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Recognizing and treating obesity as a disease – 60 Minutes

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Nearly half of American adults are obese, a fraction of that number just 40 years ago, and scientists disagree about what caused the dramatic increase. . What everyone agrees is that this is a major health crisis, as obesity can lead to her type 2 diabetes, high blood pressure, stroke, and a dozen types of cancer.

There are now drugs that lead to dramatic weight loss. But it is very expensive. Hollywood celebrities take it to flatten their bellies, but few can afford to spend thousands of dollars a year on it.

And while some say the American Medical Association finally recognized obesity as a disease in 2013, few insurance companies cover it.

Dr. Fatima Cody Stanford: This is a brain disease.

Leslie Stahl: Really?

Dr. Fatima Cody Stanford: It’s a brain disease. And the brain tells us how much to eat and how much to store.

Fatima Cody Stanford, M.D., an obesity specialist at Massachusetts General Hospital and an associate professor at Harvard Medical School, says all popular beliefs about obesity are wrong.

And diet shows like “The Biggest Loser” are snooker people.

Leslie Stahl: Dieting makes you lose weight, right?

Dr. Fatima Cody Stanford: Many of us can diet. It’s like “The Biggest Loser,” right? You go and limit people. Exercise 10 hours a day, then feed 500 calories. For most people, weight is lost quickly. However, 96% of his participants in “The Biggest Loser” regained weight because their brains worked better. I was supposed to put them back in order to save what I needed or what my brain thought I needed.

Leslie Stahl: Willpower, then?

Dr. Fatima Cody Stanford: Throw it out the window. The last patient I saw today was a young woman of 39 years old who suffered from severe obesity. She works out consistently, she does 5-6 times a week. She eats very little. Her brain adheres to certain settings.

According to Dr. Stanford, a setpoint is the range of weight your brain maintains by controlling how much you eat and how much you store. One theory is that it’s an evolutionary survival mechanism that helped preserve fat during famine.

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Dr. Fatima Cody Stanford

Leslie Stahl: So we had COVID. Did those people have new settings higher now?

Dr. Fatima Cody Stanford: Of course. So when you have a chronic stressor, reach a certain weight, and maintain that weight for at least 3-6 months, it will readjust that set point to another set point.

Lesley Stahl: I always heard it was fast food. That it’s Diet Coke, something like that, that’s the instigator. TRUE?

Dr. Fatima Cody Stanford: So I think we have to look at the different causes of obesity as a big pie. And that’s one factor. But notice how I’m using this piece of pie.

Dr. Fatima Cody Stanford: But the biggest cause of obesity is genetics. This means that if you are born to obese parents, you have a 50-85% chance of becoming ill yourself, even with optimal diet, exercise, sleep management and stress management. , “Hmm. What are they feeding those kids? They’re doing something wrong.” Actually, do you know this? He 79-90% of US doctors have a prejudice against overweight people. A doctor listening to me now might say, “Oh, that’s not me.” I said, so please hug your horse. “Hey Doctor, I’m working out.”

Leslie Stahl: Wait, you mean doctors don’t understand obesity? Doctors?

Dr. Fatima Cody Stanford: Doctors don’t understand obesity.

In one of his published studies, Dr. Stanford found that most medical schools don’t teach that obesity is a disease, and don’t really even offer courses on obesity. smoking.

Nicole Sams, a mother of five from Rhode Island, spent years visiting doctors with the same message.

Nicole Sams: “Well, I have to go see a nutritionist.” And I did. I did everything I was told. I went to a nutritionist. I sit down and when a piece of rubber food comes up in front of me, ‘oh you only eat this part’, I’m like ‘oh’.

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Nicole Sams

Maya Cohen first started dieting when she was 13. When he was at his heaviest, he was 5 feet tall and weighed 192 pounds.

Lesley Stahl: People look at you and say, ‘Why doesn’t she stop eating?

Maya Cohen: I know you look at someone and internalize, “Oh, they must think I eat too much.” It is. Therefore it must be true. And you start believing this.

Dr. Caroline Apobian: If people walking down the street with obesity are stigmatized and shunned on the street, if they can lose weight and keep it off, they will. Would you like to

Caroline Apobian, Ph.D., co-director of the Weight Management and Wellness Center at Brigham and Women’s Hospital in Boston, who sees both Maya Cohen and Nicole Sams, said she is committed to providing patients with safe care. I am relieved that I finally have a very effective drug. to the FDA.

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Dr. Caroline Apovian

It is part of a new generation of medicines that can help you achieve and maintain an impressive average weight loss of 15% to 22% of your body weight. Doctor. Apovian and Stanford have advised companies developing obesity drugs, including Danish company Novo Nordisk, the broadcast’s advertiser. It’s like an EpiPen that makes Wegovy, a drug that you inject yourself once a week. Medicines are currently in short supply. Moreover, the monthly fee is 1300 yen or more.

Lesley Stahl: People in Hollywood can afford these expensive injections. And they are taking them.

Dr. Fatima Cody Stanford: Yes.

Leslie Stahl: And they’re not necessarily obese people.

Dr. Fatima Cody Stanford: Yes. These medicines are in short supply nationwide. Those who have the means can get them, but those who really need them cannot. haves and have-nots.

The majority of obese people can’t afford Wegovy, one of the reasons most insurers refuse to cover it, the AHIP (Association of Health Insurance Industries) explained in a statement. As such, these drugs “have not yet been proven to work well for the body.” Long-term weight management can lead to complications and adverse patient outcomes. “

Dr. Caroline Apovian: What we’ve seen is really nausea and vomiting.

Lesley Stahl: Oh, buildup?

Dr. Caroline Apovian: And get back on your feet.

Dr. Apobian says most side effects go away over time.

Dr. Caroline Apobian: Every day we are disappointed when we see patients desperately needing to lose weight to reduce diabetes, high blood pressure, stroke and heart disease. effective and safe. And I can’t give it to them because insurance doesn’t cover it. I get an email about the denial – stating that they are denying this because “Doctors have not advised their patients about behavioral changes as part of this.” And here’s the idea that you can do it with exercise. I guess.

Novo Nordisk also makes a type 2 diabetes drug called Ozempic, which is covered by most insurance companies and employers. What’s frustrating doctors is that Ozempic and Wegovy are exactly the same drug.

When Maya Cohen wanted obesity pills…

Maya Cohen: My insurance company said it considered it a “vanity drug.”

Leslie Stahl: “Vanity Drugs”.

Lesley Stahl: So insurance companies don’t see obesity as a disease.

Maya Cohen: Right.

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Maya Cohen

Nicole also declined to be interviewed. On its website, her health plan, through Rhode Island, puts anti-obesity drugs in the same category as drugs for erectile dysfunction and cosmetic purposes.

With about 110 million Americans covered by anti-obesity drugs, the investment in insurance is high, but if covered, it would likely reduce overall government and private health care costs. . Diabetes, which is often caused by obesity. Diabetes costs more than $300 billion annually, most of which is covered by Medicare and Medicaid. But Thomas Phillipson, a health care economist at the University of Chicago, points out that there are actually laws that prohibit Medicare from covering weight-loss drugs.

Lesley Stahl: Do you think insurance programs for the elderly will greatly benefit these drugs?

Tomas Philipson: Yes, one-third of Medicare spending is on diabetes. This is highly associated with obesity. And Medicare pays for all your medical bills when you get older with things like heart disease from obesity. I think that’s what it means.

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Thomas Phillipson

They were blown away when Dr. Apovian told both Maya Cohen and Nicole Sams that obesity isn’t lack of willpower.

Nicole Sams: I looked at her and said. That’s my fault. ‘ Because that’s what I’ve been hearing all my life.

Maya Cohen: I went home that day. It’s like, “Okay, I finally have hope. I have hope.”

Leslie Stahl: Did you cry?

Maya Cohen: I did. a lot. (smile)

Dr. Caroline Apobian: For years I thought you had no willpower, it was your moral failure, you were a glutton, why were you eating so much and feeling ashamed? It’s a shame.

Leslie Stahl: Yeah, yeah. It’s a shame.

Dr. Caroline Apobian: I’m sorry.

Maya has type 2 diabetes, so she was finally able to get the medication covered by her insurance. She has lost over 50 pounds. Dr. Apobian says she needs to keep dieting and exercising and, like most patients, takes medication indefinitely to maintain her weight.Nicole does not have type 2 diabetes in her case.

Lesley Stahl: Nicole, we called your insurance company and they gave us a statement.

Nicole Sams: Okay.

Lesley Stahl: “Earlier this year, the state of Rhode Island, in consultation with pharmacy benefits managers, decided that Rhode Island employee health insurance would cover the entire class of anti-obesity drugs.”

Nicole Sams: Oh really?

Lesley Stahl: “This coverage change will go into effect in January” —

Nicole Sams: Okay.

Leslie Stahl: –“2023”

Maya Cohen: Nice to meet you.

Nicole Sams: Yes. This is fantastic. This is fantastic. (Applause) Wow. Wow.

In its statement, the Association of Health Insurance Industries said, “Obesity is a complex disease, and the evidence and clinical guidelines related to treating obesity … are evolving rapidly. Health insurers will continue to review clinical evidence.” ‘ said.

Up to 60 minutes from Novo Nordisk Statement

Produced by Asha Siddiqui. Associate Producer Kate Morris. Broadcast Associate Len Woodson. Edited by Craig Crawford.

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