Skip to content
Search

Latest Stories

Top Stories

How the government can solve America's obesity epidemic

How the government can solve America's obesity epidemic
Getty Images

Pearl is a clinical professor of plastic surgery at the Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.

Dying younger. Living harder. Going broke. It is difficult to overstate the longitudinal effects of excess weight in America.


An estimated seven in ten Americans are overweight or obese. The combination, according to the National Institutes of Health, results in an estimated 300,000 preventable deaths per year with extreme obesity lowering life expectancy by 14 years on average.

Added weight not only makes everyday life more difficult, but it also produces serious health consequences that include cardiovascular disease, diabetes, musculoskeletal disorders and cancer. In total, obesity costs an estimated $260 billion annually in inpatient and outpatient care.

Whether weight gain is caused primarily by genetics, societal influences or individual will, scientists aren’t altogether sure. What’s clear, however, is that most efforts to lose weight ultimately fail.

New Hope In Diabetes Drugs

Ozempic, one of a new class of medications, has been shown in studies to spur significant weight loss. The others include Mounjaro, Rybelsus and Wegovy with several new (and convenient, pill-based) options in development.

Sign up for The Fulcrum newsletter

A Heavy Price For Weight Loss

Last year, more than five million Americans were prescribed one of these drugs for weight reduction.

The annual price of treatment ranges from $12,000 (Mounjaro) to upwards of $16,000 per year (Wegovy). As a result, most users are either wealthy or have generous health-insurance coverage.

But as more Americans seek these medications for moderate weight loss, not diabetes, insurers have started clamping down. They’ve issued threatening letters to doctors, warning they’ll be referred to state regulatory boards for writing “off-label” prescriptions.

The Ozempic Paradox: Highly Effective But Unaffordable

Ozempic and other medications that help with weight loss are part of an ongoing national debate in which two competing truths collide.

The first truth is that these drugs work, leading to significant and sustained weight reduction: 14 to 25 pounds per individual on average during the medication course. And while they’re not a replacement for proper nutrition, exercise or healthier living, they do reduce the likelihood of heart attack, stroke and cancer.

Second, despite the medical opportunity at hand, making these drugs available to all 100 million obese American adults would prove cost prohibitive for businesses, private insurers and the government.

This means that the medications could drastically rollback the nation’s $260 billion in obesity-related medical expenses each year, but prescribing them at today’s prices would cost more than $1.5 trillion annually—increasing national healthcare expenditures by as much as 25 percent.

What’s more, these medications are considered “forever drugs,” requiring users to either maintain their dosage or regain most of the weight they lost.

Insurers are eager to draw a line between those seeking prescriptions for appearance’s sake and those at heightened risk of disease or death. They’re happy to cover the latter but, as with cosmetic surgery, insurers believe patients should foot the bill for the former.

Lost in this debate is an important question: Why not figure out how to make these lifesaving drugs broadly available and affordable?

The U.S. Government Can Lead The Way

With hundreds of thousands of obesity-related deaths each year, the magnitude of the problem qualifies as an “epidemic” and justifies forceful government intervention.

The current administration, with congressional approval, could initiate a nationwide campaign to fight obesity, similar to Operation Warp Speed. The program, with a $10 billion upfront investment, led to the speedy development of a safe and effective coronavirus vaccine. The government then was able to purchase more than one billion doses at one-third the cost of the vaccine’s current list price.

Here’s how the administration could replicate Operation Warp Speed to fight the obesity epidemic without breaking the bank.

Operation: Slim Provisions

The government would invest $4 billion up front—twice the average R&D cost to bring a new drug to market.

In return for funding and a ten year contract, the first drugmaker to develop a safe and effective weight-loss drug would be required to sell that medication back to the government at $40 per dose (or $2,000 per patient/year), significantly below the retail price of Ozempic and similar drugs. The winning pharma company would benefit financially, earning up to $1.2 trillion in sales over the contract’s lifetime without having to shoulder R&D costs.

With the new medication in hand, government-sponsored health programs, Medicaid and Medicare, would make it available to all obese enrollees (roughly 60 million people) for the next decade.

And by providing the drug to more than half of all obese adults, the government would reduce medical expenses by up to $130 billion annually or $1.3 trillion over 10 years, making the effort cost-neutral for American taxpayers.

Risks vs. Rewards

The only financial risk to the government (outside of defending likely lawsuits) would be failing in its search for a new drug, thus wasting the

$4 billion of taxpayer money. But that’s a relatively insignificant sum compared to the potential healthcare benefits.

The role of government is to protect the health and financial well-being of the nation. Fulfilling that function led to a lifesaving Covid-19 vaccine. Doing so again is the best option our nation has to address America’s growing obesity epidemic.

Read More

Business professional watching stocks go down.
Getty Images, Bartolome Ozonas

The White House Is Booming, the Boardroom Is Panicking

The Confidence Collapse

Consumer confidence is plummeting—and that was before the latest Wall Street selloffs.

Keep ReadingShow less
Drain—More Than Fight—Authoritarianism and Censorship
Getty Images, Mykyta Ivanov

Drain—More Than Fight—Authoritarianism and Censorship

The current approaches to proactively counteracting authoritarianism and censorship fall into two main categories, which we call “fighting” and “Constitution-defending.” While Constitution-defending in particular has some value, this article advocates for a third major method: draining interest in authoritarianism and censorship.

“Draining” refers to sapping interest in these extreme possibilities of authoritarianism and censorship. In practical terms, it comes from reducing an overblown sense of threat of fellow Americans across the political spectrum. When there is less to fear about each other, there is less desire for authoritarianism or censorship.

Keep ReadingShow less
"Vote" pin.
Getty Images, William Whitehurst

Most Americans’ Votes Don’t Matter in Deciding Elections

New research from the Unite America Institute confirms a stark reality: Most ballots cast in American elections don’t matter in deciding the outcome. In 2024, just 14% of eligible voters cast a meaningful vote that actually influenced the outcome of a U.S. House race. For state house races, on average across all 50 states, just 13% cast meaningful votes.

“Too many Americans have no real say in their democracy,” said Unite America Executive Director Nick Troiano. “Every voter deserves a ballot that not only counts, but that truly matters. We should demand better than ‘elections in name only.’”

Keep ReadingShow less
Hands outside of bars.
Getty Images, stevanovicigor

Double Standard: Investing in Animal Redemption While Ignoring Human Rehabilitation

America and countries abroad have mastered the art of taming wild animals—training the most vicious killers, honing killer instincts, and even domesticating animals born for the hunt. Wild animals in this country receive extensive resources to facilitate their reintegration into society.

Americans spent more than $150 billion on their pets in 2024, with an estimated spending projection of $200 million by 2030. Millions of dollars are poured into shelters, rehabilitation programs, and veterinary care, as shown by industry statistics on animal welfare spending. Television ads and commercials plead for their adoption. Stray animal hotlines operate 24/7, ensuring immediate rescue services. Pet parks, relief stations in airports, and pageant shows showcase animals as celebrities.

Keep ReadingShow less