Let’s Not Kid Ourselves

At this point, many of us are posing the rhetorical query, “How much does obesity cost the overall economy, anyway?” This sounds like a trick question, one posed not to extract a factual answer, but to take an indirect route toward confrontation with a really unpopular conclusion. It sounds this way because it is.

One reason the question is virtually unanswerable is, the price of each separate factor involved in bariatric medicine continues to rise. Another reason is that even with modern lightning-speed communication, it is still pretty difficult to guarantee that a pile of information about anything is the latest and greatest.

In many cases, multiple factors change too quickly to be meticulously tracked and compensated for. Sometimes, even experts review their work or the work of others and conclude that “Oops! Those numbers are on the wacky side.” We can take a snapshot that captures a moment in time and compare it to another snapshot in a later or earlier time frame, or in the same moment but in a different place.

A considerable fraction

Back in 2015, the management consulting firm McKinsey Global Institute announced that almost one-third of Earth’s population, or 2.1 billion people, were overweight or obese. In developed economies, “about 15 percent of health care costs […] are driven by [obesity].” Moneyweb.co.za noted that “healthcare costs are more than 40% higher for obese patients than normal-weight patients.”

The investment advice website added that the global impact of obesity was estimated to be “on a par with the impacts of smoking or armed violence, war and terrorism.” Expressed numerically, this figure amounted to around $2 trillion, or 2.8% of the global Gross Domestic Product. As the saying goes, “no matter how you slice it,” this was a real wake-up call. To put the icing on the cake, McKinsey issued the understatement of the century, namely, that “global disagreement on how to move forward is hurting progress.”

Some widespread misunderstandings

In the same year, a mere decade ago, Dr. Bruce Y. Lee compiled a list of seven myths that conspired to convince employers that they could safely ignore the encroaching threat of obesity — the first one being that obesity did not exist in their particular line of work. But in truth, few businesses were found to be exempt. While relatively few responsible authorities were paying attention, obesity had snuck into “nearly every country, income level, race, ethnicity and age group.”

Rising obesity rates were not random accidents, but established facts of life. Even if one particular corner of a commercial field had not yet been invaded, suppliers, subsidiaries, and other connected areas would be affected. And to simply hire skinny people was no solution, because the possibility that they could balloon up was always lurking.

The second prevalent myth was that obesity invariably sprang from each employee’s individual lifestyle choices. But the author pointed out how mistaken a boss would be to assume that anyone who put on pounds was simply lazy or lacking in self-control. To assume that everyone just needed to eat less and exercise more would be a serious error in judgment. People in positions of authority were urged to remember that behavior is governed by “a number of social, environmental, cultural, and financial factors,” which will be looked at in the next installment.

Your responses and feedback are welcome!

Source: “A fat investment opportunity, Moneyweb.co.za, 04/16/15
Source: “Obesity is Everyone’s Business,” Forbes.com, 09/01/15
Images by fabioeliasp1 and miosyn/Pixabay

In the Age of GLP-1 Weight-Loss Medications, Lifestyle Changes Still Matter

The rise of GLP-1 receptor agonists such as semaglutide and tirzepatide has transformed obesity management. Millions of patients now use these injectable drugs in pursuit of significant weight loss, and professional guidelines increasingly emphasize pharmacologic treatment. Yet, despite the promise of double-digit weight loss, many physicians still start with lifestyle interventions — nutrition, physical activity, and behavioral support — as the foundation of care.

At first glance, this may seem like resistance to innovation. In reality, it reflects a deeper philosophy shaped by evidence, clinical experience, and a long-term view of health outcomes.

Guidelines emphasize combination, not replacement

Current clinical guidance supports the use of weight-loss medications for adults with a BMI ≥ 30, or ≥ 27 with obesity-related conditions, provided that lifestyle changes alone haven’t been sufficient. Importantly, guidelines recommend combining pharmacotherapy with behavioral strategies rather than using medication as a standalone solution.

This shift from “last-resort” use of medication to a more proactive tool marks progress in obesity care. Still, the emphasis on adjunctive therapy reassures physicians who keep lifestyle-first approaches at the center of their practice. They aren’t ignoring guidance — they’re interpreting it through the lens of long-term sustainability.

Real-world data underscore the challenge

Clinical trials show dramatic results with GLP-1s, but real-world adherence is a major hurdle. A Cleveland Clinic study of 7,881 patients highlighted this gap:

• 50% stopped GLP-1 treatment within one year.
• 20% discontinued within three months.
• More than 80% remained on subtherapeutic doses.

Weight-loss outcomes reflected these patterns:

• Early discontinuers lost only 3.6% of body weight.
• Patients who stayed on treatment lost 11.9% on average.
• Those who reached full therapeutic doses achieved up to 18% loss, approaching clinical trial results.

For physicians like Dexter Shurney, MD, MPH, MBA, these findings validate a lifestyle-first model:

The majority of common chronic conditions — hypertension, CHF, hyperlipidemia, diabetes, depression, and obesity — are fundamentally lifestyle issues. Therefore, a lifestyle-first approach to care makes perfect sense because it addresses root cause.

Why lifestyle remains the foundation

Many clinicians see firsthand that without lifestyle changes, even the most effective drugs or surgeries can fail. Kenji Kaye, MD, an internist in Denver, explains:

Without foundational lifestyle changes, medications and surgery are destined to fail. We have seen many patients not lose weight or even gain weight despite max dosages of these pharmaceuticals.

Physicians stress that obesity is a multifactorial condition, shaped by diet, activity, genetics, hormones, and comorbidities. Addressing only one piece of the puzzle rarely yields durable results.

Dr. Shurney highlights another benefit: Lifestyle medicine reduces polypharmacy risk. Unlike single-condition drugs, lifestyle interventions improve multiple markers simultaneously — cholesterol, blood pressure, insulin resistance, and mental health.

In fact, intensive programs can yield rapid systemic improvements: Insulin doses cut in half within days for type 2 diabetes patients, plus 20–50% cholesterol reductions within two months.

Medications as strategic tools

Even physicians who prioritize behavior change often incorporate GLP-1s selectively. Elizabeth Slauter, MD, an obesity medicine physician in Texas, says:

Studies consistently show that the best outcomes with obesity medications occur when they are combined with lifestyle changes. So, it makes sense to start with lifestyle interventions as a foundational approach.

Barriers like high costs, inconsistent insurance coverage, and frequent shortages make long-term GLP-1 use impractical for many patients. For this reason, physicians frame medications as tools within a broader treatment plan, not as standalone solutions. As Dr. Kaye explains:

My usual practice is to discuss these medications as an option but only after a careful review of their food choices, activity level, health history, and current medications.

Navigating patient expectations

The popularity of GLP-1s in the media has created new dynamics in the exam room. Patients often request them directly, influenced by celebrity endorsements and online testimonials. Dr. Kaye sees this as an opportunity for education:

Medications like GLP-1s are mentioned almost everywhere including the media, pharmaceutical ads, and celebrity gossip. When a patient presents asking for a prescription, it is a perfect opportunity to really delve into the details of what these medications can offer and also the risks involved.

Expectation-setting is critical. Many patients assume they’ll only need medication short-term, but research shows discontinuation usually leads to weight regain. Helping patients understand the realities of long-term therapy protects both outcomes and trust.

System pressures and practice choices

Healthcare systems often incentivize quick, measurable results. Writing a prescription is more easily rewarded than time-intensive counseling sessions. Dr. Shurney explains:

The lack of reimbursement parity for lifestyle interventions is a disincentive to practice this way. It’s much easier to prescribe a medication and receive the “quality prize” for checking the drug adherence box than to prescribe lifestyle and not receive a similar financial reward.

To counter this, some physicians have shifted to direct primary care models, which allow longer appointments and more patient-centered counseling.

The long-term view

Ultimately, physicians who remain committed to lifestyle-first approaches are guided by long-term outcomes and healthcare sustainability. Dr. Kaye reflects:

After seeing many patients start down the pathway of pharmaceuticals and ultimately not reaching their goals reaffirmed my commitment to a more holistic approach. In my experience, without a strong foundation of lifestyle changes, the long-term success rate is low even with antiobesity medications.

Dr. Shurney adds a cautionary note:

What we risk are ever-higher healthcare costs, since these medications are very expensive and need to be taken for years, if not forever, to sustain the weight loss. Additionally, we still do not know the long-term effects of these medications.

Your responses and feedback are welcome!

Source: “Why Some Physicians Still Lead With Lifestyle-First Obesity Care Despite the GLP-1 Revolution,” Medscape, 8/12/25
Source: “Pharmacologic Treatment of Overweight and Obesity in Adults,” NIH.com, 8/20/24
Image by Los Muertos Crew/Pexels

The Devil Is in the Details

The most recent installment of this series focusing on the cost of obesity mentioned smart beds that can track patients’ vital signs, weight, and other factors.

It also mentioned a complex issue with which hospitals never cease to struggle: guaranteeing the correct amount of any medication to precisely fulfill the requirements of the patient’s body and condition. This obviously is of crucial importance not only to the clinically obese patient but to each and every patient. Meticulousness in this area is necessary for everyone from the pre-born infant to the geriatric patient who (where legal) opts for an assisted demise.

In the domain of medication, so much can go wrong. It must be the right medication, untainted, and within its use-by date. For numerous reasons, including public safety and legal liability, all the documentation has to be correct, and strictly accounted for. Substances need to be shipped and stored correctly. All communication regarding administration must be clear, accurate, timely, and easily accessible.

And of course, as already emphasized, the necessary factors include…

[…] a current, accurate weight instead of relying on a historical, stated, or estimated weight; and obtaining, documenting, and communicating patient weights in metric units only (i.e., grams or kilograms). Key patient information used to guide appropriate medication therapy includes age, weight, height, allergies, diagnoses, laboratory values, and vital signs…

The very explicit Pennsylvania Patient Safety Advisory is a good example of the thorough inclusion of multiple factors involved in risk reduction, like equipment cost, and its upkeep and repair cost, and the expense of training people to use it correctly. It comes as no surprise to see accurate weighing equipment at the top of the list, as always. As we have mentioned, such hardware includes “floor scales, stretchers and beds with built-in scales, and standing, chair, and wheelchair scales.”

The personnel who employ these devices are expected to be familiar with the manufacturers’ recommendations for keeping them accurately calibrated, lubricated, titrated, or whatever. And despite the USA’s stubborn refusal to join the world in using the metric system for general purposes, it must be employed in the realm of weights and measures having to do with humans and medications.

One important factor discussed by this document is that of organizational expectations. Specifically, the best practice is to specify and assume that…

[…] obtaining the patient’s actual weight is part of the mandatory nursing assessment and reweighing of the patient occurs as warranted, based on patient’s clinical condition. Consider requiring reassessment of a patient’s weight when initiating or changing the dose of weight-based medications, clinical situations in which weight fluctuations are expected, or situations in which a weight variation may impact the course of care.

In other words, stay on top of this factor. Even in situations where it may not seem very important, documentation creates reality. As more attention is paid to the phenomenon of weight fluctuation in patients, more factual information will accumulate and reveal its significance, for the good of future patients.

It is also recommended to pay meticulous attention to this factor, other than in the midst of an emergency, of course. And for goodness’ sake, be sure all pertinent weight stats are recorded clearly, and in a quickly findable location, in the patient records. The document contains even more suggestions about the administration and implementation of weight-related policies, and about sketching out contingency plans in advance.

Weight is one of the easiest variables to keep track of in a clinical setting, especially with the newest specially developed or adapted equipment. The weight factor’s ubiquity and banality place it in danger of being overlooked and undervalued, but excellent arguments can be made for paying meticulous attention to this issue.

Your responses and feedback are welcome!

Source: “Update on Medication Errors Associated with Incorrect Patient Weights,” PA.gov, June 2016
Image by geralt/Pixabay

Smart Beds — for Bariatric and Other Reasons

In the field of bariatrics, it seems obvious that heavy people face physical challenges and restrictions that can require some pretty elaborate equipment. It is also apparent that ever more complicated hardware must and will inexorably raise the total cost of healthcare. But obese people should not be assigned the whole blame. Increasingly, medical equipment related to weight is for everyone.

We spoke of the transfer safety factor, with an uncomfortable number of mishaps, resulting in what are somewhat euphemistically called “delays in care.” Moreover, for hospital inpatients of many sorts, continuous weight monitoring is increasingly seen as essential.

A company called SonderCare explains why:

A bed equipped with load sensors provides real-time information that derives from, and in turn affects, the patient. Treatment options can change minute-by-minute, rather [than] according to orders tied to an 8-hour shift.

Despite the best intentions of staff members, the big danger point connected with patient injuries is movement from place to place. If the patient can just stay right there in bed and be weighed, so much the better, because a potential cause of injury has been eliminated.

In this style of bed, load sensors convert the pressure they feel into electrical signals for crucial weight monitoring, while other technology includes keeping track of the patient’s vital signs. A sudden weight change, either up or down, may indicate a problem with the heart or kidneys, and can be quickly investigated.

In some conditions, fluid buildup may be detected before it causes serious damage. Overall, continuous weight monitoring, without the need for actual transfer of the body, greatly reduces injuries.

According to SonderCare,

Advances in bed technology include vital signs monitoring and alerts to prevent pressure ulcers, increasing safety and comfort for patients. Future innovations will incorporate smart fabrics and touch-sensitive sensors that offer real-time health updates directly into electronic medical records.

But wait, there is more…

Another entire area in which very large people can be particularly vulnerable is medication dosage. We are accustomed to the idea of child-size doses, to ensure that the young and vulnerable don’t get too much. But we think less often about the need for accurate measurement in the ratio of medication to body weight, in the case of an extremely large adult.

Both insufficient dosage and overdosage would be problematic. GoodRx.com says,

Some medication dosages are weight-based because your body weight or body composition could affect their absorption, distribution, metabolism, or elimination. These four factors predict how a medication will behave in your body. Drug toxicity can also play a role.

Changing any one of these factors can potentially make a medication more or less active in your body. In turn, this can lead to unwanted side effects or a less effective treatment.

Another paper points out that “the weight effect may be minimal or dosage can be affected only when weight is combined with other factors. Findings of sporadic studies in recent years indicated that fixed dosing was more advantageous than weight-based dosing in some cases…” It stresses that the medical facility needs to establish good processes for both weighing and documentation, and to ensure “sufficient and convenient availability of appropriate and properly functioning equipment for patient weighing and medication delivery.”

Insulin, antibiotics, and anesthetics are some of the drug types that need very careful consideration when prescribed. In the overall cost of obesity, this factor is not very large. Although considering it over and over again in each case certainly takes time, which adds up. But just one case that goes to court because a patient was under-treated or died from an overdose can become very expensive.

Any reader of this piece who treats lightly the matter of dosage calculation might take a look at this website, “How To Calculate Drug Dosage By Weight | Essential Guide.” This excerpt is just a tiny sample:

\[
\text{Required Volume} = \frac{\text{Total Dose}}{\text{Available Concentration}} = \frac{700 \text{ mg}}{250 \text{ mg/mL}} = 2.8 \text{ mL}
\]

Got that? This is why medical school is so expensive, and why physicians are so well-compensated. The matters discussed here are relevant not only to the status of obese children as they exist now. The whole area of concern involves viewing children not just as young people per se, but as precursors of the adults they will grow into.

We strive to avoid these very costly problems, both for the sake of each individual child and for the sake of the economy, as they will grow up to impact with their ever-increasing number of expensive obesity-related issues.

Your responses and feedback are welcome!

Source: “Do Hospital Beds Weigh You?,” SonderCare.com, 06/27/24
Source: “Weight-Based Dosing: What to Know About Medication Dosages and Body Weight,” GoodRx.com, 02/09/23
Source: “Weight-based dosing in medication use: what should we know?,” NIH.gov, April 2016
Source: “How To Calculate Drug Dosage By Weight | Essential Guide,” Wellwisp.com, undated
Image by [name not given]/Pixabay

Bariatric Hardware By the Numbers

In this series concerning the costs of obesity, today’s post is about equipment. We mention some specifics of why the issue is an ongoing and ever-growing problem for patients, family members, and/or caregivers, medical professionals, other hospital personnel, insurers, and basically the American public at large.

“Bariatric” is a term that refers not only to weight reduction surgery but to the entire field of obesity treatment. Let us confront the issue of equipment — first, by looking at some available devices. Several sources were consulted for bits and pieces of information; a typical website of this genre describes items designed for patients in their everyday lives at home and out in public.

Crutches can be found for people who weigh up to 650 pounds and maybe even heavier. There are canes guaranteed to support 500 pounds. Specialized companies make extra-wide, super-strong walkers. A combination walker and seat called a rollator will support up to 500 pounds and run you $800 or more.

An extra-wide wheelchair that supports up to 850 pounds can be had for just under $1,000, while a less sturdy model might go for half that price. And who would have guessed that a “transport chair” is a whole different category of item?

Other locales

For the home, a furniture company has designed a super-strong lounge chair that can be had for around $2,500, and a scooter available for approximately $3,750. A special bed for home use can serve a person of up to 450 pounds (or even heavier), but the basic horizontal structure itself is only the beginning. The side rails, for instance, may represent a separate, additional expense.

A home bed may cost around $3,000, but quite possibly might add up to more. In a hospital, a high-tech, specialized bariatric care bed could run for 10 times as much. A mattress particularly designed for very obese individuals is composed of different materials from the standard hospital mattress, and may cost as much as $4,000.

In either case, the patient will probably need a trapeze (around $1,000) to lift himself or herself off the bed’s surface and change the body position. For patients who need help when in physical therapy recapturing their ability to walk, there are ceiling lifts.

Similar devices are able to lift a very large person from the floor onto an exam table or bed. Although modern hospitals are designed from scratch with such contingencies in mind, the structure of a typical home might need some expensive refurbishment to handle a suspended load of this kind.

Different strokes for different folks

For more intimate needs in the individual’s bedroom and/or bathroom, there are transfer benches to help get a person on the toilet; bedside commodes (starting at around $200), shower chairs, raised toilet seats, toilet safety rails, and other beefed-up versions of standard items, and they all cost more if a lot of poundage is involved.

Equipment that will probably be found only inside a medical institution includes an extra-sturdy exam table that sells for around $2,000. For the use of the bariatric surgeon, special stapling equipment is available in the $4,000 – $5,000 range. But this begins to impinge on a whole different, related area.

Let’s take a moment to scope out an article about patient safety, with a long and explicatory title: “How Safety Is Compromised When Hospital Equipment Is a Poor Fit for Patients Who Are Obese.”

This assessment is five years old, but not much has changed since then:

Event reports […] indicate that some healthcare facilities do not have the necessary equipment to monitor and care for some individuals in this patient population, leading to embarrassment for patients, delays in care, and injuries to patients.

The most frequent problem situations involve imaging equipment, “especially MRI and CT scanners,” or at least events in the imaging department. Stretchers and wheelchairs are statistically implicated to a startling degree. Almost 75% of patient safety mishaps result in what is euphemistically called “a delay in care,” with most of the delays consisting not only of pausing to assess the damage, but in treating the resulting damage. Nobody wants this.

A huge field of knowledge is involved here, which mainly concerns adult patients rather than children. But this is the point we make again and again: The odds of an obese child growing into an obese adult are daunting. No parent wants to peer into the future and see this kind of picture. And looking at a bit of specialized bariatric equipment, and the associated prices, hopefully will cause some degree of a “scared straight” effect.

Your responses and feedback are welcome!

Source: “Bariatric durable medical equipment product guide,” Medline.com, undated
Source: “Bariatric and Heavy Duty Patient Lifts and Slings,” AdaptiveSpecialties.com, undated
Source: “How Safety Is Compromised When Hospital Equipment Is a Poor Fit for Patients Who Are Obese,” PatientSafety.pa.gov, March 2020
Image by dmchannelsng/Pixabay