The Price of Inaction: Why not treating obesity costs more in the long run

Obesity — today’s fastest-growing public health crisis impacting over 40% of Americans — deserves aggressive treatment. Far from just “a weight problem,” obesity significantly impairs people’s physical and mental health, quality of life, and longevity. That was certainly true for my father, whose obesity led to diabetes, COPD, depression, and mobility issues. I watched as his health spiraled and a broken health system let him down. That’s why I’ve devoted the last decade to building a continuous care solution that I believe could’ve saved him.

But the devastating effects of obesity go beyond the common cardiometabolic and mental health conditions my dad suffered from. It also encroaches on reproductive, sexual, brain, and cellular health, increasing the risks of cancer, infertility, sexual dysfunction, and Alzheimer’s disease. The costs to quality of life and longevity are heartbreaking — and the economic costs are staggering. 

And yet we still hesitate to treat obesity as a dangerous disease. Even with advancements in new anti-obesity medications like Ozempic and Monjauro that promote impressive outcomes, many employers and health plans recoil at the sticker price. They’re not looking below the surface at what happens when we let obesity go untreated. 

Obesity is a major risk factor for some of the most devastating and expensive common conditions Americans face. We need to take a harder look at obesity’s connection to diabetes, cancer, fertility, dementia, and more when weighing the cost of treatment. The price of inaction doesn’t come cheap.

Diabetes and cancer

Obesity multiplies the likelihood of developing type 2 diabetes by seven and doubles the risk for many cancers. At the top of this list is a 5-fold risk of esophageal cancer and a 7-fold risk of endometrial cancer.

Perhaps not surprisingly, diabetes and cancer are some of the costliest chronic conditions in the US. Five years ago, the estimated cost of diagnosed diabetes was $327 billion in medical expenses and lost productivity. By 2030, experts expect the annual cost of cancer to reach $240 billion. 

Fertility and sexual health 

Surges in male infertility coincide with increasing rates of obesity due to impaired hormone levels, sperm functionality, and offspring health. Similarly, women with obesity deal with prolonged conception times, higher miscarriage rates, and reduced success with conception treatments. Many women turn to IVF, which can cost up to $30,000 per cycle, though it often takes multiple cycles to get a viable pregnancy. 

Reproductive health aside, obesity can erode sexual function and satisfaction. A large bariatric surgery study at Temple University revealed over 40% of surgery candidates reported sexual dissatisfaction as a reason for seeking treatment.  

Dementia and Alzheimer’s Disease 

Obesity is an often overlooked risk factor for dementia and Alzheimer’s (AD), a devastating disease that affects more than 6 million Americans. People with obesity are twice as likely to develop dementia and AD. Research efforts to explain this correlation are ongoing. The University of Texas linked obesity to changes in 21 AD-related genes, potentially revealing the underlying mechanism. 

The financial implications are immense given that AD is America’s costliest health issue, consuming one-fifth of Medicare’s annual budget at around $155 billion. Considering midlife obesity accounts for nearly a third of America’s AD cases, we urgently need targeted obesity control strategies. 

A step-therapy approach to treatment cuts costs and saves lives

Whether obesity snowballs into diabetes, cancer, sexual dysfunction, or cognitive decline, the outcome can be catastrophic. As individuals grapple with the downstream effects of obesity, employers face increased absenteeism, diminished productivity, and a flood of healthcare expenditures. Health plan leaders don’t get off easy either, with huge drains on their budgets.

Nationally, the cumulative direct and indirect expenses tied to obesity were $1.4 trillion in 2014. If the current trajectory persists, this could exceed $4 trillion by 2035 — more than 4% of the U.S. GDP and nearly half of all healthcare spending.

But our fate isn’t sealed. Employers and health plans can proactively take a step-therapy approach to treatment. They can partner with obesity management solutions that center on behavior change as the foundation of treatment, layering on medications as needed. For some who need extra support, lower-intensity anti-obesity medications (AOMS) may help people reach their goals. Others, with severe obesity or multiple conditions, may need higher-intensity AOMs like GLP-1s to see 15% weight loss.

Using this careful step-therapy approach should result in only 5-10% of any given population ending up on GLP-1s, while the majority of people could still get clinically meaningful results without such intensive treatment. After all, people only need about 5% weight loss to see significant health improvements.

It’s futile to treat all of the downstream effects of obesity — like diabetes, cancer, infertility, and Alzheimer’s — without a laser-focused determination to minimize its root cause. Let’s put an end to obesity and get our healthcare system and budget back on track.