March 2024
Heart disease has been the leading cause of death in the United States since 1950; accounting for 20% of all deaths in 2019. Cardiovascular health is both directly and indirectly impacted by the disease of obesity. Over 40% of adults in America have the preventable disease of obesity (including severe obesity) and that percentage is projected to continue to increase.
The disease of obesity increases the risk for type 2 diabetes, hypertension, and sleep apnea — all which increase the risk of cardiovascular conditions. For example, individuals with obesity and high blood pressure have a “12% increase in coronary heart disease and 24% increased risk for stroke”. The statistics are even more stark in communities of color. According to the Office of Minority Health, “in 2019, African Americans were 30 percent more likely to die from heart disease than non-Hispanic whites”. Among Hispanic women in the US, the most prevalent risk factor of cardiovascular disease is obesity.
Groundbreaking, Effective Interventions
The American Medical Association (AMA) recognizes obesity as a progressive, chronic disease state with multiple pathophysiological aspects. Comprehensive treatment protocols include both intensive lifestyle interventions and pharmacotherapy. In recent years, advances in pharmacotherapy have made treating obesity and its many comorbidities increasingly effective. Earlier versions of anti-obesity medications (AOMs) increased average weight-loss from 5-7%, however, modern versions are showing up to 15% weight-loss.
An August 2023 study affirmed that the use of a modern AOM (a glucagon-like peptide-1 receptor agonist or GLP-1) can also cut the risk of heart attacks in patients with obesity by 20%. Furthermore, for patients already taking statins and other medications to prevent heart problems, taking the AOM cut the rate of heart attacks by 28%. Over the course of the five-year study of people with obesity but not diabetes, researchers also found that use of an AOM reduced the rate of strokes by 7%, cardiovascular-related deaths by 15%, and a 19% lower rate of death from any causes. Expanding utilization of AOMs to treat obesity will address this treatable healthcare crisis by improving overall survival and reducing healthcare costs for consumers as well as insurers.
The disease of obesity also leads directly to the development of cardiovascular disease through its adverse effects on heart structure and function. Obesity has long been linked to poorer overall cardiovascular health; however, new studies have identified that obesity itself can cause damage to heart muscle. Research has shown that “those who were the most obese developed the most heart failure.”
“Being very overweight puts you at risk for heart disease even if you seem otherwise healthy…even if you don’t have high blood pressure, high cholesterol or diabetes.”
— Chiadi Ndumele, M.D., Johns Hopkins cardiologist
Simply put, abdominal body fat “is associated with cardiometabolic disease, and cardiovascular disease and is predictive of mortality”. Actions and policies to support treatment of the disease of obesity are sure to also reduce cardiovascular disease mortality.
“This is the first weight management therapy that we’ve proven in a rigorous trial to reduce the excess risk of cardiovascular events associated with overweight and obesity.”
— Michael Lincoff, MD, lead investigator of the Select trial and an interventional cardiologist at the Cleveland Clinic
Reducing Barriers to Access
While science and options for intervening against the disease of obesity have made strides, insurers and the US Healthcare system are lagging behind. Currently, only 2% of US adults eligible for obesity pharmacotherapy receive it. Many obesity patients report barriers such as access to healthcare, cost, and bias preventing them from receiving treatment.
Public insurance coverage is also slowly expanding. In more than a third of US states, Medicaid fee-for-service or managed care now covers AOMs. Similarly, State Employee Health Benefit plans in over half the states have coverage policies to ensure access to AOMs. However, while all Federal Health Employee Benefit (FEHB) programs, TRICARE, the Veterans Health Administration, and the Indian Health Service, provide coverage of AOMs, Medicare does not.
Providers are increasingly recognizing the value of using AOMs to treat the disease of obesity. In November 2023, the AMA stated, “Providing evidence-based treatment options that include weight loss medications … to effectively manage obesity is important to reduce health complications” and therefore, “the AMA will urge health insurers to provide coverage of available FDA-approved weight-loss medications, including GLP-1 medications.”
“As a result, health care professionals are left to treat patients without access to clinically proven and effective tools to promote weight loss, including FDA-approved pharmaceutical therapies to treat obesity.”
— Robert Gabbay, chief science and medical officer for the American Diabetes Association
Medicare’s Coverage Gap
Under current policy, Medicare does not provide coverage for anti-obesity medications, citing Medicare Part D’s outdated prohibition on covering drugs used for weight loss. This crude interpretation of a 20-year-old statute has not kept pace with life-saving medical advances and stands as a major barrier for older adults, Americans with disabilities, and some dual eligible beneficiaries from receiving medically necessary, safe, and effective FDA-approved pharmacotherapy to treat obesity.
Further, as more private and public insurers cover AOMs, Medicare’s lack of coverage leaves older adults vulnerable as they may lose access to treatment when they age into Medicare.
Moving Forward: Expanding AOM Coverage & Access
As Medicare expands access to GLP-1s for the treatment of cardiovascular disease and diabetes, we must not lose sight of the fact that obesity is its own medically recognized chronic disease which demands treatment — treatment that, if provided, can slow or prevent the onset of poor cardiovascular health and other conditions. Medicare beneficiaries should not have to become sicker to gain coverage for these revolutionary treatments.
We call on Congress and the Administration to reduce barriers to life saving obesity treatments. CMS can distinguish between FDA approved AOMs and weight loss treatments of a bygone era and update its regulations to include coverage of AOMs; or Congress can clarify that exclusion of weight loss drugs under Medicare Part D does not include FDA approved AOMs.
Learn about the Health Equity Coalition for Chronic Disease and our partners at HealthEquityAction.org.
