Commentary: Obesity is a disease – treating it like one could be a game changer for healthcare
If obesity is seen not just as a personal struggle but a disease of public health concern, we can look for systemic solutions, says Novi Health’s Kyle Tan on World Obesity Day (Mar 4).
An obese man standing at a bus stop (Photo: AFP/Paul Ellis)
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SINGAPORE: For 52-year-old Michael*, food noise was a reality. No matter how much he ate, he never did experience the sensation of fullness. Diet after diet failed – not for a lack of discipline but because the hunger never truly subsided.
Obesity has been seen as a simple problem of willpower, diet, and exercise for decades. But science is now pointing to it being far more complex than a physical sign of our moral failings.
Obesity is now recognised – by the World Health Organization and many medical professional bodies – as a chronic disease influenced by genetics, hormones and environmental factors. There is increasing evidence that metabolic and hormonal imbalances can make weight loss challenging without the help of medical intervention.
It is this shift in understanding that is changing how we view and approach obesity management. Those who have struggled with their weight have long been told to “try harder” and just find it within themselves to eat less and move more.
Identifying obesity as a disease is a real game changer, especially when it comes to destigmatising the condition. Treating obesity as a medical condition opens the door to better support and resource allocation, including how such treatments that can lead to lasting improvements in health could be paid for.
CONTROLLING HUNGER AND SATIETY
Things all changed for Michael when he started on a weight-loss drug. For the first time in his life, he knew what being satiated felt like after every meal.
Over the next year, he lost more than 20 per cent of his body weight. His blood pressure and blood sugar improved, and he was able to cut back on multiple medications. But to him, the biggest win was finally feeling in control of his own hunger.
Michael’s case is not unique. New weight loss medications (such as GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists) are revolutionising how we treat obesity by helping people regulate hunger and satiety. Patients taking these medications can lose up to 20 per cent of their body weight on average.
But improvements go beyond weight loss. Research in the United States has shown that weekly injections of tirzepatide or semaglutide can reduce the risk of developing Type 2 diabetes by more than 90 per cent over three years.
They have been shown to reduce the risk of cardiovascular disease and renal disease in individuals with diabetes; and improve numerous weight-related conditions such as fatty liver, obstructive sleep apnea and joint pains. Emerging research even suggests potential longevity benefits, through the improvement of cardiovascular and metabolic health and its neuroprotective effects.
GAINS BEYOND WEIGHT LOSS
This also paints a future where long-term healthcare expenditures could be reduced by preventing weight-related conditions from turning into more serious – and more costly – diseases.
Consider that for the first time in a decade, obesity rates in the US are finally starting to decline, largely thanks to these weight loss medications. This shift is similar to how statins revolutionised heart disease prevention through lowering cholesterol and have become the cornerstone in cardiovascular health.
Beyond personal health, the larger financial impact is compelling. Illnesses related to obesity are projected to cost global healthcare systems over US$4.32 trillion annually by 2035. In the US alone, obesity costs the economy US$147 billion per year, factoring in the treatment for diabetes, cardiovascular disease and obesity-related cancers and lost productivity.
WHO PAYS?
The recognition of obesity as a disease raises a critical question: Who should pay for treatment? For many years, healthcare systems and insurers have been reluctant to cover the cost of weight loss medications, as they are usually classified as lifestyle drugs and not essential treatments.
Now that is starting to change.
The United Kingdom’s National Health Service (NHS) has integrated weight loss medications such as Ozempic, Wegovy and Mounjaro into its obesity treatment pathways, making them available free to eligible patients.
It’s going even further by studying the broader socioeconomic impact of obesity treatment and conducting the first “real-world” study in Greater Manchester to see how obesity treatments are affecting employment opportunities in the area. With obesity costing the NHS £11 billion (US$13.8 billion) per year and contributing to labour force and productivity losses, the UK government is looking beyond health outcomes.
In the US, some insurers are starting to cover weight loss medications, particularly for patients with diabetes or cardiovascular disease. But coverage is still inconsistent.
In Singapore, obesity treatment still remains largely self-funded, despite steps to encourage healthier lifestyles. According to the National Population Health Survey 2022, obesity rates rose from 8.6 per cent in 2013 to 11.6 per cent in 2022. This is a concerning trend contributing to increasing metabolic diseases.
If obesity rates continue to climb, policymakers may need to reconsider whether to subsidise treatment that can prevent expensive hospital admissions for heart disease and kidney failure. Expanding coverage for obesity treatment is a long-term investment in public health.
A HOLISTIC APPROACH TO OBESITY TREATMENT
Obesity is not just a personal struggle but a public health crisis that necessitates systemic solutions. Recognising obesity as a disease shifts the conversation from outdated notions about willpower to a science-backed understanding of the underlying biology. It would help ensure the right resources are in place – from government funding to insurance coverage, to medical support.
To be clear, medication alone is not the answer. The most successful obesity management strategies take a multi-faceted approach, combining medical treatment, behavioural therapy and environmental changes.
Countries like Japan have successfully lowered their obesity rates through comprehensive policies that integrate education, taxation on unhealthy foods, and easy access to public health services.
To make a real impact globally, employers, insurers and governments must work together to expand access to treatment options and create environments where healthier choices are easier to make. This means looking into workplace wellness programmes, better urban planning and ensuring that the latest medical treatments are affordable and accessible.
World Obesity Day (Mar 4) is the perfect time to move toward treating obesity as a disease. It does not just benefit individuals; it builds healthier societies.
*A pseudonym was used in this commentary.
Dr Kyle Tan is co-founder and consultant at Novi Health and Adjunct Assistant Professor at the NUS Saw Swee Hock School of Public Health, National University of Singapore.
