Stigma About Obesity Keeps Patients From Seeking Care, Creating Nationwide Disparities

Doctor talking to overweight patient | Image credit: New Africa - stock.adobe.com

Stigma surrounding obesity is keeping patients from seeking adequate care, leading to nationwide disparities and exacerbation of the obesity epidemic, according to panelists at the Academy of Managed Care Pharmacy (AMCP)’s annual Nexus conference.

Eileen S. Myers, MPH, RDN, CEDRD-S, FAND, consultant at Eileen Myers, LLC, began the discussion with an overview of the obesity epidemic, clarifying the differences between obesity and overweight and which states have the highest obesity rates.

Although obesity affect at least 30% of the non-Hispanic White population in about half of states, the rates are much higher for Hispanic and non-Hispanic Black populations. When looking at the Hispanic population, most states have an obesity rate of 30% or higher, and when looking at non-Hispanic Black Americans, 37 states and the District of Columbia have an obesity rate between 35% and 50%.

Myers noted the misconception that obesity is the result of poor choices, clarifying that genetic risk is the main factor contributing to the disease and that obesity is the result of several complex, adaptive systems. Weight bias often leads patients to seek less care, resulting in worse outcomes later in life and ineffective policies to address the issue.

As the use of obesity drugs, such as Ozempic/Wegovy (semaglutide), have risen, some have expressed concerns about patients with obesity having to be on medication for the rest of their lives. However, this is not a concern in other disease states, such as epilepsy or rheumatoid arthritis, and many providers, patients, and other stakeholders do not consider obesity to be a disease, explained Patty Taddei-Allen, PharmD, MBA, BCACP, BCGP, director of scientific services at MJH Life Sciences, parent company of The American Journal of Managed Care^®.

“I think we all need to come to the realization and come around to the fact that [obesity] is a disease, and we have to treat it. We have the technology available today, we understand some of the elements of why obesity exists. If we have that technology and we have medications that can improve that, why would we not use it?” she explained.

Additionally, access to therapy is a major challenge for patients with obesity, as there’s debate over pharmacy coverage for antiobesity medications, and these therapies and surgery are often too expensive for most patients.

Muhammad Ghanem, MD, FACS, DABOM, bariatric surgeon and codirector of bariatric fellowship at Orlando Health, gave a medical benefit perspective on the epidemic, noting that a vast majority (about 98% to 99%) of patients who qualify for bariatric surgery do not undergo surgery, and 65% of the patients who do are White with high incomes. About 35% of patients with obesity who are eligible for surgery are uninsured or underinsured.

Justin Bioc, PharmD, BCPS, BCGP, RPh, head of clinical pharmacy at Devoted Health, noted that providers create a disparity themselves by choosing not to treat obesity because stigma has led them to believe that patients with obesity are not sick enough to warrant medical intervention, despite obviously being sick.

Bioc and Ghanem emphasized the importance of keeping cultural differences in mind when trying to address obesity challenges in non-White or non–native English-speaking populations.

“We're already making all the mistakes. There's so much to learn from disparities and obesity. One is when we’re talking about weight. As you know, this is the weight loss drug class or the weight loss disease state. And that's such a narrow slice of what we need to be talking about, when we talk about obesity… It's hard to have these conversations from a practical lens, when we have policy that reinforces kind of the behavior that we are only looking at the costs and not looking at the problem,” said Bioc.

Myers and Taddei-Allen noted that labeling obesity medications as “weight loss” drugs or “new” when they’ve been around for years is not helping the cause to improve obesity care, and the media has a hand in how these drug are viewed by society and what their purpose is.

In response to a question about whether patients just want to hear that a medication will make them lose weight, she said, “100% I think there's a lot of patients. I think that that's because patients don't think obesity is a disease state, because they've been taught and they've been hearing it in media that it's their fault that they're fat. It's their fault that they're overweight…. We need to treat obesity like we treat other disease states.”