I am an advocate for people doing their best to use people-first language in discussing obesity (for detailed information on this topic, there is no better website better than the Obesity Action Coalition), especially in professional situations, however, I do think making this the central focus of addressing obesity bias can have a downside, especially now.
Why now?
Well, on June 4th, the FDA approved semaglutide ( under the brand name Wegovy) where the average weight loss was 12.4% compared to placebo, based on a small, once-a-week injection.
And how much is this wonder drug going to cost?
That hasn’t been determined yet, but Novo Nordisk says the cost of Wegovy will be in line with Saxenda and the cost of that drug is $1300 per month.
Now for sake of argument, let’s just say the good folks of Novo Nordisk decide to make this drug available at $1000/month. Obesity affects>1/3 of the US population. How keen do you think health insurance companies are going to be to cover this medicine for $12,000/year indefinitely?
They’re not! I would bet right now every major insurance company is meeting this week strategizing the best ways to not cover this medicine ( which shouldn’t be too hard, because most of them already have strategized ways to not cover bariatric surgery (the gold standard of obesity treatment), and in my insurance company’s case, all treatments for obesity, including dietary counseling, cognitive behavioral therapy and all medicines for obesity.
And here we hot the crux of the matter. Health insurance companies do not want to have discussions about treatment options for obesity—especially treatment options such as semaglutide and bariatric surgery. And they especially don’t want politically astute obesity activists with strong voices getting involved in state and federal legal and regulatory discussions which will mandate covering these types of interventions.
Heck no! Insurance companies would much rather have discussions about people-first language, magazine covers, body positivity, and how the word “fat” should be used. Any discussion except the one needed in their domain: money.
Now, don’t get me wrong. I believe there is a deep overlap between media’s portrayal of obesity as “a lifestyle choice” and the financial interests of health insurance companies, and I also believe this media portrayal is entwined with our language, and over the next decade, we simply must try to move the needle on this. But I suspect this language (culture?) change will take at least a generation. (As an aside, my sense is the stigma and bias towards people with obesity is actually accelerating in the wrong direction, but that’s a topic for another post.)
But right now, we have effective treatments for obesity that are not within reach for most people “now”. Shouldn’t this be the highest priority “now” in terms of social investment?