Financial Blame and Shame

In just about any place or time, one of the favorite excuses for blaming and shaming is money. It is considered rude and in very bad form to cost other people money, especially by making them pay for something that you did or caused to be done.

Many Americans are overweight, not because they are helplessly afflicted by incurable disease processes, but because of their personal inclinations and habits. And, right or wrong, other people who are presented with the bill feel resentful, disrespected, and used.

Because of amazing events in the field of pharmacology, a person can now take expensive weight-loss drugs, but few can afford the cost, so if they are going to be bought at all, that logically means that someone else has to pay for them.

If “the government” pays, those funds are extracted from other citizens — many of whom are not overweight, and many of whom believe their tax dollars could be better spent, perhaps to help patients suffering from conditions and injuries that were not self-caused.

Citizens of two minds

The ordinary taxpaying American wants to be kind and helpful, but in the considered opinion of many citizens, a problem caused by sitting around and eating high-calorie snacks all day simply does not qualify as an emergency that requires their sympathy, whether expressed through voluntary contributions or in the form of coercion known as taxation. And if ordinary, average citizens are so ambivalent, just imagine the grim mindset of the executives who run corporations, and the shareholders who hold them accountable.

In April of this year, a very large number of Chief Financial Officers were surveyed with regard to their company’s top five “operating expense concerns,” and about three-quarters of them said that healthcare is right up there. Roughly the same number stated that the cost of healthcare cannot be sustained without incurring “business impacts” which will necessarily include the need to reduce hiring, slow wage growth, or jack up prices to the consumers. In other words, someone will pay, and it will not be the shareholders.

This is nothing new

Meanwhile, for a large number of employees, the corporation might already be paying between 70% and 100% of their GLP-1 drug bill, which typically runs from $1,000 to $1,500 per month. Allegedly, a large corporation might be paying insurance premiums of $18,000 per year, per employee, already.  Even leaving anti-obesity drugs out of the equation, “employer-sponsored health insurance costs are projected to rise 6.7% in 2026, the highest increase in 15 years.”

Journalist Alexei Alexis reported that, according to the Kaiser Family Foundation’s reckoning, “Medicare spending on GLP-1 drugs reached about $27.5 billion in 2024, more than five times higher than in 2019…” Late in 2024 in the USA, it looked like Medicare/Medicaid might begin to pick up the cost of all GLP-1 drugs, but by spring of the following year this notion was off the table.

Around the same time, in a different piece of reportage, Alexis mentioned that, among companies with at least 500 employees, about half of those employers are currently picking up the tab for employees’ GLP-1 prescriptions. He interviewed Beth Umland, Director of Health Research at Mercer U.S., who said,

Those that currently provide this coverage are evaluating all methods for managing utilization, from eligibility controls that help ensure the medications are used by those who will benefit most, to requiring participation in a support program that will help ensure members who do use these medications are positioned to get the maximum benefits.

This reads like an endorsement of the notion that perhaps employees are being asked to take a little more personal responsibility, which can’t be a bad thing.

Your responses and feedback are welcome!

Image by Quince Creative/Pixabay

Some Hard-Won Numbers About Obesity Costs

Many people are motivated to consult the records of the Congressional Budget Office to learn just how much cold, hard cash is being spent to both prevent and alleviate obesity. As parents, potential parents, or other familial caregivers, or as socially responsible adults, we might want to keep an eye on the obesity expenses reported by the Milken Institute, and here is why. Its documents are easier to understand.

To track the social and economic costs of obesity back to their plethora of roots in American society is definitely a multifactorial task, ideal for adoption by a nonprofit, nonpartisan think tank. In the Institute’s 2020 report, “Weighing Down America,” three authors (Claude Lopez, Ph.D., Joseph Bendix, and Ken Sagynbekov, Ph.D.) explained all the interconnected factors that influenced everything else going on during that portion of the century.

It took some time to collect, record, and crunch all the relevant numbers, but eventually the heap of information emerged in usable form as the report subtitled “A Community Approach against Obesity.” It said that in 2018, the economic cost of obesity was…

[…] roughly 6.76 percent of gross domestic product (GDP) […] compared to 5.57 percent in 2014, or in dollar terms, $1.389 trillion in 2018 compared to $0.976 trillion in 2014.

That was quite an increase for just four years of history, and the COVID-19 pandemic did nothing to help the situation. Many trends were observed, such as the tendency of 40- to 59-year-olds to become larger, especially among the Black and Hispanic communities, and especially if they are male.

But actually, all humans are getting bigger, and there is no point in singling out any group for blame. Various medical demographics seem to more seriously afflict people who have certain characteristics, but it also appears that every subgroup’s turn to be a scapegoat will come around, eventually.

As in so many cases, the universe demonstrates a certain fondness for balance and fairness. This may be why, for instance…

The obesity rates among Hispanic women and all women aged 40-59 show a marked decline during the same period.

The report looks into why and how obesity catches up with some folks sooner than others. There are the “social and behavioral factors,” otherwise known as a little thing called your life. The most influential of those factors are “unemployment, excessive drinking, smoking, post-secondary education, and single-parent households.”

Also, other circumstances intervene, like…

[…] rurality, housing concerns, population density, metropolitan area, violent crime rate, and the number of fast-food establishments per 100,000 people… The Black population factor has the third strongest association with obesity prevalence…

Collectively, the communities queried in order to garner these statistics are said to represent 61% of the U.S. population. All told, the analysis is said by the authors to combine…

[…] health, behavioral, economic, and social data sets and suggests that some aspects of the obesity epidemic would be better addressed at the local level, while others would benefit from a federal initiative. It also identifies factors for each community to consider when coordinating national and local authorities and other partners such as health-care professionals, business and community leaders, school, and child care.

Great amounts of thought are being put into these matters, and official bureaus may be unable to offer much help, because funds sometimes turn out to be unavailable for the projects to which they were supposedly allocated. Answering the obesity questions should be a top priority, because obesity has a close relationship with some of the leading causes of death in this country, “including diabetes, heart disease, stroke, and some types of cancer.”

Here is a thought that the writers of this page definitely want readers to come away with:

Obesity is often mischaracterized as a lifestyle choice while it is a complex chronic disease resulting from social, environmental, genetic, and behavioral factors.

The authors also remind the reader how much work is involved in a project like calculating what obesity costs America. Opinions vary about where regular life ends and obesity takes over. Exactly which medical expenses should be thrown into the count? What expenditures are reasonable, which are unreasonable, and who gets to decide?

A very great number of small decisions are involved in producing these statistics, and that is before people even start arguing about them. The whole project is a gigantic challenge that no end user will be entirely happy with. A lot of really important detail has to be left out:

Medical expenses and lost workdays represent only a portion of obesity-related costs. Other expenses, such as the use of informal caregivers or those related to lost productivity outside of work, premature mortality, and impact on family and potential income, are extremely difficult to measure and are not included here. Yet, as imperfect as this measure is, its message is clear: Obesity remains very costly to society.

Your responses and feedback are welcome!

Source: “Weighing Down America: 2020 Update,” MilkenInstitute.org, 12/1/20
Image by Milken Institute/Fair Use

GLP-1 Prescriptions Are Rising Among Children

Prescriptions for GLP-1 medications among children ages 8 to 11 with obesity have risen sharply, according to a study published in Pediatrics. The finding has drawn attention to a difficult question for families and clinicians: When a child has serious obesity-related health concerns, how should they weigh a promising treatment against limited evidence for children who are still growing?

Researchers examined electronic health records for more than 3.5 million children ages 8 to 11 with obesity and without diabetes. Across the study period, 0.6% received a GLP-1 prescription. The reported prescribing rate rose from 0.03% in 2019 to 9.3% in 2026, a 310-fold increase. The large relative increase needs context: Prescriptions remained uncommon across the full study population. NYU Langone Health’s summary of the study reports that 20,282 children in this age group received a prescription during the seven-and-a-half-year period.

“I think it is a meaningful shift,” said Sarah C. Armstrong, M.D., a professor of pediatrics at Duke University School of Medicine and Chief, Division of General Pediatrics and Adolescent Health, in Durham, NC. The rise suggests that some families and clinicians are considering medication before age 12, particularly when a child has severe obesity or related health problems. It does not, by itself, show that routine use in younger children is appropriate.

What does “off-label” mean for a child under 12?

A clinician may prescribe a medication off-label for a use outside its FDA-approved labeling. For obesity treatment, medications such as Saxenda and Wegovy are approved for eligible adolescents beginning at age 12, but not for general weight management in children ages 8 to 11.

Dr. Armstrong describes treatment below that age as “an exceptional, highly individualized decision rather than routine care.” A clinician considering it would need to discuss the limited evidence with the family, assess the child’s other health conditions and treatment history, and arrange close follow-up with professionals experienced in pediatric obesity care.

What does the research tell us about safety?

Evidence for younger children is emerging, but it differs by medication. A clinical trial of daily liraglutide in children ages 6 to 11 found improvement in measures of obesity over its study period. That result does not answer every question about longer-term use, and it cannot be assumed to apply equally to other medications.

Children’s needs also differ from adults’. An appetite-suppressing medication could make it harder for a child to get enough protein and other nutrients. Clinicians must watch for effects on growth, physical development, and a child’s relationship with food, as well as side effects such as nausea, vomiting, diarrhea, and constipation.

“The goal is to improve health while supporting normal growth, adequate nutrition and a healthy relationship with food and the body,” Dr. Armstrong said.

Who can access treatment?

The study found that children in less socially vulnerable communities were more likely to receive these prescriptions. It does not establish why. Insurance coverage, medication costs, access to specialists, transportation, and the time required for appointments may all affect a family’s options.

Dr. Armstrong said:

We should be careful not to create a system in which highly effective obesity treatment is available primarily to families with the greatest resources.

What should parents take from the trend?

More prescriptions show that families and clinicians are already facing this decision; they do not settle whether GLP-1 medications should become standard treatment for younger children. Parents who are concerned about a child’s obesity or related health conditions can start with a pediatrician who knows the child’s growth history and can discuss the full range of care options.

For a growing child, the measure of successful treatment is broader than a number on a scale. It includes physical health, nutrition, growth, and emotional well-being.

Your responses and feedback are welcome!

Source: “More Young Children Are Taking GLP-1 Drugs. What Parents Should Know,” Forbes, 9/21/26
Source: “Trends in GLP-1 Receptor Agonist Prescriptions for Children Ages 8 to 11 With Obesity: 2019–2026,” Pediatrics, 9/4/26
Image by Alex Green/Pexels

Could Semaglutide Expand Treatment Options for Children With Obesity?

A newly announced clinical trial may mark an important step toward expanding medical treatment for childhood obesity. On September 7, 2026, Novo Nordisk reported topline results from STEP Young, a phase 3 trial of once-weekly semaglutide in children ages 6 to younger than 12 with obesity.

After 68 weeks, 40.4% of children assigned to semaglutide were below the obesity threshold, compared with none of those assigned to placebo. Both groups also received support for a reduced-calorie diet and increased physical activity.

The result is notable because medication options for younger children remain limited. It also arrives amid a broader change in how clinicians approach pediatric obesity: as a complex chronic disease that may require more than advice about diet and exercise alone.

Still, the announcement is an early look at the study. Families and clinicians will need the complete data before they can fully judge the treatment’s benefits and risks.

What the STEP Young trial found

STEP Young enrolled 165 children in a randomized, double-blind, placebo-controlled multinational trial. More than 85% had class II or class III severe obesity at enrollment. Children received either semaglutide at a maximum weekly dose of 1.7 or 2.4 milligrams, based on starting weight, or a placebo. The primary endpoint was the percentage change in BMI from baseline through week 68.

Novo Nordisk said the study met that primary endpoint, meaning BMI declined more with semaglutide than with placebo. The company highlighted a secondary result that may be easier for families to understand: Roughly two in five children receiving semaglutide moved from the obesity range into the overweight or normal-weight range on age- and sex-specific growth charts.

Ania M. Jastreboff, M.D., Ph.D., Yale Obesity Research Center, said:

Treatment with semaglutide resulted in a BMI percentile category below the obesity threshold in approximately 40% of the children.

For children, BMI is interpreted differently than it is for adults. Clinicians use percentiles that account for age and sex because children are still growing. Crossing below the obesity threshold therefore reflects a change in BMI category, not a single adult-style BMI cutoff.

Why these findings matter

Childhood obesity can affect health well before adulthood. It is associated with cardiometabolic risk factors as well as depression, disordered eating, bullying, and reduced quality of life. Severe obesity is also likely to persist into adulthood, increasing the likelihood that related complications will appear earlier.

Let’s note that Wegovy, the semaglutide product used for chronic weight management, is already used in older populations, but current reporting notes that GLP-1 weight-loss drugs are not approved for children younger than 12. STEP Young could therefore support a future regulatory review for a group with fewer evidence-based medication choices.

Medication would not replace comprehensive care

The trial did not test semaglutide by itself. Every participant received lifestyle support, including dietary changes and increased physical activity. That detail matters: Pediatric obesity treatment is typically family-centered and may involve nutrition, physical activity, sleep, behavioral health, and management of related medical conditions. If semaglutide is eventually authorized for younger children, it would be considered one possible component of individualized care rather than a standalone solution.

Important questions remain

The 40.4% figure is promising, but the initial announcement did not disclose several details needed for a complete benefit-risk assessment. Contemporary Pediatrics noted that the topline release did not provide the mean BMI change, the difference between groups, confidence intervals, or a full statistical analysis. It also did not report detailed rates of gastrointestinal side effects, serious adverse events, or treatment discontinuation.

Novo Nordisk reported that overall safety and tolerability were consistent with prior semaglutide and liraglutide studies and that no new concerns involving growth or pubertal development were identified. Even so, longer follow-up is essential in children. Researchers and clinicians will want to understand effects on growth, puberty, body composition, metabolic health, emotional well-being, and what happens if treatment stops.

STEP Young offers encouraging evidence that semaglutide, combined with lifestyle treatment, may help some children with severe obesity achieve a clinically meaningful change in BMI category. It does not yet establish that the medication should be broadly used in children under 12.

Full results are expected to be presented at ObesityWeek in November 2026, when independent experts will be able to examine the magnitude of BMI reduction, adverse events, discontinuations, and other outcomes in greater detail. In the meantime, parents should not use medication prescribed to another person or seek a GLP-1 product without age-appropriate medical evaluation and monitoring.

Your responses and feedback are welcome!

Source: “Novo Nordisk STEP Young phase 3 data: 40.4% of children living with obesity achieved a BMI below the obesity threshold with semaglutide and lifestyle modification,” GlobeNewswire, 9/7/26
Source: “Semaglutide improves BMI category in children aged 6 to 11 years in phase 3 trial,” Contemporary Pediatrics, 9/8/26
Source: “GLP1 Drugs Work for Kids, Says Novo Nordisk. They Could Be Another Huge Market.,” Barrons.com, 9/8/26
Image by Vitaly Gariev/Pexels