It’s About Damn Time: Treating Obesity as a Chronic Disease

During one of my TikTok scrolling sessions, I came across a video made by Nurse Practitioner Maria Lena Walls reading a letter one of her patients wrote to the CEO of her employer in regards to adding anti-obesity medications to their employer provided health insurance formulary. I was moved by the words she spoke and reached out to Maria to request that she put me in contact with the writer. HIPPA is tricky, but she was able to give my contact info to @lauralai_7 who eventually reached out to me and gave me permission to post her letter here. Please take the time to read it, it is so important to so many of us, one in three people in the USA, to be exact. Also, I will attach a link to a fill-in-the-blank version of this letter for you to forward to your own employer’s CEO in hopes that a small wave will turn into a tsunami and make a difference in the lives of all people affected by obesity. People like her. And people like me.

1 in 3 Americans are affected by the chronic disease of Obesity.

15 September, 2022

Dear [CEO],

With Diversity Week 2022 approaching, I felt inspired to write a letter regarding a topic that is near (and not dear) to me, but not often discussed because of the social stigma. When I think about diversity and inclusion, one of the first questions that comes to mind is, “Can I be my true and authentic self at work?” The answer I must give is, “No, not all the time.”

The American Medical Association (AMA) classified obesity as a disease in 2013. Almost ten years later, many healthcare organizations, insurance companies, and even physicians, do not treat obesity as a disease, but consider it a moral issue, a personal failing, a problem with willpower and laziness, and not a result of genetics, epigenetics, societal factors, medication side-effects, environment, and/or underlying diseases.

There is implicit and explicit bias of obese individuals that is often ignored and at times even encouraged. If [our] employee and non-employee population is a cross-section of the rest of the population of adults in the United States, then approximately one in three of our caregivers is personally affected by obesity per the AMA.

When I worked [on site], my chair would frequently sink down, and eventually broke, because of my weight. A lot of task chairs have a weight restriction. The Americans with Disabilities Act doesn’t consider obesity as a disability, so filing an ADA request for a reasonable accommodation of a larger chair would have likely been denied immediately upon filing. “Will that chair hold me?” “How many people are already on the elevator?” “Can I fit at this crowded conference room table in this small room?” “Should I sit in a chair in the back so other people aren’t uncomfortable?” “What will the temperature of the room be?” Those are some of the questions that frequently crossed my mind.

I once asked during an HR town hall why [our medical plan] doesn’t cover medications that are FDA-approved treatments for obesity but does cover the exact same medication for other diseases like type 2 diabetes. The answer I was given by one of the benefits leaders at the time was that [our organization] is on par with what other organizations don’t cover, plus we have discounts to Weight Watchers. As someone who has battled obesity for most of her life, and attended Weight Watchers in the past, it was another in a long list of brush-offs I’ve received from healthcare.

My first thought was, “So? Who cares if it’s what everyone else is doing? Why can’t we be the groundbreakers?”

Many insurance plans, including [our medical plan], consider medications like Wegovy (the semaglutide brand marketed to treat obesity) to be “vanity drugs” and not treatment for a disease. Yet, [our medical plan] does include Ozempic on its formulary, the same semaglutide medication as Wegovy, but branded to treat type 2 diabetes.

Considering the many medications in clinical trials that will eventually be FDA-approved to treat both diabetes and obesity (tirzepatide, mazdutide, retatrutide), we will see more and more in the coming years. Mounjaro (tirzepatide) is a new medication that hit the market a few months ago as a treatment for type 2 diabetes, but it has been so overwhelmingly successful in the SURMOUNT-1 clinical trial for weight loss in non-diabetic overweight and obese patients that tirzepatide will be approved by the FDA as a treatment for obesity likely within the next year.

These medications have been described as game changers for the treatment of obesity, on par with what can be lost via weight loss surgeries and will be a welcome and safe tool for so many who have struggled for years battling this disease, even after going to Weight Watchers.

We, as an organization, can make the decision to cover medications like Wegovy and other FDA-approved medications for obesity in our formulary. Instead of being leaders of change, we, like so many others, kick the can down the road. We cover treatments and medication for the high blood pressure, the cardiovascular disease, the joint replacements, the cancer, the infertility, the diabetes, the strokes, the mental health issues, the organ failures, and many more secondary diseases that are linked to obesity. These can ultimately cost just as much or more than the cost of medication that could help someone not suffer from secondary disease in the first place.

[Our medical plan] does cover certain weight loss surgeries if eligible after being on a physician-supervised plan (like Weight Watchers) for six months, but I hypothetically ask, should asking someone to remove 80-90% of their stomach in a risky and costly last-resort surgery be the preferred treatment to a medication approved by the FDA and prescribed by a physician?

It is time to end weight bias and stigma, and treat obesity like the disease that it is proven to be. If one in three adults is affected by obesity, then more internal medicine physicians need to be certified by the American Board of Obesity Medicine (ABOM). If I wanted to find a new primary care physician with an ABOM certification for all my general health needs, not just for weight management, then I would have to look outside of [our system]. I could only find one ABOM-certified internist with [our system], and she’s not accepting new patients. Hiring more internal medicine physicians who are ABOM-certified and encouraging our current physicians in [our organization] to become ABOM-certified, would go far in improving the health of the communities we serve.

I appreciate your time in reading this letter.


*Updated to add this from @lauralai_7:

“The CEO did write me back, and said he appreciated my vulnerability and that he would share my request for anti-obesity medications with our benefits team. I also escalated to my boss’s boss, who is a director of Human Resources, so that she could escalate to her colleagues in benefits. I found out a few weeks ago that it’s officially on the agenda for the benefits team to review for 2024. I’m assuming they will review it this spring, as most plans and formularies are decided on for the following plan year in June or July of the previous year. Fingers crossed we get good news, but I’m using every opportunity that I have to be vocal! My organization has over 30,000 employees, and I know it would make a difference to not just me, but to them, as well as other organizations as they follow suit to remain competitive.“


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