Obesity: the economic case for action

One area that begs for policy change is the federal environment for innovation. Today, the U.S. regulatory infrastructure can stifle even the most ground-breaking new therapies, owing to an often burdensome review process and an inadequate appreciation of the medical implications of obesity. Even though obesity is the leading cause of heart disease, diabetes and a host of other dangerous and costly chronic diseases, our own Department of Health and Human Services does not approach it as a medical disorder. These policies create misguided restrictions on reimbursement for obesity therapies currently available in the marketplace and excessive hurdles for regulatory approval of new drugs and medical devices. As a result, new capital investment in device and pharmaceutical companies has decreased substantially. Companies developing new, more effective solutions for patients with obesity are reducing their efforts in this area, decreasing their workforces, or focusing on foreign markets.
O’Grady and Capretta’s study compares an array of programmatic interventions against obesity, and reports that, of those studied, pharmaceutical therapies and surgery can be among the most cost-effective.  Given the tremendous cost of obesity to our nation’s health and economy, and the fact that medical innovations are key to reversing this perilous trend, it is critical that our regulators develop a more effective strategy to help bring proven, valuable and much-needed medical solutions to the marketplace more efficiently.
{mosads}Congress can and must also do its part. A key recommendation in O’Grady and Capretta’s study that should be considered is to revise the way our budget analysts model the cost impact of federal obesity interventions. Today in Washington, we are limited by a 10-year picture of the costs of new programs measured against the returns that they are expected to generate. This approach fails to account for savings that extend beyond that window, the type of generational benefits that are particularly notable for investments that will halt or reverse the rising prevalence and severity of obesity. Effective prevention and treatment of obesity reduction has clear, long-term benefits, not least of which are the health and economic benefits of reducing its many complications such as diabetes, heart disease, and many forms of cancer.  If we take a slightly longer term perspective on the costs of tackling obesity and the payoffs to be gained from this investment, Congress will gain the necessary perspective to make more realistic and strategic investments in obesity reduction programs and policies.
Policy-makers, economists, physicians and other clinicians all recognize that to successfully restrain the rising costs of health care, we need to manage chronic diseases more efficiently. Obesity is the most common and most costly of the chronic diseases affecting our country, and it is a primary cause of many of the others.  The magnitude of the obesity crisis requires timely, focused and sustained efforts.  These efforts must come at many levels — individuals, families, communities and health care providers certainly — but also the local, state and federal public health establishment, where policy-makers, regulators and budget modelers have a crucial and urgent role to play.  The data is clear.  We cannot and should not wait any longer to act.

U.S. Congressman Erik Paulsen (R-MN) is co-chairman of the Congressional Wellness and House Medical Technology Caucuses as well as a member of the House Ways and Means Committee.

Lee M. Kaplan, MD, PhD, is Director of the Obesity, Metabolism & Nutrition Institute at Massachusetts General Hospital, Associate Professor of Medicine at Harvard Medical School, and Chairman Emeritus of the Campaign to End Obesity.



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