New obesity treatments offer hope, but can we afford them?Mar 31, 2023
Worldwide obesity has tripled since 1975. WHO surveys tell us that more than 2 billion adults, 18 years and older are overweight and of these nearly 800 million are actually obese. 39 million children under the age of 5 were overweight or obese in a 2020 survey and it is estimated that 400 million children and adolescents aged 5-19 are overweight or obese. At least 6 million people die each year as a direct result of their obesity rather than its complications.
While perhaps for genetic and cultural reasons the incidence of obesity per capita is highest in the pacific islands, among developed nations, Australia has one of the highest rates of overweight and obesity. The complications of obesity, such as diabetes, heart disease, arthritis, sleep apnoea, some cancers etc are well known but there is also a tremendous loss of the enjoyment available through physical activities to those with a body not compromised by being too heavy.
Here are the latest (2022) sobering statistics for our nation.
- Around 36% of adults in Australia (9.2 million people) are overweight. Around 31% of adults in Australia are obese (7.9 million).
- There has been a 10% rise in Australians overweight over the past 25 years.
- The obesity rate in Australia is projected to increase by 2% in 2023.
- 9% of adults in Australia suffer from severe obesity disorders (life-threatening).
- More than 1 million people in Australia have type 2 diabetes due to obesity.
- Around 16,700 deaths in Australia happen annually because of obesity and type 2 diabetes.
- Around 140 premature deaths are caused by obesity in Australia every day.
- Australia is ranked 5th among OECDs (Organisation for Economic Cooperation and Development) for obesity.
- Overweight or Obesity affects 1 in every 4 children in Australia.
Overweight and obesity have significant financial impacts. In 2018, obesity cost the Australian community $11.8 billion and if nothing is done, may cost an estimated $87.7 billion by 2032! A disproportionate incidence of obesity is associated with poorer economic circumstances. Cheaper packaged foods high in calories and poor in micronutrients as well as sugar laden drinks are clearly part of the problem.
As is so obvious, losing weight and then managing not to regain the weight lost is very difficult and the failure rate is very high. However new strategies that have emerged from a better understanding of the cause of obesity are producing encouraging results. To appreciate these developments we need to discuss some relevant physiology.
If that hasn’t resulted in your moving on to the next P & I article here is some important new knowledge of relevance.
From intensive research over the last few years we have learnt that we (and other animals) have developed mechanisms to help us control the appropriateness of the amount of food we eat. As our stomachs fill with food the resultant stretching of our stomachs reaches a point where mechanisms are activated to slow the emptying of the stomach. This helps us feel that we have ingested enough food.
As this occurs chemicals are released into our blood stream which are carried to our brain where they activate receptors that results in our brains giving us a feeling of satiety, a ‘turn off” switch which stops us feeling hungry. These same chemicals activate our pancreas to secrete insulin to help us get the sugar we have ingested into cells that need it to produce energy.
All well and good (and clever) BUT what if you didn’t have this ‘turn off’ mechanism working? If you were so unfortunate, you would be very likely to consume more calories than you need and dieting would be extremely difficult. If that was the case, and clever scientists could synthesise a chemical that would activate these turn off mechanisms, might you not reduce your food intake and lose weight?
Well we now have a number of drugs that do just that and the weight loss associated with their use has in many cases been extraordinary.
These developments demand a paradigm switch in how we think about obesity and the obese. Just as diabetics can’t metabolise sugars efficiently because they don’t produce enough insulin, so many who are obese don’t secrete the chemicals that nature intends us to use to have us ingest calories appropriately. This concept requires us to regard obesity as a disease.
These newly developed drugs should be used as part of a comprehensive, professionally supervised weight management program helping with any mental health issues, providing dietary advice, an exercise program and any number of other related issues.
Not surprisingly, these drugs are in short supply all over the world such is the demand and in Australia at the moment our Pharmaceutical Benefits Scheme (PBS) only subsidises their use by individuals with poorly controlled type 2 diabetes who certainly have much to gain from such treatment.
If not subsidised the drugs are extremely expensive and currently the socio-economic circumstances of millions of obese Australians would not make their purchase possible. One drug that doctors can currently prescribe to help with weightless, (Saxenda) is available but costs at least $380. There are better, but very expensive, drugs for the management of overweight/obese diabetics that are subsidised by our PBS but are currently unavailable. The manufacturer is hoping to have the drug available in the next few months.
Debate continues about how to broaden the program and which cohort should be next to benefit. There’s a strong argument to prioritise treatment for obese younger Australians who have not as yet developed serious co-morbidities.
Of course the drug companies that created these drugs deserve and indeed need a fair profit but debate is raging about what a fair profit should look like given the huge worldwide demand for enough medicine to adequately respond to the statistics that I have tabled above. Evidence is accumulating that weight gain, even after the loss of huge amounts of weight, is common when treatment stops. Many may need life time therapy and that, of course, will significantly increase the cost of maintaining low rates of obesity.
In the US health economists suggest that obese Americans, eligible for Medicare benefits, could bankrupt the program if all were treated at current costs. As noted obesity is costing us billions of dollars a year and destroying the quality and duration of life for many of us. The cost/benefits analysis requires constant review but given projections for the ever increasing disease burden associated with obesity in Australia, the provision of these medicines through our PBS to overweight/obese Australians with or without diabetes is surely justified.