Obesity, COVID-19, and Racial Disparities

August 4, 2020

July 2020

This month's newsletter is written by guest author Fatima Cody Stanford. Dr. Fatima Cody Stanford, MD, MPH, MPA, FAAP, FACP, FAHA, FTOS is an obesity medicine physician and scientist at Massachusetts General Hospital and Harvard Medical School. This article was originally published by Newsweek under the title "America’s COVID-19 Response Must Tackle Obesity." It has been reproduced here with minor edits with the permission of the author. The views expressed in this article are the author’s own.


It wasn’t just the current White House that botched our nation’s response to COVID-19. This pandemic, which has led to more death in the United States than any other country in the world, hit us especially hard because it came on top of another health crisis that has disproportionately devastated Black and brown Americans: obesity.


The obesity epidemic impacts over 42 percent of all Americans, and the numbers are even higher in the Black and Hispanic communities—with obesity rates of nearly 48 percent and nearly 45 percent, respectively. Overall, more than 70 percent of American adults are considered overweight.


Recent studies clearly demonstrate that people with obesity and COVID-19 are at higher risk of getting seriously ill and hospitalized. Patients with severe obesity have been overrepresented among those hospitalized for severe COVID-19 illness, especially among younger patients. These studies led the U.S. Centers for Disease Control and Prevention to acknowledge obesity as a serious risk factor for COVID-19.


And when we have more people—particularly people of color—battling obesity in the United States than anywhere else in the world, we can’t tolerate inaction by our leaders any longer. It’s time for Washington to treat obesity like the disease that it is, rather than the personal failing it is not, and do its part to protect the most vulnerable Americans with targeted legislation like the Treat and Reduce Obesity Act (TROA).


Our longstanding approach to weight loss—one that emphasizes willpower and quick fixes—is clearly broken and doesn’t align with what is known about the genetic, biological and environmental factors that contribute to obesity. I’ve spent my medical career not only conducting obesity research but also working to improve the lives of countless patients who look like me—patients who often feel hopeless and lost in this broken system. And the data backs this up: In 2019, health insurance plans spent $344 billion on weight issues, while consumers spent $290 billion on weight-loss products—yet the country still gained 1 to 2 pounds per person.


Doctors and scientists studying metabolic health have known how to sustainably treat obesity for years. It comes down to finding the optimal treatment strategy, which may include successfully combining prescribed medication and personalized coaching over a year or more to give people the metabolic reset they need to lose excess body mass and keep it off. But with 175 million Americans with obesity and just over 4,000 obesity doctors, access to the proper care and treatment is nearly impossible.


This approach to tackling obesity has proved so successful that it’s one of the few things that Democrats and Republicans have agreed on over the past few years of unprecedented partisan gridlock.


Since 2013, the TROA has been introduced in each new Congress with bipartisan primary co-sponsors in both the House and Senate. It now has over 170 congressional co-sponsors across the political spectrum. The bill would expand Medicare to cover intensive behavioral health therapy that would help Americans with obesity address underlying lifestyle factors that can significantly impact a person’s ability to lose weight, such as diet, sleep, exercise and emotional health. It would also expand obesity screenings and authorize Medicare Part D to cover FDA-approved weight loss medications that complement intensive behavioral health therapy.


This is exactly the kind of treatment and resources that Medicare covers for people with diabetes, but not for Americans on the brink of developing diabetes in the first place. It’s the same twisted logic that has given us a Congressional Diabetes Caucus but no similar caucus on obesity – even though obesity affects three times the number of people as diabetes and is at the root of many of the life-threatening chronic conditions – including diabetes itself.


Now, as lawmakers debate another inevitable COVID-19 relief package—it’s critical that they include the TROA to significantly reduce America’s disproportionate vulnerability to the coronavirus. It’s a smart investment that will not only create an immediate impact in communities hardest hit by COVID-19, but also save around $20 billion in Medicare spending over the first 10 years.


If a deadly virus that disproportionately impacts those with obesity doesn’t build the political will to finally tackle this country’s weight crisis, then what will?


We can’t continue to perpetuate the myth that the millions of Americans with obesity
simply don’t have the willpower to improve their health. need to mobilize public health resources around obesity, as we have with COVID-19 and as we would with any other disease threatening American lives.


Building a healthier world is very much within our grasp, but Washington has to do its part.