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Thread: The health care system rethinks obesity

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    The health care system rethinks obesity

    Categorizing obesity as a disease may open up more care / scripts to insurance payments. Some new drug do appear to actually work. But they are very expensive and life long. Once you stop taking them, assuming you have not fixed your lifestyle, the weight comes back. There are also side effects.


    The health care system rethinks obesity

    Doctors and medical experts are leading a rapid cultural shift around obesity, viewing it as a disease rather than a lifestyle choice.


    Why it matters: That shift is opening new treatments and better care — but also new controversies over who can access those treatments and how best to use them.



    What they're saying: "Obesity is a highly prevalent chronic disease characterized by excessive fat accumulation or distribution that presents a risk to health and requires life-long care. Virtually every system in the body is affected by obesity," six obesity advocacy organizations recently wrote in a joint statement.

    • "Every person with obesity should have access to evidence-based treatment."
    Driving the news: An existing class of diabetes drugs has shown enormous promise for weight loss, offering a ray of hope to the millions of Americans with obesity.

    Yes, but: Many insurers, including Medicare, won't cover those drugs for weight loss. And they can be unaffordable without insurance coverage.

    • Wegovy, which is approved for weight loss under certain conditions, has a list price of $1,349 for a month's supply.
    • "A majority of my patients can't afford to pay $1,300 a month, especially for a medication that they need to be on long term," Veronica Johnson, an obesity specialist at Northwestern Medicine in Chicago, told NBC News.
    The other side: Kristine Grow, a spokesperson for America's Health Insurance Plans, recently told Axios that the therapies have limitations and "have not yet been proven to work well for long-term weight management and can have complications and adverse impacts on patients."

    • The same class of drugs also can be misused. Some digital health startups are advertising and prescribing the drugs to people who aren't overweight, the Wall Street Journal reported this week.
    Between the lines: The treatment landscape is changing rapidly for children as well as adults.




    • New guidance released last month by the American Academy of Pediatrics recommends against delaying obesity treatment for children, and argues that doctors should be proactive about approaches like intensive health behavior and lifestyle treatment and, in some cases, prescription drugs or surgery.
    • But the guidance is already drawing pushback. Eating disorder specialists, for example, are warning that it could backfire, NPR reported this week.
    • "We run the risk of doing significant harm to kids who are 6 or 8 by telling them that they have a disease ... simply based on their weight status," Kim Dennis, an eating disorder specialist, told NPR.
    What we're watching: An unusual array of interest groups is already pushing for Medicare to cover the drugs for obesity, STAT reports.

    • And more broadly, the existence of an effective treatment raises big questions about how to prevent yet another prescription drug from becoming commonly misused — and how to balance access to obesity treatment against the risks of perpetuating a stigma.
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    I think it is a mistake to be entirely in either camp. Saying the obese have a disease becomes an excuse for poor eating habits and lifestyle choices.

    Doctors should apply treatments along with dieting and exercise advice on a case by case basis.
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    Quote Originally Posted by RMNIXON View Post
    I think it is a mistake to be entirely in either camp. Saying the obese have a disease becomes an excuse for poor eating habits and lifestyle choices.

    Doctors should apply treatments along with dieting and exercise advice on a case by case basis.
    A work collogue was deciding whether to get that stomach surgery. I read the list of what to do after the surgery. I told him that all he has to do is skip the surgery and follow that list.

    He got the surgery. Didn't change his diet/lifestyle and is heavier now than before.
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    Quote Originally Posted by Peter1469 View Post
    A work collogue was deciding whether to get that stomach surgery. I read the list of what to do after the surgery. I told him that all he has to do is skip the surgery and follow that list.
    He got the surgery. Didn't change his diet/lifestyle and is heavier now than before.
    Different health issue, but I consulted with a surgeon regarding 'frozen shoulder' and the possibility of surgery to address it. He handed me a list of exercises I needed to do for a minimum for (I think it was) 6 weeks before he would consider surgery. He said if a patient didn't do the exercises before surgery, they sure wouldn't do them after the surgery.

    I did them with a level of determination. After 6 weeks of doing them, I no longer needed the surgery, and thank the surgeon for his recommendation.

    Your co-worker proved that point also.

    IMO, obesity is a symptom of other health problems, physical or mental. The number of people who actually have an underlying health issue that 'causes' obesity is miniscule compared to the number in the never ending cycle of emotion driven eating and the 'I'm too heavy to exercise' so they move less and less and eat more and more.

    Not everyone is built the same, and people can carry a little more weight than others without being obese.
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    Quote Originally Posted by Collateral Damage View Post
    Different health issue, but I consulted with a surgeon regarding 'frozen shoulder' and the possibility of surgery to address it. He handed me a list of exercises I needed to do for a minimum for (I think it was) 6 weeks before he would consider surgery. He said if a patient didn't do the exercises before surgery, they sure wouldn't do them after the surgery.

    I did them with a level of determination. After 6 weeks of doing them, I no longer needed the surgery, and thank the surgeon for his recommendation.

    Your co-worker proved that point also.

    IMO, obesity is a symptom of other health problems, physical or mental. The number of people who actually have an underlying health issue that 'causes' obesity is miniscule compared to the number in the never ending cycle of emotion driven eating and the 'I'm too heavy to exercise' so they move less and less and eat more and more.

    Not everyone is built the same, and people can carry a little more weight than others without being obese.
    And being overweight (on the BMI scale) is healthier than being "skinny-fat."
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    Quote Originally Posted by Peter1469 View Post
    And being overweight (on the BMI scale) is healthier than being "skinny-fat."
    Interesting term. I have a BMI of 19. Part of it is genetics, everybody in our branch of the family tends to the slender side, add T1d to the mix and I am very lean.
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    If people want to live longer then they need to at least start off healthier.
    Video games and pizza isn't going to give you that good start. Life before video games involved sports. Pills are not going to fix the fat kid over the long term.
    Let's go Brandon !!!

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    Quote Originally Posted by carolina73 View Post
    If people want to live longer then they need to at least start off healthier.
    Video games and pizza isn't going to give you that good start. Life before video games involved sports. Pills are not going to fix the fat kid over the long term.
    Wait... give up pizza?

    Seriously though, the trend of the last 10 years or so is more room IN the house, and less yard. Growing up we only had .6 of an acre, but add on the whole neighborhood to ride bikes, explore the creek, the woods, and play in someone else's back yard.

    Too much worry about kids getting hurt, or molested by strangers is 'strangling' childhood, along with social media. Not to make light of the nutcases out there, but them and criminals not being held accountable for their actions isn't helping in keeping kids safe these days.
    "I believe there are more instances of the abridgement of freedom of the people by gradual and silent encroachments by those in power than by violent and sudden usurpations." -- James Madison

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    Quote Originally Posted by Collateral Damage View Post
    Wait... give up pizza?

    Seriously though, the trend of the last 10 years or so is more room IN the house, and less yard. Growing up we only had .6 of an acre, but add on the whole neighborhood to ride bikes, explore the creek, the woods, and play in someone else's back yard.

    Too much worry about kids getting hurt, or molested by strangers is 'strangling' childhood, along with social media. Not to make light of the nutcases out there, but them and criminals not being held accountable for their actions isn't helping in keeping kids safe these days.
    I grew up on asphalt and concrete and it also never stopped us.
    Let's go Brandon !!!

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    Quote Originally Posted by RMNIXON View Post
    I think it is a mistake to be entirely in either camp. Saying the obese have a disease becomes an excuse for poor eating habits and lifestyle choices.

    Doctors should apply treatments along with dieting and exercise advice on a case by case basis.
    It's not an excuse, it's just a description. Anyone who wishes to stay fat can and others may now have drugs to help them lose weight. It's not really news , we have known that weight loss is much harder for some than for others. I don't know how you would provide

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