Co-founder and Chief Medical Officer at Knownwell, Dr. Angela Fitch discusses the importance of recognizing obesity as a chronic disease, the insurance barriers surrounding access to medication for patients and how the Treat and Reduce Obesity Act (TROA) could solve the approach to treatment across the nation.

Would the passing of TROA eliminate the issues surrounding a carve-out insurance plan? What will the continuation of selling compounded versions of the patented weight loss drugs mean when shortages end? Dr. Fitch, who is board certified in internal medicine, pediatrics and obesity medicine walks us through the challenges in obesity care for clinicians and patients alike and how she hopes to implement change.

Here are five takeaways from the conversation with Dr. Angela Fitch:

1. Complexity of Obesity as a Disease

Dr. Fitch emphasizes that obesity is a complex medical condition, comparable to cancer in its complexity. It requires a multifaceted approach involving lifestyle changes, medication, and sometimes surgery, rather than just diet and exercise alone.

2. Bias and Stigma in Obesity Treatment

The conversation highlights the significant bias and stigma surrounding obesity, which often leads to it being treated as a personal failure rather than a medical condition. This stigma affects both patients and the healthcare system’s approach to treatment.

3. Challenges in Access to Treatment

There is a discussion about the challenges patients face in accessing effective obesity treatments, including the high cost of medications and the lack of insurance coverage. Dr. Fitch advocates for obesity to be recognized as a standard benefit in health insurance policies.

4. Advancements in Pharmacologic Therapies

The episode covers the evolution of medications for obesity, noting significant advancements in efficacy. Newer medications like semaglutide and tirzepatide have shown promising results in achieving substantial weight loss.

5. The Role of Policy and Legislation

Dr. Fitch discusses the importance of legislative action, such as the Treat and Reduce Obesity Act, to improve access to obesity treatments. She highlights the need for bipartisan support to address this public health challenge effectively.

Transcript

Dr. Angela Fitch
We’ve had just tons of bias and stigma in our world as we’ve learned that obesity itself is a complex medical condition, as complex as say cancer or the multitude of different cancers we have.

Dr. Ned Palmer

Dr. Jerkins. How’s it going?

Dr. Michael Jerkins
It’s going very well. It’s going very well.

NP:
Man, come on, I was going to do a bit.

MJ:
Nope, I lost it.

NP:
Okay. You have something witty.

MJ:
I have something witty. How about this? Can we just splice in a something witty here?

NP:
I don’t think that’s how it works.

MJ:
Is that not how it works? Some pithy aphorism or something. I don’t think I’ve ever used the word pithy in the conversation. I should. Maybe that’s a goal.

NP:
I think there’s enough time left that you could work this. Well, I think today’s topic is very interesting. Not only is it interesting, but also I would argue this is probably the nation’s leading expert on obesity medicine that we have with Dr. Angela Fitch. I have a lot of questions and I know that you probably have a lot of questions you want me to ask, but we are excited to have Dr. Fitch on. I’ve known her and you’ve known her for a long time. Very well published, very well respected. She’s a leading thought expert on obesity medicine.

MJ:
I don’t know about you, but I have a lot of patients ask me questions related to this topic based on information they got on TikTok, Twitter, or from a friend or cousin. So it’s really nice to have someone like her. That’s kind of a focus now in the last couple of years, but she’s been doing this for a couple of decades. She brings a wealth of knowledge and experience to the conversation.

NP:
Yeah. I would say it’s kind of incredible to be able to talk to one of the nation’s leading experts in what is still continuing from a demographic standpoint to be one of the leading epidemics or pandemics that we’re dealing with across the country from a non-communicable disease standpoint.

MJ:
Like you said, we’ve known Dr. Fitch for a long time. She was actually my preceptor when I was in resident clinic way, way back when. And so she’s seen me from when I was a very bad outpatient doctor in my first year of residency till now. So it’s incredible to get to talk to her about what can actionably be done about obesity. That’s for primary care doctors. She talks about it from the inpatient side. She really talks about it from the surgical side—how obesity needs to be managed, which we know is multimodal therapy, continued long-term progress, and consistent effort.

I loved her very practical and pragmatic approach across different care delivery phases. I have a lot of questions on not just how we do it, but also macro-level factors that influence how we can do this at scale. Every conversation I’ve had with a patient about pharmacologic therapy or obesity always comes back to access and cost. It becomes the driving factor—not what’s medically appropriate, but what’s available based on where they live, what kind of insurance they have, etc. So there’s a lot of questions I have for her, and maybe let’s just cut to it with Dr. Angela Fitch.

We are pleased today to have Dr. Angela Fitch, who is the co-founder and chief medical officer at KnownWell and immediate past president of the Obesity Medicine Association. She’s board certified in internal medicine, pediatrics, and obesity medicine, and has been practicing obesity medicine for over 15 years. She is an international expert in obesity treatment and currently provides comprehensive obesity care to patients of all ages at KnownWell as they develop the first-of-its-kind patient-centered medical home for people with obesity and metabolic health concerns.

Also, fun fact—Dr. Fitch was the first person ever to interview me for a real job after residency. Dr. Fitch, welcome to The Podcast for Doctors (By Doctors).

AF:
Thank you so much. Thanks for having me.

MJ:
We’re very excited. We have lots of questions and things to get into today, but I think it would be very interesting for our doctor audience to understand a little bit about your story and why you chose to really pursue this pathway in obesity medicine.

AF:
My undergraduate degree was in chemical engineering. I was always super passionate about metabolism and how the human body works as an engineering organism, so to speak. I thought about going to graduate school, I thought about going to medical school. I ended up working after undergrad before I went to medical school.

I’ve always been impressed with how the human body functions metabolically. Then as I got into primary care, so many patients were coming in asking, “How do I lose weight?” And honestly, no one taught us how to do that in medical school. We were trained to treat septic shock and other critical conditions, but weight loss was always a mystery.

The default advice was always “eat less, exercise more,” or “go do this program.” It was always put on the patient—they had to pay for it, find a program, use an app. Because of that, we’ve had tons of bias and stigma as we’ve learned that obesity itself is a complex medical condition, as complex as cancer. We actually think there are multiple types of obesity, not just one. The science has changed, and now the medical and treatment world is catching up.

MJ:
Yeah, that’s interesting because you are a pretty big trailblazer in this movement, especially integrating different modalities of treatment for patients with obesity. Just your role in its progression over the years has been pretty integral, right?

AF:
Yeah. I was one of the first people to get board certified in obesity medicine back in 2012. I was waiting for the board certification to come out. At the time, I was busy in primary care—3,500 patient panel—in a very progressive health system in Minnesota. We had embedded pharmacists doing medication management, chronic disease managers, and we were doing virtual visits back in 2005, long before telemedicine became “new.”

We even had a $3 million grant in the early 2000s to redesign primary care. Out of that, my love for weight management grew. There were no obesity fellowships back then, so I shadowed people at the University of Minnesota, sat in bariatric surgery case conferences, and eventually got board certified.

Then I transitioned to building large academic weight centers within health systems, combining medical, surgical, and comprehensive care. Most recently, I was co-director of the Massachusetts General Hospital Weight Center, a 20-year-old center that had 5,000 people waiting for appointments when I left to start KnownWell.

This was before everyone knew about GLP-1s. Patients would come to see us for expert care, but we often had to convince them to use the tools we had. Treatment was so stigmatized, and people believed they could just do it on their own if taught how to eat and exercise better. But most of them had tried that many times without success.

Lifestyle change alone is not enough to treat a disease state. It never has been—not for heart disease, not for obesity. Just like we need surgery, stents, and medications for heart disease, we need a multimodal approach for obesity. That’s where the field is finally heading now.

AF:
It’s actually a combination between lifestyle intervention, medication, and surgery—plus new non-surgical procedures that are coming about as well. It really is a pivotal time to scale treatment and deliver it longitudinally. That’s key. We’ve never treated obesity as a chronic disease, but that’s what it is. We have to recognize that, both as patients with obesity and as care providers. It’s not a “fix it once and done” issue.

MJ:
It’s interesting you say that. Given your history in the field, can you talk a little about how pharmacologic therapies have changed over the last couple decades? The last four or five years have been intense, of course, but even my patients ask about medicines that were recalled in the 1990s and early 2000s. And now there are newer medicines. Can you walk us through how medications have evolved over time to treat this disease?

AF:
Certainly. Even 20 years ago, we had GLP-1s. GLP-1 isn’t new. For those of us in practice that long, we were the first group in the country at the University of Minnesota to do a pilot study of adolescents with obesity. Back in 2010, we did a study with Byetta, the first GLP-1 on the market.

You had to inject it twice a day, within 30 minutes before eating. If you took it too late, your gastric emptying slowed and you’d get sick while eating. Timing had to be perfect. Asking people to give themselves an injection twice a day is rarely successful, but we piloted it in adolescents back then.

It wasn’t until much later that we had our first GLP-1—Saxenda—approved for adolescents. It took over 10 years from that first study before an FDA approval for adolescent obesity. To compare, during the HIV epidemic, it took only three years for AZT to be approved for pediatrics because of the urgency. But that urgency didn’t exist for adolescents with obesity.

You’d think that since we had data showing it was effective, it would be prioritized. Byetta wasn’t even very effective, yet it still took 10 years for approval. That shows how little importance was placed on treating pediatric obesity.

As we’ve advanced GLP-1s and now newer nutrient-stimulating hormone drugs, our understanding of obesity pathophysiology has driven pharmacologic progress. The medications have gotten much better, especially in efficacy.

MJ:
In training, we weren’t prescribing a lot of these medicines for obesity, partly because patients couldn’t access them anyway. We learned about them, but my real experience prescribing them came later. I wonder if other programs faced that too—where a lack of patient access meant less prescribing experience. Have you seen that?

AF:
Yes, but remember we also have generic medications—older treatments like phentermine and topiramate. We’ve had decent treatment options for a while.

As the immediate past president of the Obesity Medicine Association (OMA), I can say the OMA has existed since 1950 to support clinicians working in obesity medicine. We’ve had effective treatment for decades, though nothing as effective as what we have today.

The critical thing for people to understand is weight-loss expectations. When you look at a 20% weight loss, that’s not “that much” from a patient’s perspective. For someone who weighs 250 pounds, 20% means 50 pounds. Many believe they can lose that quickly with an app or fad diet.

Most patients think, “I can lose 50 pounds.” The cover of People Magazine tells them someone did it with the soup diet or something similar. But metabolism doesn’t work that way. Studies show that even if you can lose 20%, over eight years you’ll regain most of it. The body resists long-term weight loss.

We’ve had medications that helped some people—about 15–20% of patients achieved 20% weight loss with phentermine-topiramate. But with semaglutide, our first highly effective anti-obesity medication, 40% of patients can achieve that 20% loss. With tirzepatide, a dual-agonist, 60% can reach it.

Surgery still helps 80–90% of patients achieve that goal, but our healthcare system hasn’t caught up to how hard it is to lose and maintain 20% of body weight.

That 20% benchmark matters because beyond 10%, you see prevention of cardiovascular disease, extended life expectancy, remission of sleep apnea, hypertension, fatty liver disease, and diabetes. That’s why we focus on 20% weight loss, not just 5%.

Of course, if someone loses 5% and keeps it off, that’s still a huge accomplishment. But most people don’t hear that—it’s not celebrated. Part of my job is to tell patients they’re doing well and should be proud, because most people can’t achieve even that.

Only about 5% of people can lose 20% with lifestyle intervention alone. Those people exist—you’ve met them, you may even be one—but they’re the minority, not the majority. And we have to come to a national realization that obesity is a disease worthy of treatment.

MJ:
I’ve found that managing expectations is even harder now, with TikTok videos and celebrity stories about medications. Patients come in with unrealistic expectations. It makes it tough to set the right goals, fight misinformation, and build a healthy relationship as we treat this disease.

AF:
And understanding that you have to do it forever. I think the biggest problem we have today—though in a good way—is that we’ve let the cat out of the bag. More people are getting treatment, which is great. But if treatment is episodic and patients regain the weight, they can actually end up sicker than if they’d never lost it in the first place.

There needs to be a public service announcement: treating obesity is a chronic disease process. You need a care partner, ideally your primary care physician, because they’re designed to be there for you long-term.

If you lose weight and regain it, your metabolism isn’t the same as it was before. You tend to gain more fat mass than lean mass, and your metabolic rate slows. For example:

At 250 pounds, your baseline metabolic rate might be 2,000 calories a day.

You lose 50 pounds.

If you regain back to 250 pounds, you may now burn only 1,700 calories at that weight.

So, you’re starting out with a 300-calorie deficit compared to before. That’s why people say, “I lost the weight before, but this time it’s harder.” And it is—because the body resists it.

This is why we must take treatment seriously. These aren’t drugs you buy out of the back of a van to self-medicate. There’s a reason we have the FDA and prescribing protocols—because metabolism and biology are not things to mess around with.

MJ:
Yes, and that’s a good point. I’ve heard you speak on this before, and I’m glad you brought it up. Insurance coverage is a big barrier. Last I checked, only four state Medicaid programs covered weight loss medications.

AF:
We’re up to about 16 now.

MJ:
Wow—my numbers were off. Still, that’s a small minority.

AF:
Right. The Stop Obesity Alliance just published research on this. It’s hard to know the true number, but the fact that obesity treatment coverage isn’t standardized is part of the bias and stigma we face.

The real issue is that obesity is not a standard benefit on health policies. It’s a carve-out—just like infertility care. Those are the only two things not treated as standard benefits. Historically, both were considered “elective,” and employers had to add them on.

But today, to say obesity treatment isn’t necessary is simply wrong. It shouldn’t be an optional add-on. Health insurers in this country make billions of dollars in profit every quarter, yet don’t cover the largest pandemic we face.

Now, covering it doesn’t mean every person gets a $1,000-a-month medication. We know that’s not affordable. But some patients need those medicines, and as a society, we have to figure out how to manage access until costs come down—which they will. Someday, we’ll look back at this conversation and say, “Remember when we couldn’t cover obesity treatment?”

MJ:
I hope so. But right now, Medicare doesn’t cover weight loss medications either. That’s been on the docket for a decade, right?

AF:
Twelve years, actually. I’ve been going to Capitol Hill that long, lobbying for the Treat and Reduce Obesity Act. Think of that old “Schoolhouse Rock” song: I’m just a bill, sitting here on Capitol Hill. Well, after all these years, the bill finally made it to committee. It passed the Ways and Means Committee—the furthest it’s ever gone.

We’re hopeful. With new research showing obesity treatment reduces cardiovascular risk and helps conditions like sleep apnea, kidney disease, and fatty liver disease, it’s becoming harder to ignore. But here’s the absurdity: drug companies are running huge, expensive trials for these secondary conditions just to get coverage—because obesity itself isn’t covered. Imagine how many patients could have been treated with the money spent on duplicative trials.

MJ:
It would be a huge deal if Medicare covers these medicines. For our audience, can you explain why that matters, even for people not on Medicare?

AF:
If the Treat and Reduce Obesity Act passes, Medicare coverage could push private insurers to follow. Right now, commercial insurers can still carve out obesity. When I was president of the Obesity Medicine Association, I dreamed of getting all the big insurers in a room to agree obesity is a standard benefit—no carve-outs, no extra fees.

That doesn’t mean unlimited spending. Medications like Qsymia or Contrave are about $99/month cash price, far cheaper than other drugs. So there are ways to manage cost. But coverage has to start with recognizing obesity as a disease.

Shockingly, in some parts of the country, you can’t even bill for obesity. In Massachusetts, where I practice, that’s rare, but in many states, if a patient comes in with obesity and no other comorbidities, the insurer rejects the claim. The doctor can’t bill for obesity as the diagnosis. That’s absurd in 2024—it shouldn’t even be legal.

MJ:
Yeah, that’s like not getting paid for treating someone’s hypertension or diabetes. Then you end up working the diagnosis into something else, which just disincentivizes actually treating the disease. It’s nuts.

And that’s really what this carve-out does—it creates haves and have-nots. It’s a bigger equity issue when you think about it. Right now, maybe 16–18 states cover obesity medications. Medicaid has always been relatively good about allowing you to bill for obesity, and even Medicare to some extent.

With Medicare, it’s rare that someone comes in only for obesity, since most patients at that age have other conditions too. But if obesity is the only diagnosis, you can generally still bill for it. The real issue is that the medications and ancillary services—dietitians, lifestyle programs—aren’t covered. And that’s despite the fact that Medicare has long covered bariatric surgery. So it’s not that they don’t recognize obesity as a disease; they just exclude the very tools we use to treat it outside of surgery.

For example, you can refer a Medicare patient with diabetes or kidney disease to a dietitian, but not one with obesity alone. That’s absurd.

So the hope is, once this bill passes and Medicare starts covering medications, the big commercial insurers will follow. That’s the goal. But what’s your over/under on this bill actually passing?

AF:
That’s the hope. And honestly—I’m extremely confident it’s going to happen this year. The tone in Washington has shifted dramatically. Twelve years ago, when we’d go to the Hill, staffers would basically say, “Obesity? Really? Sorry, I’ve got another meeting,” and half the time they’d be on their phones while we talked.

Now, it’s different. The staffers tell us directly: “We get it. We know it’s a huge problem. We want to make this work.” Of course, the big pushback is always: “It costs too much.”

But here’s the thing—what other disease do we require to be cost-effective before we treat it? None. We don’t deny people dialysis because it isn’t cost-efficient. We don’t withhold cancer treatments because they don’t show return on investment. We treat those diseases to keep people alive. Obesity is the only disease we demand a financial justification for before agreeing to cover treatment—and that’s pure bias and stigma.

The idea that “if people just behaved, they wouldn’t need medication” still lingers. And that’s also behind this weird push to “get people off” obesity medications. Of course, it’s always great when someone can stop a medication—but if they need it long-term, why should that carry stigma? We don’t take people off their blood pressure meds once their blood pressure is normal.

MJ:
Exactly. I guess I haven’t heard that line of thinking as much in my circles, but it’s interesting.

AF:
It’s very common at the payer and employer level. Remember, most large employers are self-insured, so they’re the ones deciding whether to provide coverage. But from their perspective, they don’t always see the long-term financial benefit.

Say an employee avoids diabetes because of obesity treatment—that payoff might not show up for ten years. But the average person only stays at one company for a couple of years. So the benefit accrues to another employer down the line. That’s the short-term thinking we’re fighting against.

Really, we need to take a collective approach: employer A should cover treatment because when that person moves to employer B, they’ll reap the benefit, and vice versa. If everyone participates, we all win.

MJ:
I’ve actually heard that exact argument from pharmacists at commercial insurers—they’ll say, “We’d cover it if everybody else did too.” Nobody wants to foot the bill just for another company to get the long-term benefit.

AF:
Exactly. And keep in mind, we already cover plenty of expensive medications and diseases. But we do need to be thoughtful. It’s like antibiotic stewardship. Years ago, doctors were handing out antibiotics for every sniffle, and we created resistant bacteria. Eventually, we had to get smarter.

Now, we need that same stewardship mindset for anti-obesity medications. There simply aren’t enough right now. People think the drug companies are “holding out,” but that’s not the case. The demand is massive.

There are about 140 million Americans with obesity. Novo Nordisk recently reported they’re adding 25,000 new patients a week on GLP-1 medications. If Eli Lilly matches that, and production stayed at that level, it would take 58 years to treat everyone who qualifies.

Of course, production capacity will grow—they’re building plants and scaling up—but the gap is enormous. That’s why we need to use all the tools available and figure out which patients will succeed with which treatments, so we can allocate resources wisely.

MJ:
Right—and given that not everyone can access the medications, a lot of patients are turning to other routes. That’s something I really wanted to ask you about.

When a local compounding pharmacy puts up a billboard saying, “We have semaglutide, and we’ll add B12 or whatever you want,” that’s incredibly misleading. Patients think they’re getting the real thing, but they’re essentially experimenting on themselves.

Can you talk about what you’re seeing there, and the risks of this kind of workaround?

AF:
Yes, that’s a huge concern. We just published a statement on this in Obesity Pillars, the Obesity Medicine Association’s journal. It’s open-access, so anyone can read it.

The key issue is that there’s no FDA-approved generic semaglutide or tirzepatide. None. Which means there’s no approved source for the active pharmaceutical ingredient (API) that compounding pharmacies claim to be using.

Now, compounding itself isn’t inherently bad. Hospitals use it during shortages—say with heparin—and it’s done under strict oversight. But with semaglutide, what’s being sold often isn’t regulated or validated. And that raises real safety concerns.

As physicians, our oath is first, do no harm. We want patients to have access, but we also have to make sure the treatment is safe. Right now, with compounded semaglutide, we just can’t guarantee that.

AF:
Right? You’re still getting it in an “emergency” setting, but at least you’re getting it safely, covered by insurance. With obesity, we’re basically telling people, “We don’t care enough to treat you properly. You can go over here, pay cash, and maybe it’ll work.” But is “maybe” really the standard we want for pharmaceuticals?

That’s why we have the FDA—so we don’t have to guess. Novo Nordisk and Eli Lilly spent years and billions of dollars developing these molecules, testing them, proving they’re safe. Now we have copycat versions being made in uncontrolled environments, imported without oversight, and sold directly to patients.

Sure, there are brilliant chemists who can reproduce the API. But is every batch tested? Is it free from contamination? When it’s for-profit, cash-based, corners get cut. And once it’s in the supply chain, there’s no guarantee of safety.

If this were truly an emergency—like a shortage—we could imagine a controlled system where APIs are vetted, tested, and used temporarily with insurance oversight. That’s very different from what’s happening now: mass production, direct-to-consumer marketing, and unproven add-ons like “semaglutide with B12.”

When I worked at Procter & Gamble, every conversation was about margins—Can we cut this ingredient? Can we make it cheaper? That same mindset is creeping into compounded obesity medications, and when you apply that to unregulated drugs, people get hurt. Estimates suggest over two million people are using compounded versions right now. That’s not the same as a hundred people during a heparin shortage. If anything goes wrong, the fallout will be enormous.

And according to the FDA’s own database, there have already been at least nine deaths reported in relation to compounded products like these. It’s hard to prove causation, but the fact remains: patients shouldn’t be dying because of unregulated versions of a treatment that should be safe.

We need a coordinated, national response—something like an “Operation Warp Speed” for obesity. This is a pandemic-level problem, and we should treat it with the same urgency we did COVID.

MJ:
I’m honestly surprised there haven’t been more legal challenges from Eli Lilly or Novo Nordisk.

AF:
Well, the main reason compounding has been allowed is the drug shortage. But Eli Lilly just announced in their latest earnings call that they consider the shortage over. There may still be a six-month window, but there’s no way compounding at today’s scale will continue long-term, at least not legitimately.

Of course, compounding will always be appropriate in certain cases—like if a patient is allergic to a dye in a formulation. But mass-producing “semaglutide with B12” for millions of people? There’s zero clinical evidence for that, and it’s not the intent of compounding laws.

MJ:
I love your passion for this and the way you’re advocating for patients. I imagine that same drive was behind your new venture, Knownwell. Can you share what led you to start it, and how it’s helping people with obesity?

AF:
Yes! Knownwell was actually inspired by my co-founder, Brooke Bajorski-Pratt. She’s lived with obesity her entire life and has faced stigma and bias at every turn. She moved frequently for work—she was with a Berkshire Hathaway company—and every time she had to re-establish care, it was exhausting.

She’d wait months to get into a weight center, and when she finally saw a doctor, she never knew what to expect. Would they berate her and say, “Just eat better,” even though she’d tried for decades? Or would they refill her Wegovy or Saxenda without judgment?

One day, after another frustrating experience, she said: “Why isn’t there a clinic specifically for people with obesity? A place where we’re respected, where our goals are heard—whether we want to lose weight or not?”

That idea resonated deeply with me. We started doing focus groups with patients, and the demand was clear. So we built Knownwell: a comprehensive, longitudinal care model for obesity, treating it as a chronic disease across the lifespan—including adolescents.

We launched in March 2023 with seed funding from Flare Capital, and just completed a Series A with Andreessen Horowitz. We call ourselves “click and mortar”: we provide both virtual care and in-person clinics, so patients can choose what works best for them.

MJ:
That’s fantastic. Congratulations on the launch and the funding—that’s huge. Where can people learn more about Knownwell or connect with you?

AF:
Thank you! The website is www.knownwell.co—not .com, just .co. We have a blog there, and people can reach out directly.

MJ:
Perfect. One last question before we wrap up. You work with doctors across many specialties—what’s the one thing you wish all physicians understood about obesity medicine?

AF:
That it’s not the patient’s fault. People with obesity have been conditioned by society to believe they’re to blame. But this is not just about willpower, or eating less and moving more.

Our world is obesogenic—it promotes stress, poor sleep, constant digital distractions, and easy access to unhealthy food. Lifestyle changes matter, but they’re not enough on their own. Physicians need to acknowledge that, treat patients with compassion, and either provide treatment or refer to someone who can.

MJ:
Beautifully said. Dr. Angela Fitch, thank you so much for joining us today.

AF:
Thank you—it’s been a pleasure.

MJ:
That was great to talk with Dr. Fitch. Lots of questions I had were answered, and I think there were so many interesting takeaways—not only practical insights on how to manage obesity, but also the history of how treatment has evolved, from the insurance side to the legislative side.

NP:
Yes, absolutely. Something that really resonated with me—and I’m sorry I wasn’t there to interview Dr. Fitch alongside you, Michael, but it was wonderful to listen to—is how obesity has almost been ignored. The ability for doctors to treat it hasn’t been fully recognized as addressing a distinct, standalone disease.

As a result, policy has often gotten in the way. There hasn’t been collective action or even a unified approach to reimbursement in obesity medicine. And reimbursements drive behavior. So we end up with a patchwork system: some plans cover certain treatments, others don’t.

In fact, almost immediately after the interview, the New York State public employees union announced they would no longer cover Wegovy or Ozempic. That was just a day or two after we spoke. It shows the chaos in this space—employers, health systems, physicians, and patients are all experiencing this fragmented approach.

I’ll be interested to see how Medicare ultimately plays a role. Where Medicare goes, private insurers usually follow. That will impact access to these medications for many people. Dr. Fitch and others are actively lobbying, and it does sound like bipartisan support may finally be emerging as awareness grows and more people see successful outcomes. Hopefully that momentum continues.

MJ:
I think it really will require bipartisan action because the amount of money being discussed to cover these treatments is substantial. But the disease itself is not partisan—it affects everyone across the country. Obesity is one of our most significant public health challenges right now.

It will take collective effort to turn the tide, including negotiating with drug companies and structurally rethinking how our government provides public health for its citizens. I think back to our episode with Mark Cuban about transparency in pricing—patients need to understand where the money is going with insurers, pharmacies, and PBMs. That’s a huge issue with these medications too.

Overall, this was such an important conversation. We were thrilled to talk with Dr. Fitch, who is probably the nation’s leading expert on this topic.

MJ:

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