Just a few days later, Boris Johnson gave a speech at the Conservative Party Conference alluding to his anti-obesity campaign by striking a personal chord: “I had a very common underlying condition: My friends, I was too fat.” The prime minister also mentioned he’d since lost 26 pounds. He went on to outline a vision for the future of Britain that included a healthier population, with more biking and walking.
Stateside, the U.S. government was still not raising the alarm about the link between rampant metabolic disease and greater risk. It was never part of White House messaging on the virus and the suite of policies needed to respond to the crisis — something that didn’t change when President Joe Biden took the reins, either.
“It’s not central to the discussion at all,” said Dan Glickman, who served as agriculture secretary during the Clinton administration and is now a senior fellow at the Bipartisan Policy Center.
Glickman noted that the country’s leading voices on coronavirus, including Anthony Fauci, don’t focus on underlying conditions and what could be done about them long term. Instead, the focus is solely on vaccines, which have been proven to be safe and effective.
“They hardly ever talk about prevention,” Glickman said. “It’s missing. It’s a gigantic gap in the discussion about how health care relates to Covid and how it relates to the prevention of disease.”
As the pandemic heads into its third year, the connection to diet-related diseases and the overall vulnerability of the American population is a theme that remains absent at the highest levels of government. The only high-level Biden administration official who routinely talks about the issue is Agriculture Secretary Tom Vilsack — and he brings it up often.
Vilsack, who’s serving in the role for a second time after eight years during the Obama administration, likes to point out in his speeches, for example, that the government now spends more treating diabetes than the entire budget of the USDA, which is about $150 billion.
In an interview with POLITICO, Vilsack noted that more than half of the $380 billion per year spent treating just cardiovascular disease, cancer and diabetes is now picked up by the government, including through programs like Medicare and Medicaid.
“Ironically, if you could eliminate those costs you would be able to afford a $3.5 trillion Build Back Better bill [without pay-fors],” he said.
“It’s a significant issue that requires elevation,” Vilsack said. “We’re moving the dials that we can move at USDA. I think, however, it takes more than that. I think it takes multiple departments focused on this and multiple leaders saying this is an issue that requires some attention.”
Dealing with diet-related diseases hasn’t been top of mind in Congress, either. For example, there’s a bipartisan bill to require Medicare to cover medications and more types of specialists to help treat obesity. The legislation has been introduced repeatedly since 2013, the year the American Medical Association formally recognized obesity as a disease, but has not gotten much traction even as major Covid aid bills have moved through Congress.
Fatima Cody Stanford, an obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School who is a key advocate for the bill, said the pandemic has sparked much more interest among lawmakers and staff, but it hasn’t yet translated into legislative action.
One of the biggest challenges, she said, is that most people still do not understand obesity is a complex disease, not something that can be blamed on or fixed by personal choices, and it often requires multidisciplinary treatment that many people do not have access to.
“We aren’t taught about obesity,” Stanford said, referring to a lack of education in medical schools. “If doctors don’t understand obesity, why would the general public? Why would policymakers?”
Last month, the Government Accountability Office released a report on the state of the country’s response to diet-related diseases, concluding that there are scattered efforts across the federal government, but there isn’t enough coordination, nor an overarching plan.
“Congress should consider identifying and directing a federal entity to lead development and implementation of a federal strategy for diet-related efforts aimed at reducing Americans’ risk of chronic health conditions,” the GAO recommended.
Jerold Mande, a professor at the Harvard T.H. Chan School of Public Health and a fellow at Tufts University, who served in high-level positions at FDA and USDA in the H.W. Bush, Clinton and Obama administrations, said the report should be a gut check. “We’re not serious,” he said. “You look at the GAO report, and you conclude we’re not serious.”
The GAO identified just six “regulatory” actions the government has taken to try to combat diet-related diseases, but those policies are “largely educational” Mande noted, citing the Nutrition Facts label, which he helped design and launch during the H.W. Bush administration.