A Comprehensive Approach to Obesity

Subject: A letter I sent to HSS regarding payment for anti-obesity Medications

Obesity, which affects 36% of Tennessee’s population, remains one of the most pressing challenges in the effort to Make America Healthy Again. As a physician who advocates for a holistic approach to healthcare, I have seen firsthand how obesity impacts the mental, emotional, social, and physical health of individuals. Additionally, obesity significantly raises the risk of numerous health conditions, many of which can be debilitating or even life-threatening.

Addressing this public health crisis requires a comprehensive approach—one that combines sustainable lifestyle changes, preventative education, and, when appropriate, anti-obesity medications (AOMs). The rising rates of obesity are influenced by a range of factors, including the consumption of ultra-processed, high-sugar foods and a reduction in physical activity across the population. These challenges demand a multifaceted response.

While I support the proposed Federal rule to ensure that AOMs are covered under Medicare and Medicaid, I believe it is critical to recognize that medications like GLP-1 inhibitors—though effective for some patients—should not be viewed as a standalone solution to the obesity epidemic. These medications, like all pharmacological treatments, come with side effects, some of which can be significant. They can serve as part of a broader, holistic strategy to improve health, but without complementary lifestyle changes, they may only offer temporary benefits. The long-term reliance on such drugs, without addressing root causes such as poor diet and sedentary behavior, would likely perpetuate a cycle of dependency and increased healthcare costs.

Furthermore, the high cost of GLP-1 inhibitors raises additional concerns about their sustainability and accessibility. There is a risk that these medications could be diverted and misused, similar to the illicit trade seen with other controlled substances. Therefore, we must approach this issue with both caution and foresight.

To effectively combat obesity and improve public health outcomes, I urge Congress to consider the following complementary strategies:

1. Food as Medicine: One of the most powerful tools we have in preventing and treating obesity is food. Encouraging a shift toward whole, nutrient-dense foods and away from ultra-processed, sugar-laden products is essential. Initiatives that promote food as medicine can have a lasting impact on individual health and reduce the demand for expensive pharmaceutical interventions.

2. Community Gardens: Expanding local access to fresh produce through community gardens is a proven strategy that can improve food security and health outcomes, especially in low-income and underserved areas. By revitalizing “Victory Gardens” and making it easier to grow and sell locally sourced produce, we can help combat food deserts and encourage healthier eating habits.

3. Education and Prevention: We must invest in education programs that teach people of all ages about the importance of nutrition, physical activity, and preventive healthcare. Schools, workplaces, and community centers should be empowered to provide resources that emphasize healthy living as a means of preventing chronic diseases, including obesity.

4. Access to Comprehensive Weight Loss Programs: In addition to medications, patients should have access to structured, evidence-based weight loss programs, including metabolic surgery where appropriate. For many individuals, weight loss surgeries like gastric sleeve procedures have proven to be more effective—and often more cost-effective in the long term—than relying solely on medications. This should be a part of a full spectrum of care options.

5. Behavioral Health Support: Behavioral change is critical to the long-term success of any obesity intervention. Studies show that adherence and behavior are responsible for up to 75% of health outcomes. To truly reduce the incidence of obesity, we need to provide robust behavioral support, counseling, and coaching to help individuals make and sustain lifestyle changes. This will help ensure that any medical treatment, including AOMs, is more effective and sustainable.

In closing, we all share the goal of empowering Americans to lead healthier, more active lives and to reduce the long-term costs associated with obesity and its related health conditions. A truly effective strategy for reducing obesity must be built on a foundation of addressing its root causes. While medications like GLP-1 inhibitors may play a role in a broader treatment plan, relying solely on pharmaceuticals would be an unrealistic and unsustainable solution. We must instead prioritize prevention and education, ensuring that Americans have access to healthy food, behavioral support, and healthcare solutions that promote long-term well-being.

The United States already spends more on healthcare than any other nation, yet we continue to face high rates of chronic illness. This reflects a system that too often focuses on treating disease rather than preventing it. By adopting a more holistic approach—focused on food, education, community, and behavioral health—we can achieve meaningful change and reduce the burden of obesity on our healthcare system.

Thank you for your time and attention to this critical issue. I look forward to working together to promote a healthier future for all Americans.