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Comment by bdcravens | Hacker News Reader

Do you have diabetes, heart disease, or another condition necessitating a GLP-1?

Why is obesity not considered a necessitating condition? It often carries the comorbidities you just mentioned. Should not exclude people just because they haven’t had these specific health problems (yet) but will eventually have them.

While I tend to agree, insurance companies don't see it that way. They need a doctor to indicate a necessity to treat a condition, as opposed to it being the easiest way to treat it.

For example, I have to take digestive enzymes to digest my food (pancreatic insufficiency). For someone with an unusually high metabolism, they would also give them a leg up on gaining weight, even though there are other approaches to gaining that weight. However in many cases, the insurance company wouldn't cover their prescription when they will mine.

As always it’s insurance nonsense. If incentives were aligned insurance companies would be lining up out the door to give this to obese people because they (the insurance companies) would eventually be on the hook for paying for the care of the conditions you just mentioned. It is very well demonstrated in literature that obese people have a much higher occurrence of these conditions than non obese people.

But the system is not set up with aligned incentives

The problem is that if it's just about obesity, you have to prove that cheaper treatments such as diet and exercise didn't work. That's not impossible to do, but it's hard and annoying even for people who really were trying. My doctor told me that you basically have to keep a detailed journal of your weight loss efforts for months on end.

Are GLP-1s so much more effective that we should make an exception to the general principle, maximizing healthcare resources by providing the cheapest effective treatment? I kinda think so, but I have a conflict of interest, and I can understand why others might think that money is better spent elsewhere.

I think you would be hard-pressed to find any human who has been 100 pounds overweight for any amount of time that doesn't have an obesity-related comorbidity.

Hypertension, sleep apnea, high cholesterol, etc are all common in the general population and exacerbated or even caused by the physical and lifestyle conditions that beget obesity.

I was 347lbs at the time. Wasnt a diabetic (nor pre-diabetic) no heart disease, blood pressure or really anything other than my weight. Prior to then Id had two massive bouts of weight loss at 50-100lbs so I know what it takes. Id tried but this last time without meds was extremely hard. You cant do much in the way of productive exercise when both your shoulders need replacement at 30 and between two knees have an ACL tear and two MCL tears. To top it off I had wildly out of whack hormones.

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