Current Perceptions Affect Managed Care of Obesity as Chronic Condition

As obesity prevalence grows, it is important to consider it as more than just weight gain. Obesity is a chronic disease comprised of dysregulated adipose tissue, which increases the risk of developing serious health conditions, including diabetes, cardiovascular disease, and cancer.

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In a session at the Academy of Managed Care Pharmacy’s Nexus 2023, presenters Justin Bioc, PharmD, BCPS, BCGP, RPh, head of Clinical Pharmacy at Devoted Health, Muhammad Ghanem, MD, FACS, DABOM, a bariatric surgeon and co-director of Bariatric Fellowship at Orlando Health, Patty Taddei-Allen, PharmD, MBA, BCACP, BCGP, director of Scientific Services at MJH Life Sciences; and Eileen Myers, MPH, RDN, LDN, CEDRD-S, FAND, a consultant at Eileen Myres LLC, discussed the obesity epidemic in the United States, health disparities, and the effect of obesity on health care outcomes and costs.

“The public, educators, health care professionals have mostly looked at obesity as a matter of poor choices,” Myres said in the session. “We all understand now this disease of obesity is not about just making poor choices. The majority is not. The reality is on the other side of the pyramid, where we know the genetic risk [is] 70%, the environment absolutely is a risk factor, and then there are poor choices.”

One of the major challenges for patients who live with obesity or overweight is access to therapies, according to Taddei-Allen. She emphasized that this could include medication but is not limited to just that, as it can also include access to surgery. Access to pharmacy coverage for anti-obesity medication is particularly important, especially because there is a debate over pharmacy coverage for these medications.

Bariatric surgery results in weight loss at approximately 25 to 35%, but medication is slowly catching up. Trizepatide results in weight loss of approximately 15% to 25%, and semaglutide at 10% to 20%.

The access to bariatric surgery is still lacking, with only 1% to 2% of eligible patients getting approved for the surgery, Ghanem said. Barriers to access can include patient-physician communication, as some patients do not even know that this is an option. Patient and physician views and attitudes about surgery can also contribute, but the biggest barriers include cost and insurance benefits, Ghanem noted.

There is a need for coverage of these therapies to create more access to care, specifically for underserved patients. Patients do not necessarily believe that obesity is a disease, however, according to Taddei-Allen, who added that some physicians and other health care professionals also do not believe obesity is a disease. According to the session, managed care pharmacies and stakeholders share responsibility in accessibility.

Additionally, there is recovery not just among the general population, but in different communities in racially and ethnically diverse groups, Taddei-Allen said. Racial and ethnic groups have challenges to accessing health care in a general sense, which has caused a higher prevalence of obesity in these populations as well.

Bioc added that managed care pharmacies can address disparities in health by hiring individuals who are native speakers, with the same dialect, as their patients. He said this should be obvious, but this does not happen as much as it should because it has been proven to help racially and ethnically diverse patients with their health.

In obesity more broadly, he said that there are a lot of mistakes being made in managed care. Bioc said that weight loss is a small part of obesity. Obesity can also cause cardiac conditions, diabetes, and more. He said there is still so much to consider and learn about obesity in ethical, racial, and health disparities in varying communities.

Taddei-Allen said that the current environment is not sustainable, noting that sponsors are spending billions of dollars on wellness programs, which is not having the desired efficacy, but some medications are achieving better outcomes. She also said that this should not be an either-or situation; there needs to be a combination of wellness and other therapeutic options. Health care is not a one-size-fits-all, according to Taddei-Allen. There should not be a “cookie cutter” response to obesity as everyone’s experiences and health have different needs.

“I keep hearing all of these medicines, [all of] these patients are going to have to be on it for the rest of their lives. I think to myself, would you say that to someone who has epilepsy or someone who has [rheumatoid arthritis] or has any other disease state?” Taddei-Allen said.

Reference

Bioc J, Ghanem M, Taddei-Allen P, Myers E. Navigating Health Disparities in Obesity for Managed Care Pharmacists. AMCP Nexus 2023. October 17, 2023. Accessed October 17, 2023.