ago could have very well saved thousands of lives when COVID-19 struck, including more than 20,000 Black Americans. Obesity’s gravity remains unaddressed and largely untreated in Black, Latinx and other historically disadvantaged communities.
Physically, obesity is associated with more than 200 other diseases: Type 2 diabetes, heart and lung diseases, 60 types of cancers, stroke, liver disease, and more. The bias and stigma people living with obesity endure adds mental and social health stressors as they strive to achieve better health status, often without appropriate support. Financially, patients and the health care system are spending billions of dollars every year to manage conditions that could be prevented or eliminated with appropriate treatment and insurance coverage, according to government research.
The National Medical Association represents the interests of more than 50,000 Black physicians in the United States and is dedicated to providing the highest quality care for the patients and communities we serve. We strive to remove inequities in health care access while improving health outcomes, and obesity care must be fundamentally reformed to realize this goal.
We know the disease is caused by multiple biological, genetic and environmental factors that disproportionately impact communities of color. And, we know that when these factors are in play, lifestyle changes such as healthy eating and exercise will not be an effective form of treatment.
In fact, a recent segment on CBS’ “60 Minutes” noted that, “The number one cause of obesity is genetics. That means if you were born to parents that have obesity, you have a 50%-85% likelihood of having the disease yourself, even with optimal diet, exercise, sleep management and stress management.” So a vast number of patients in communities of color require medication to properly treat obesity, but they face systemic barriers.
For too long, obesity treatment has relied on diet and exercise or on surgical intervention, ignoring the need for anti-obesity medication. The full range of treatment is met with significant barriers from health care providers, policymakers, insurers, and public opinion because people simply don’t believe obesity is a chronic disease. Many don’t recognize that lifestyle choices are not always effective, and they don’t realize the inequities in access to treatment.
Medicare — which serves millions of Black and Hispanic Americans — denies coverage of anti-obesity medications. A review of the CDC’s Adult Obesity Prevalence Maps reveals that obesity is prevalent in the same states where Black American senior citizens already make up large swaths of the Medicare population. Among these are South Carolina, Alabama, Louisiana and Mississippi. With an expected 10 million African Americans reaching Medicare eligibility by 2038, it is critical that Medicare amend its coverage to embrace obesity treatment for the best health of every senior citizen.
Obesity is unquestionably the pandemic hidden in plain sight, and combating the continued rise of the disease will require aggressive action. We clinicians must educate ourselves about the latest obesity science and adjust care delivery to incorporate each person’s unique needs. Policy makers and public and private insurers must boldly close coverage gaps to permit access to the full spectrum of obesity care to everyone.
Now is the time to take important steps in turning the obesity pandemic around. The future of our families, communities and our country depends on it.
Dr. Garfield Clunie is president of the National Medical Association. Based in Silver Spring, the NMA is the nation’s oldest and largest scientific and professional organization representing African American physicians and patients.