Shame won’t solve America’s obesity crisis: How Congress can help

The alarm bells should be ringing in Congress: A disease that is already a leading killer of Americans is now projected to afflict almost half of all adults within the next eight years.

The disease is obesity. For decades it was thought to be a personal moral failing. Science proved that to be wrongheaded, just as chemistry showed substance abuse to be impervious to “just say no.” Congress needs to act because body shaming can’t be a stand-in for national health policy. 

Today, more than 4 in 10 U.S. adults have obesity, up from 3 in 10 in 2000. Those defined as having severe obesity increased even faster, from roughly 1 in 20 to 1 in 10.

Obesity kills 300,000 Americans annually, and poor diet is the leading risk factor for mortality in the U.S. Obesity is also an underlying condition in almost a third of COVID-19 hospitalizations. It damages nearly every system in the human body, leading to diabetes, heart disease, stroke, several forms of cancer, mental illness, difficulty with physical function and many other maladies.

Strikingly, the medical establishment spent nearly a quarter trillion dollars in 2020 treating conditions where obesity was a driving cause, but spent alarmingly little on preventing or treating obesity itself. Not only does preventing obesity and obesity-related diseases eliminate unnecessary suffering and death, it also makes financial sense. A 2022 Bipartisan Policy Center report coauthored by one of us concluded that obesity costs $248 billion (in 2020) in annual medical expenditures, 6.2 percent of total expenditures. A USC Schaeffer Center health microsimulation model found that obesity is a bigger risk to public finances than smoking. 

Despite this, Medicare and private insurers cover few obesity treatments. Currently, coverage is limited to behavioral counseling in primary care settings and weight loss surgery for people with severe obesity and other related conditions — leaving most people with obesity with too few effective options.

More intensive behavioral counseling could help battle obesity, but Medicare falls short by limiting coverage to primary care providers who are rarely fully trained in weight management and lack the time to provide lengthy interventions. Intensive behavioral counseling could be delivered more effectively — and potentially at a lower cost — by specialized providers, including registered dietitians and psychologists. Medicare coverage for Medical Nutrition Therapy — a type of nutrition counseling provided by a registered dietitian — is also limited to people with diabetes or kidney disease, leaving out care for those with obesity and numerous other diet-related diseases.

When the Medicare drug benefit was created almost 20 years ago, Congress prohibited coverage of weight loss therapies on the grounds that they were cosmetic, rather than health, treatments. As they usually do, private insurers followed suit: Less than 10 percent of people have commercial health insurance that covers weight management medications.

Despite the lack of incentive from Medicare, five drugs have come to market that can reduce weight by 6-16 percent over 52 to 68 weeks. Reducing just 5 percent of body weight improves blood sugar, blood pressure, triglycerides, HDL cholesterol, sleep apnea and other chronic conditions. The medications are safe and important tools for Americans’ health but can’t meaningfully contribute to the battle against obesity without insurance coverage. 

Bipartisan bills in Congress aim to solve the problem. 

The Treat and Reduce Obesity Act (TROA) was introduced by Sens. Tom Carper (D-Del.) and Bill Cassidy (R-La.), Reps. Ron Kind (D-Wis.), Raul Ruiz (D-Calif.), Brad Wenstrup (R-Ohio) and former Rep. Tom Reed (R-N.Y.). It would expand Medicare coverage to include FDA-approved prescription drugs for chronic weight management and intensive behavioral counseling provided by registered dietitians and other specialists. 

Another bipartisan bill, the Medical Nutrition Therapy Act, was introduced by Sens. Susan Collins (R-Maine) and Gary Peters (D-Mich.) and Reps. Robin Kelly (D-Ill.) and Fred Upton (R-Ill.). This bill would expand Medicare coverage for Medical Nutrition Therapy (MNT) to include obesity and other diet-related diseases and allow a range of professionals to refer for the service.

Beyond access to medications and nutritional counseling, bipartisan political leadership is needed to advance policies that improve nutrition security for all. In the United States, childhood obesity is more common than childhood hunger, even in low-income households. The Child Nutrition Reauthorization — which includes the National School Lunch Program and Special Supplemental Nutrition Program for Women, Infants and Children, among other programs — should be passed with an eye to battling childhood obesity by improving food and nutrition security. In addition, the reauthorization of the Farm Bill by the upcoming 118th Congress will provide an opportunity to elevate diet quality as part of SNAP (Supplemental Nutrition Assistance Program), known as the “food stamp” program.

Medicare and private insurers pay for treatments for diabetes, heart disease and high blood pressure. If saving lives is the objective, then logic, clinical evidence, and compassion dictate that they should also pay for preventing and treating obesity, starting now.

Anand Parekh is a board-certified internal medicine physician, chief medical advisor at the Bipartisan Policy Center, and former deputy assistant secretary of Health at the U.S. Department of Health and Human Services. Dana Goldman is dean of the Price School of Public Policy, and co-director of the Schaeffer Center for Health Policy & Economics, at the University of Southern California.