More physicians are seeking a better understanding of obesity medicine, as knowledge of the disease grows and weight-loss drugs like Wegovy and Ozempic capture the nation’s attention.
Physicians across specialties are pursuing a certification in obesity medicine, including internists, pediatricians, endocrinologists and gastroenterologists. Nearly 1,900 physicians have applied to take the annual exam in October, compared with about 1,250 in 2022, according to the American Board of Obesity Medicine, which administers the exam. In 2019, applications totaled less than 900.
About 6,700 physicians in the U.S. and Canada are board-certified in obesity medicine, more than triple the number in 2017, according to the board.
Obesity, recognized by the American Medical Association as a disease in 2013 and defined as a body mass index of 30 or more, is difficult to treat and particularly prone to relapse. Physicians typically treat it using medication, therapy, endoscopic procedures, bariatric surgery and/or lifestyle changes.
A growing number of digital health companies are also launching virtual weight-loss programs to prescribe anti-obesity medication.
As obesity numbers rise—affecting about 42% of Americans today, compared with 31% two decades ago, according to the Centers for Disease Control and Prevention—more physicians are interested in new ways to treat it.
“I think [physicians] hear from their patients that this is something they want to … address,” said Dr. Kimberly Gudzune, medical director at the American Board of Obesity Medicine and an associate professor at Johns Hopkins Medicine. “We need more physicians who feel confident in what they’re doing [and] understand the evidence-based best practices when treating obesity.”
Developments in obesity treatment
While obesity was labeled a disease a decade ago, physicians say that recognition has taken years to gain traction.
Obesity was historically chalked up to poor lifestyle and lack of willpower, but more clinicians are considering the role of hormones, brain chemicals, mechanisms of the digestive tract and other factors, Gudzune said. That’s one driver behind the increase in certifications, she said.
“I think back to when I first started practicing obesity medicine … [and] it was something where a lot of other physicians didn’t know that the field existed,” Gudzune said.
Today, Johns Hopkins' Healthful Eating, Activity and Weight Program sees 30 to 40 new patients per month, and hundreds more are on the waiting list, she said.
The Food and Drug Administration’s approval of Novo Nordisk's Wegovy in 2021 for weight management thrust obesity medicine into the spotlight and sparked more patient demand for treatment options.
Wegovy is a weekly semaglutide injection that helps reduce appetite by mimicking the glucagon-like peptide-1, or GLP-1, hormone. Ozempic, another Novo Nordisk semaglutide injection used to treat Type 2 diabetes is not approved for weight management but has shown potential weight-loss benefits. In the coming months, the FDA is expected to approve Eli Lilly's Type 2 diabetes drug Mounjaro for weight management.
“We had medications that could help us achieve about 5% weight loss in our patients, at most 10%, with a single medication. In the last few years, we now have highly effective medications both that are in the market now and in the pipeline," said Dr. Katherine Saunders, clinical assistant professor of medicine at Weill Cornell Medicine and co-founder of telehealth and software company Intellihealth.
Barriers to care
One of the biggest issues with newer medications is the high cost, with per-month prices often exceeding $1,000 without insurance. Ozempic has a monthly list price of $936, while Wegovy’s is $1,349.
High costs have led some health plans to pull back on coverage, said Dr. Angela Fitch, assistant professor of medicine at Harvard University and president of the Obesity Medicine Association.
Employers can voluntarily add obesity treatments to their health plans, but many do not.
St. Louis-based Ascension Healthcare, for example, stopped covering anti-obesity drugs for health plan members July 1. The University of Texas System on Sept. 1 ended coverage for plan members of Wegovy and Saxenda, a weight-loss drug approved in 2014.
Some physicians, including Fitch, believe obesity treatment should be a standard benefit. She also said high-cost medications should not be as widely prescribed.
“People have been treating obesity for a long time in the United States. It just hasn’t been as trendy,” Fitch said. “We have older medications, we have other pathways, we have behavioral interventions, other nutritional interventions, etc., so we have to think about it as getting patients with obesity to doctors, not getting patients with obesity to medication.”
Physicians are also pushing for more training in medical school programs.
Medical school curriculums address obesity as a risk factor for other diseases such as diabetes and hypertension, but don’t typically cover it as a standalone disease, said Dr. Amanda Velazquez, assistant professor of medicine and surgery and director of obesity medicine at the Center for Weight Management and Metabolic Health at Cedars-Sinai Medical Center.
She and several other physicians are leading The Obesity Society’s Education QI Project, which seeks to include obesity education in medical school curriculums. Ten medical schools, including the UT Health San Antonio Long School of Medicine, Howard University and University of Illinois College of Medicine, were chosen to collaborate on an obesity-focused curriculum that will launch in the coming years.