Is obesity a manifestation of systemic racism? A ten-point strategy for study and intervention.

In the recent past, there has been rising attention to systemic racism. The ensuing discussions have largely focused on COVID-19 and policing. Despite long-standing disparities in obesity across racial and ethnic groups and obesity's important role in COVID-19 disparities, there has been minimal attention to whether obesity itself could be a manifestation of systemic racism. Nor has there been serious policy attention dedicated to alleviating obesity and its disproportionate burden on BIPOC (Black, Indigenous, and People of Color). We discuss whether obesity's disproportionate harms to BIPOC may be attributed to systemic racism, and we provide a ten-point strategy for studying and solving the core public health issues at the intersection of obesity and systemic racism.

US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity.

OBJECTIVE: Obesity is now the most prevalent chronic disease in the United States, which amounts to an estimated $147 billion in health care spending annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for private and public health insurance plans that expanded coverage for lifestyle/behavior modification and bariatric surgery for the treatment of obesity. Pharmacotherapy, however, has not been included despite their evidence-based efficacy. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans. METHODS: We examined coverage for phentermine, diethylpropion, phendimetrazine, Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide (Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and marketplace insurance plans in 34 states. RESULTS: Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. Medicare policy strictly excludes drug therapy for obesity. Only seven state Medicaid programs have drug coverage. CONCLUSIONS: Obesity requires an integrated approach to combat its public health threat. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease.