Mark Baldwin: Congress should act now to help vulnerable seniors live longer

In October , a presidential advisory from the American Heart Association issued a paper that clearly established the connection between cardiovascular disease, diabetic kidney disease and obesity. Other related illnesses such as diabetes mellitus, hypertension and stroke, make up a large segment of health care spending in the U.S. Much of this spending could be used for other areas including preventative health and early intervention in illnesses.

Fortunately, there are now safe weight loss medications available and Congress is currently considering the passage of the Treat and Reduce Obesity Act (TROA). With passage, Medicare would cover obesity treatment for many seniors.

According to datacommin.org, the obesity rate in Washington State is 29.8% and the rate of diabetes mellitus is 8.29%. For Spokane County, the rate of obesity and diabetes are 29.5% and 8.8%, respectively. In Yakima County, the obesity and diabetes rates are 39.8% and 11.9%, respectively. According to the Centers for Disease Control, obesity related illness cost $178 billion dollars per year. Obesity is a local and national health issue.

For decades, the role of healthy diets such as the Mediterranean, DASH and similar diets, limiting food additives such as antibiotics, hormones, fructose, artificial sweeteners, exercise, avoiding tobacco, minimal alcohol use, if any, adequate sleep and management of stress are the most important factors for a healthy life. With that said, this is not always feasible. Health education is limited in schools and for adults, funding programs do not encourage health choices. Inexpensive carbohydrate-based, high-calorie, low-nutritional value foods that satiate can lead to ongoing health problems. Surgical treatments for obesity have been available for many decades but are not without potential complications.

Some previous weight loss prescription medication which were amphetamine based or pharmacological derivative of amphetamine have had limited success and considerable abuse potential. Metformin, which was introduced in the mid-1990s for treatment of Type 2 diabetes mellitus has some weight loss potential.

In 2005, the first GLP-1 receptor agonists were introduced as add-on treatments for Type 2 diabetics. Since their introduction, patients have been able to gain control of their blood glucose levels. In addition, an additional salutary effect has been weight loss, the key factor in treatment of obesity-related diseases. Besides diabetes mellitus and obesity, a growing number of studies have shown that patients treated with GLP-1 medications have decreased risks of heart attacks, atherosclerosis, diabetic kidney disease (the most common cause of chronic kidney disease), and obesity associated liver disease, to name a few.

In 2014, the FDA approved several GLP-1 medication for weight loss for a Body Mass Index of less than 30 or less than 27 with other associated medical conditions. This was further expanded in 2021 and since for add on therapy for obesity along with diet and exercise.

Considerable publicity generated in the popular press and online for these medications has raised concerns about inappropriate use and potential long-term effects. Some want the prescriptions just to lose weight. Prevention and interventions, however, can save lives. Health care dollars cost a fraction of the costs of complications.

The costs of the complications of obesity-related diseases, including medications and surgical treatments, dialysis and transplantation for end-stage kidney disease, limb amputations for complications of poor blood flow are just some of the reasons for health care spending. Much can be saved through intervention and prevention.

As with so many aspects of health care in the U.S., access and cost are an important concern. With the approval of several GLP-1 medications, physicians and patients are still having difficulty in obtaining these proven medications. As production increases the cost will come down and availability will increase.

The Treat and Reduce Obesity Act of 2023 is a key to providing seniors adequate barrier free insurance coverage for these FDA-approved weight loss medications. Along with lifestyle changes including diet, exercise and close supervision should be the cornerstone of the treatment of obesity-related illnesses. Contact your member of Congress and urge the passage of TROA. Tell them effective evidence-based treatments for obesity are an ounce of prevention which costs less than a pound of cure.

Dr. Mark Baldwin D.O. FACOI, FASN, is Professor and Chair of the Department of Internal Medicine, Pacific Northwest University, Yakima. He is a frequent lecturer, author and avid cyclist. His opinions are his own and do not reflect those of Pacific Northwest University. He has not received any compensation and has no disclosures or conflicts of interest