As a diabetes specialist, I have treated thousands of patients, some in Beverly Hills and others in East Los Angeles. My Beverly Hills patients live to be healthy people in their 80s and 90s. I don't remember when my last patient in this community lost vision, had an amputation, or started dialysis. Almost none suffer heart attacks or strokes.
But in low-income areas of East Los Angeles I see every week people in their 40s and 50s who have developed preventable, life-altering complications of diabetes: blindness, kidney failure, loss of a limb. These patients rarely live to old age.
Obesity is one of the drivers of this heartbreaking disparity. Health-conscious Beverly Hills is packed with doctors' offices, fresh foods, and gyms. Most residents there can spend what they need to maintain a healthy diet and get help managing diabetes. In East Los Angeles, where for some a home refrigerator can be a luxury, diabetes and obesity afflict thousands of families who rely on fast and processed food for the affordable calories they need to survive.
The history of these two neighborhoods is replicated throughout the country. Obesity kills 300,000 Americans annually. It is associated with increased risk of more than 200 other diseasesincluding heart disease, diabetes, cancer and dementia. According to the modeling According to my colleagues at USC's Schaeffer Institute for Public Policy and Government Services, the average American will soon be obese. Black and Latino people experience higher rates of severe obesity compared to non-Latino white people, which translates to higher rates of chronic diseases.
Despite decades of public health efforts, obesity is increasing. Some recent lifestyle interventions have shown promise; For the most part, however, simply urging people in minority neighborhoods to change their diets has proven ineffective. Although providing resources and education helps, these initiatives are often grant-funded and not routinely available. Many proposed solutions that might resonate in wealthier communities, such as recommending “fixed” foods, with less sugar, fat and preservatives, simply don't work in East Los Angeles. The cost and availability of healthy foods are two reasons. So is culture. When there is food insecurity, the family meal can be a celebration that is not easy to give up.
But at least one weight-loss remedy that's hugely popular in Beverly Hills also works citywide: medication. New medications such as Wegovy/Ozempic (semaglutide) and Zepbound/Mounjaro (tirzepatide), if used with proper medical supervision, can often reduce body weight. by 15% or more. Several of my severely obese patients have lost close to 100 pounds and avoided much more expensive metabolic surgery.
Drugs come with List prices that can exceed $1,200 per month.although health insurance companies often negotiate large discounts. So far Medicare is not helping to reduce costs for patients because it cannot pay for weight loss medications. But Medicaid, the state/federal program that covers the poor, faces no such limitation. And it has a big price advantage: By law, you automatically get the biggest discounts negotiated by any payer.
Several states, including Californiahave added one or more of the obesity medications to their Medicaid formularies. In Los Angeles County, use is not yet widespread as doctors must obtain prior authorizations through Medicaid managed care organizations and teach patients how to inject themselves at home. But among patients who take the medications, we are seeing improvements in health.
The balance between drug prices and benefits is a tense debate, focused primarily on what would happen to public and private sector budgets if coverage were expanded. The Congressional Budget Office recently completed that the costs of authorizing coverage in Medicare would exceed the benefits of improved beneficiary health over the next 10 years.
I'm not an economist, but I know that focusing solely on the government's accounting books can be short-sighted. I see firsthand that medications play an important role in the treatment of obesity and diabetes. Like many other medications I have prescribed for other illnesses, over time they will become more affordable and will reduce the costs of treating associated illnesses. Research at USC Schaeffer projects that Medicare coverage for obesity treatments could generate 4 trillion dollars in social value to Americans for three decades.
Of course, we must also continue to push for better and broader access to fresh food, healthier diets, and safe places to exercise around the clinic where I work in East Los Angeles. However, using these newer medications anywhere in the city can provide real benefit even if lifestyle changes are more difficult to implement.
I'm all for whatever works for my patients, no matter where they live, as long as preventative healthcare and individualized treatment plans are part of the equation.
In addition to her medical practice, Anne L. Peters is a senior researcher at USC's Schaeffer Institute for Public Policy and Government Services..
