How the government can solve America's obesity epidemic

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.

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.