Obesity
People with obesity are living with a disease—not a choice—and it comes with physical, mental and emotional hurdles. It's time to address misperceptions, eliminate stigma, and imagine a better future for people around the world navigating this disease.
:00-:03 [Ambient music plays in background] [Red Lilly Logo animation appears on screen on a white background] :03-:26 [A woman sits in a chair with plants and windows behind her. There is an empty chair in the background. She speaks to the camera.] LIZ: I was put on my first diet that I was aware of in sixth grade. [Two photos of Liz as an adolescent appear on screen. In the first photo, she is smiling while holding a rock by a lake. The second photo, she is smiling while standing on a rock with trees behind her.] LIZ: I was going to France as an exchange student and my mom said, Hey, if you lose X amount of weight, you can earn your pocket money while you're there. [Video returns to Liz speaking to the camera in a close-up from the side.] LIZ: It was very confusing and it was very shameful. It wasn't for not being an active kid. [Photo of Liz as a child wearing a blue dress and smiling] [Photo of Liz as a child wearing a soccer uniform and sitting on a soccer ball.] [Photo of Liz as a child wearing a white shirt, holding her hands up high and smiling as she displays a medal around her neck.] [Photo of Liz as a child, smiling and wearing a tiger costume for Halloween.] :26 - :49 LIZ: I played soccer. I spent my days riding bikes around the neighborhood. I did everything that my sister did or friends did, and I was the only one who had a problem. [Video returns to Liz speaking to the camera.] Liz: That was the first experience with “Oh, this is something society says isn't quite right.” My name is Liz Paul and I live with obesity. CAPTION: LIZ’S STORY [Video transitions from Liz on camera to a black screen with the caption.] :51 – 1:21 [Video transitions from black and we see Liz again speaking to the camera.] LIZ: We've been conditioned to say that people who live in larger bodies are lazy, eating too much. They don't exercise. We're given all of these stereotypes. It's just not true. [Video shows Liz walking into her office] LIZ: I am busy from the moment I get up to the time my kids go to bed. [Video shows Liz working in her office, typing on a computer keyboard.] LIZ: I am the Cubmaster from my daughter's Cub Scout pack. [Photo of Liz with her family in Scout uniforms] LIZ: I am the president of the Mankato Kiwanis Club, which does service projects around town. [Video shows Liz conducting a Kiwanis meeting at a local restaurant.] 01:21 – 1:44 [Video shows Liz playing trumpet on stage at her church.] LIZ: I play trumpet in church. When you live in a larger body, you kind of want to hide yourself. But playing trumpet is something that people enjoy, and it's a chance to say, “Look, I can do something. I'm useful.“ [Video returns to Liz speaking to the camera, beginning to tear up as she speaks.] LIZ: Doctors told me that I was the only one who was ever going to fix me and had nothing but shame and blame for me. 01:44- 2:09 [Photo of Liz exercising at the gym.] [Photo of Liz running a 5K race with a woman by her side.] [Photo of Liz and her husband smiling at their wedding. She is holding a bouquet of red flowers.] [Photo of Liz smiling in a dress.] [Photo of Liz taking a photo in the mirror.] LIZ: I have done CrossFit. I have done five K’s. I have gained and lost hundreds of pounds over my adult life. [Video returns to Liz speaking to the camera.] LIZ: I would say my most successful was after my son was born. [Photo of Liz with her son, sitting on a large rock in front of a home.] [Photo of Liz and her son on a tire swing with tress behind them.] LIZ: I lost 80, 100lbs? And it was great and I felt really good. 2:09-2:34 [Video returns to Liz speaking to the camera.] LIZ: And then it stopped working. The actual disease of obesity came back to really bite me. LIZ: I had lost this weight, but it kept creeping back on and on and up. And I said, “Well, apparently I can't do this. Apparently, I am just a failure. I will always be living in a larger body” and kind of gave into the depression of it all. 2:34-2:45 [Video shows Liz walking up to a greet a woman behind a hotel counter and then receive a blue bag as she checks in for a conference.] LIZ: Around this time, I was invited to the Obesity Action Coalition - their “Your Weight Matters” convention. [Video shows scenes of Liz at the convention, listening to a discussion of experts on a stage in a hotel ballroom.] LIZ: Here were professionals, experts in the field who said obesity is a chronic, complex disease caused by all sorts of things [Video returns to Liz speaking to the camera.] 2:45-2:52 LIZ: that can't be cured just by eating less and moving more. Then I'm like, “What is this and why am I just hearing about this now?” [Video shows more scenes of Liz at the convention. We see a man and woman talking as Liz looks through materials on a table and then joins in their conversation.] 2:52-3:03 LIZ: People who live with obesity deserve access to care, bias-free, stigma-free treatments to help them manage their disease. [Video returns to Liz speaking to camera.] 3:03-3:18 [Video shows Liz walking in the woods. She is wearing a green shirt, a red hat and carrying a walking stick.] LIZ: I'm always trying to lose weight and make good choices and try to move my body every day. I try to eat right. I do as much as I can. I don't like to limit myself, but sometimes my body pays for it. 3:18-3:40 [Video returns to Liz speaking to camera] LIZ: Hopefully one day we'll find the tool or the treatment or anything that'll stick. But I know this will be something I'll be living with my whole life, regardless of whether I have lost weight or not. It's hard to to not be a little bit afraid of all of that. I want to see my kids grow up. I want to be there with them, which is why I never stopped trying to lose weight. [Video shows Liz on camera after her hike in the woods, looking up and then looking to the camera.] 3:40-3:43 [Ambient music fades out in background.] [Red Lilly logo appears and fades out on a white background.]
Navigating Obesity: Liz's Story
Liz's experience is personal, but it isn't unique. People living with the disease have many of the same challenges. Now, it's time to better understand what it's like.
Understanding the Disease
There is no one cause of obesity.1 In turn, there isn't just one approach to treat it. People with obesity deserve comprehensive care. The first step? Acknowledging and understanding the disease.
There are multiple causes of obesity including biological, genetic, behavioral, environmental, social and cultural factors.2,3 Just like many chronic diseases, obesity has a significant impact on the person living with it and on the people around them. And just like other long-term diseases, the approach to managing care needs to be well-rounded.
Because of misinformation and stigma, obesity is not always appropriately diagnosed or treated.4 And treatments that are available are oftentimes not reimbursed. To imagine a future beyond obesity, we need to better understand and accept it as a chronic disease.
Living with obesity can come with physical limitations, can impact mental health and is associated with more than 200 additional health complications.1 People who struggle with obesity can feel stuck after unsuccessful attempts to lose weight—due to factors completely out of their control—or can be caught in a cycle of weight loss and regain. They can even experience lower quality of life, less productivity at work, and more medical costs.5,6
We know that lifestyle choices alone often are not successful over the long term.7 But now it's possible to empower people with tools like intensive behavioral therapy, anti-obesity medications and surgery that allow them to take control of their disease.
Obesity and Moderate-to-Severe Obstructive Sleep Apnea
People living with moderate-to-severe obstructive sleep apnea (OSA) and obesity can face serious complications if their disorder is overlooked or left untreated. While OSA is frequently associated with loud snoring, its impact can extend beyond this symptom, leading to other symptoms such as excessive daytime sleepiness, observed episodes of stopped breathing during sleep, waking during the night and gasping or choking.8,9 Notably, obesity and OSA are closely linked—in the United States, approximately 69% of people with obesity have OSA, and about 32% have moderate-to-severe OSA.10 If left untreated, both conditions can contribute to a range of other serious health problems.8
Learning from the People Who Live It
00:00-00:02
[Music playing.]
[Red Lilly Logo animation appears on screen on a white background.]
00:03-00:16
[A man with a beard, named Edgar, is sitting in his kitchen talking to the camera. He’s wearing black glasses and a long-sleeved denim shirt with a green T-shirt underneath. The video cuts to photos of Edgar smiling as he talks over the pictures.]
Title: EDGAR, DIAGNOSED WITH OBSTRUCTIVE SLEEP APNEA IN 2016
EDGAR: There were moments before I was diagnosed where I would ask myself, "Why am I so tired?" I thought I was just a very sleepy person, that I was not as in shape or fit or athletically active.
00:17-00:35
[Photos show Edgar on vacation in Colorado, dressed in a warm winter coat and ski cap with snow in the background.]
EDGAR: I was diagnosed with sleep apnea as a follow-up to an emergency I had while vacationing in Colorado. The first day I was already feeling very exhausted, very weak, and I thought that perhaps it was getting used to the altitude. I had to be taken to the emergency room in the middle of our vacation.
00:36-00:38
[Photos show Edgar with wires attached to him during a sleep study.]
EDGAR: So when I came back, that's when I had a sleep study done.
00:39-00:46
[Edgar's partner, Frankie, is sitting in their kitchen, talking to the camera. He also has a beard and is wearing red glasses and a light green T-shirt under a white shirt.]
Title: FRANKIE, EDGAR'S PARTNER
FRANKIE: In the middle of the night. I'll hear a (gasping noise). He'll have that one, like gasp of air and it wakes me up because it's so loud and abrupt.
00:47-00:51
[Scenes of the men trying to sleep.]
FRANKIE: When he doesn't get a good night's sleep, he's like a walking zombie. I feel so bad when I see it.
00:52-00:58
[Edgar is talking to the camera. Scenes show Edgar watering plants in their home.]
EDGAR: Making sure that we're getting a proper good night's sleep is important because it affects everything else when you're awake.
00:59-01:07
[Frankie is talking to the camera.]
FRANKIE: When I was learning how he had to sleep with his apnea, I was more curious than anything. Tell me more about this. I want to learn.
01:08-01:12
[Edgar is talking to the camera.]
EDGAR: I have come to appreciate sleep as an activity in my life.
01:13-01:24
[Scenes show Edgar getting ready for bed, sleeping in bed, and talking with Frankie over coffee in the morning.]
EDGAR: We communicate about our sleep. We communicate about our needs. We've been able to talk about, when I go to bed, when he goes to bed, and some of the things that are necessary for us to have a successful night of sleep.
01:25-01:36
[Frankie is speaking to the camera. Scenes show the couple playing video games in their living room.]
FRANKIE: This actually ended up making our relationship stronger because we can talk about our sleep. What else do we need to talk about? We're able to share that, understand, empathize with each other, thus making that relationship even more strong.
01:37-01:40
[Scenes show Frankie and Edgar playing pickleball on a blue and green court in a local park. Edgar is wearing a yellow T-shirt and bright multi-color shorts, while Frankie is wearing a grey shirt and green shorts.]
FRANKIE: We definitely get competitive with pickleball. We really enjoy it.
01:41-01:45
EDGAR: With friends, we meet every week, we play, we've done leagues, which has been really nice.
01:46-01:48
FRANKIE: It's honestly just a good, fun time for us.
01:49-01:58
[Edgar is back sitting in the kitchen, talking to the camera.]
EDGAR: My sleep routine is sacred. I am a force and I am ready to go to bed. And nothing can stop me. It is an event. You don't need a ticket for it. It's kind of nice. It's free.
01:59-02:01
[Scene shows Edgar and Frankie outside their home. Frankie has his arm around Edgar.]
EDGAR: Sleeping is...yeah...I love it.
02:02-02:05
[Red Lilly logo appears.]
[Music fades in the background.]
Living with OSA: Edgar's Story
Like Edgar, many people are unaware of their breathing interruptions during sleep. Working to dispel misconceptions, it's time to learn more about obstructive sleep apnea.
Advancing Science, Addressing Misperceptions
We can imagine a healthier future for people living with obesity. We're closer than ever before.
As we make strides in this new era of obesity care, there's still a lot of work to be done. Just like other chronic diseases, the more options available to incorporate into a comprehensive treatment plan–including holistic cardiometabolic health—the more potential progress there is for people living with the disease. But those with obesity are also impacted by misperceptions and misinformation that can make care harder to receive.
We've been focused on investing in research to develop potential new medications. But scientific breakthroughs must come alongside a shift in how health care professionals, policymakers, employers, and society view and understand obesity.
In partnership with Cerner Enviza, we've been conducting a nationwide study focused on how misconceptions influence obesity treatment and anti-obesity medication use. We also join the obesity advocacy community—including medical, patient and health equity groups—to support the Treat and Reduce Obesity Act. The act is a step in the right direction to help modernize Medicare Part D to treat obesity as a chronic disease with evidence-based practices.
We’re prepared to do all we can to create a better future.
00:00:00:03 - 00:00:02:12 [Ambient music plays in background] [Red Lilly Logo animation appears on screen on a white background] 00:00:02:12 - 00:00:10:16 [Video footage of man in a blue sport coat working on a computer and talking with a female colleague.] SCOTT MACGREGOR: My name's Scott MacGregor. I lead the digital content team here at Lilly. I'm a big guy. The clinical term is living with obesity. 00:00:10:16 - 00:00:13:09 [Photographs appear of Scott when he was younger: he is smiling at a restaurant.] SCOTT: I've struggled with weight most of my life. I've been heavy. I've been thin. 00:00:13:09 - 00:00:14:22 [Photographs appear of Scott when he was younger: he is wearing a red baseball cap while hiking in the woods.] SCOTT: I've struggled with weight most of my life. I've been heavy. I've been thin. 00:00:14:22 - 00:00:16:11 [Photographs appear of Scott when he was younger: he is smiling and wearing a dark blue baseball jersey and cap.] SCOTT: I've struggled with weight most of my life. I've been heavy. I've been thin. 00:00:16:11 - 00:00:23:05 [Video resumes with shots of Scott at work, walking up a staircase and getting lunch at a salad bar.] SCOTT: And post COVID, I'm as heavy as I've ever been. I just turned 50 and I'm on a quest to get back to better health. 00:00:23:05 - 00:00:29:05 [Video of Scott meeting a female at a coffee shop, shaking hands and getting coffee.] SCOTT: Today, I’m having coffee with Dr. Clare Lee, one of the lead physicians on our obesity medical team. 00:00:29:05 - 00:00:34:06 [Video of Scott and Dr. Clare Lee walking down a hallway, then talking while sitting at a table in front of a wood panel.] CAPTION: Scott MacGregor, Senior Director, Lilly Communications SCOTT: It seems like we're really in a moment in terms of where obesity science has come. 00:00:34:06 - 00:00:43:04 [Video of Scott and Dr. Clare Lee walking down a hallway, then talking while sitting at a table in front of a wood panel.] SCOTT: So where have we come from and where are we now? And why are we at this point where we now can treat obesity with these medical interventions? 00:00:43:04 - 00:00:50:11 [Close-up of Dr. Lee, who is wearing a blue shirt and black jacket.] CAPTION: Dr. Clare Lee, Executive Director, Medical Affairs DR. LEE: This is such a special moment in our lifetime to be making this much progress in obesity care. 00:00:50:11 - 00:01:03:02 [The video alternates between close-ups of Dr. Lee and shots of Dr. Lee talking as Scott listens and nods his head.] DR. LEE: My aha moment in my earlier years in endocrinology was when I saw patients after bariatric surgery going through remarkable changes with regard to their metabolic health. 00:01:03:02 - 00:01:06:14 [The video alternates between close-ups of Dr. Lee and shots of Dr. Lee talking as Scott listens and nods his head.] DR. LEE: There was really this gap between lifestyle intervention and bariatric surgery. 00:01:06:14 - 00:01:08:09 [Scenes of people living with obesity: a man takes a selfie with his family at the dinner table.] DR. LEE: It's only in the recent, less than a decade that we're getting closer to the answers that patients have been looking for to achieve their health goals. 00:01:08:09 - 00:01:10:06 [Scenes of people living with obesity: a woman is exercising.] DR. LEE: It's only in the recent, less than a decade that we're getting closer to the answers that patients have been looking for to achieve their health goals. 00:01:10:06 - 00:01:13:01 [Scenes of people living with obesity: a man sitting on a bench outside an office building, typing on a laptop computer. ] DR. LEE: It's only in the recent, less than a decade that we're getting closer to the answers that patients have been looking for to achieve their health goals. 00:01:13:01 - 00:01:16:11 [Scenes of people living with obesity: A female sits in a doctor’s office as the doctor reviews paperwork. ] DR. LEE: It's only in the recent, less than a decade that we're getting closer to the answers that patients have been looking for to achieve their health goals. 00:01:16:11 - 00:01:19:03 [Scenes of people living with obesity: A man and a woman talk in a kitchen while the woman drinks a cup of coffee.] DR. LEE: And I think that's what makes this moment very special, that we now have answers and tools for our patients living in obesity that goes beyond just a lifestyle intervention. 00:01:19:03 - 00:01:21:17 [Scenes of people living with obesity: a woman in a park looking at the camera.] DR. LEE: And I think that's what makes this moment very special, that we now have answers and tools for our patients living in obesity that goes beyond just a lifestyle intervention. 00:01:21:17 - 00:01:25:22 [Video returns to a shot of Dr. Lee speaking on camera.] DR. LEE: And I think that's what makes this moment very special, that we now have answers and tools for our patients living in obesity that goes beyond just a lifestyle intervention. 00:01:25:22 - 00:01:28:07 [Video shows a close-up of Scott asking a question.] SCOTT: What is the science that's underlying that? 00:01:28:07 - 00:01:34:09 [Video of Dr. Lee speaking to Scott. The video alternates between close-ups of Dr. Lee and shots of Dr. Lee talking as Scott listens and nods his head.] DR. LEE: There are multiple causes underlying the disease physiological, behavioral, social, cultural. 00:01:34:09 - 00:01:37:16 [Video of Dr. Lee speaking to Scott. The video alternates between close-ups of Dr. Lee and shots of Dr. Lee talking as Scott listens and nods his head.] DR. LEE: It is becoming clearer and clearer to the field 00:01:37:16 - 00:01:42:18 [Video of Dr. Lee speaking to Scott. The video alternates between close-ups of Dr. Lee and shots of Dr. Lee talking as Scott listens and nods his head.] DR. LEE: that addressing the biology underlying the disease that is obesity really matters. 00:01:42:18 - 00:01:44:22 [Scenes of people living with obesity: A woman laughs as she holds a baby.] DR. LEE: Obesity is a disruption in the energy balance that leads to fat deposition in the body that ultimately makes a threat to health. 00:01:44:22 - 00:01:46:12 [Scenes of people living with obesity: A man and a woman smile as they relax on a sailboat.] DR. LEE: Obesity is a disruption in the energy balance that leads to fat deposition in the body that ultimately makes a threat to health. 00:01:46:12 - 00:01:48:08 [Scenes of people living with obesity: Two women walk in a park.] DR. LEE: Obesity is a disruption in the energy balance that leads to fat deposition in the body that ultimately makes a threat to health. 00:01:48:08 - 00:01:50:11 [Scenes of people living with obesity: A man smiles as he sits on a park bench.] DR. LEE: Obesity is a disruption in the energy balance that leads to fat deposition in the body that ultimately makes a threat to health. 00:01:50:11 - 00:01:52:15 [Scenes of people living with obesity: A man looks to the camera and smiles.] DR. LEE: Obesity is a disruption in the energy balance that leads to fat deposition in the body that ultimately makes a threat to health. 00:01:52:15 - 00:01:53:23 [Scenes of people living with obesity: A woman smiles as she looks out a window.] DR. LEE: Obesity is a disruption in the energy balance that leads to fat deposition in the body that ultimately makes a threat to health. 00:01:53:23 - 00:01:59:05 [Video returns to Dr. Lee speaking with Scott.] DR. LEE: When you do not address the underlying broken system, the broken biology, the disease comes back. 00:01:59:05 - 00:02:03:15 SCOTT: Obviously, there's a stigma that goes along with obesity and being overweight. 00:02:03:15 - 00:02:08:19 DR. LEE: The weight bias and stigma are one of the biggest sort of challenges that lie ahead. 00:02:08:19 - 00:02:10:19 [Scenes of people living with obesity: A man with a beard sits on a table in a doctor’s office as a female doctor talks to him.] DR. LEE: Providers are still having the conversations with their patients living with obesity, saying eat less, move more is all you need. 00:02:10:19 - 00:02:12:16 [Scenes of people living with obesity: A woman looks at a computer screen and writes a note on a piece of paper.] DR. LEE: Providers are still having the conversations with their patients living with obesity, saying eat less, move more is all you need. 00:02:12:16 - 00:02:14:10 [Scenes of people living with obesity: A man standing on the beach adjusts his earbuds.] DR. LEE: Providers are still having the conversations with their patients living with obesity, saying eat less, move more is all you need. 00:02:14:10 - 00:02:15:14 [Scenes of people living with obesity: A woman in a kitchen eats a salad.] DR. LEE: Providers are still having the conversations with their patients living with obesity, saying eat less, move more is all you need. 00:02:15:14 - 00:02:17:09 [Scenes of people living with obesity: A woman is running on a treadmill.] DR. LEE: Providers are still having the conversations with their patients living with obesity, saying eat less, move more is all you need. 00:02:17:09 - 00:02:19:02 [Video returns to Dr. Lee speaking on camera.] DR. LEE: and that just simply has not worked. 00:02:19:02 - 00:02:21:18 [Scenes of people living with obesity: a man with a briefcase walks and talks with a woman carrying a clipboard.] DR. LEE: Patients know what toll obesity has taken on their health, and so they're looking to partner with you to achieve weight goals that will get them closer to the health goals. 00:02:21:18 - 00:02:24:20 [Scenes of people living with obesity: A woman in a dress smiles for the camera while standing on a tree-lined street.] DR. LEE: Patients know what toll obesity has taken on their health, and so they're looking to partner with you to achieve weight goals that will get them closer to the health goals. 00:02:24:20 - 00:02:26:21 [Scenes of people living with obesity: A woman holds a dress in front of her as she looks in the mirror.] DR. LEE: Patients know what toll obesity has taken on their health, and so they're looking to partner with you to achieve weight goals that will get them closer to the health goals. 00:02:26:21 - 00:02:29:17 [Video returns to Dr. Lee speaking with Scott.] DR. LEE: Patients know what toll obesity has taken on their health, and so they're looking to partner with you to achieve weight goals that will get them closer to the health goals. 00:02:29:17 - 00:02:39:06 [Video returns to Dr. Lee speaking with Scott.] DR. LEE: It is absolutely exhilarating to be a part of this effort, to be a part of a solution that hopefully will help our patients in a meaningful way. 00:02:39:06 - 00:02:42:07 [Ambient music fades out in background.] [Red Lilly logo appears and fades out on a white background.]
The Science Behind the Disease
Scientists have been hard at work for decades trying to find new ways to help supplement lifestyle changes with therapies that could help people living with obesity better achieve their health goals.
References
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2. CDC. Updated March 21, 2022. Accessed June 17, 2023. https://www.cdc.gov/obesity/basics/causes.html
3. Mahmoud AM. An Overview of Epigenetics in Obesity: The Role of Lifestyle and Therapeutic Interventions. International Journal of Molecular Sciences. 2022; 23(3):1341. https://doi.org/10.3390/ijms23031341
4. Obesity Action Coalition. Accessed June 22, 2023. https://www.obesityaction.org/wp-content/uploads/Understanding-Obesity-Stigma-Brochure20200313.pdf
5. Rozjabek H, Fastenau J, LaPrade A, Sternbach N. Adult Obesity and Health-Related Quality of Life, Patient Activation, Work Productivity, and Weight Loss Behaviors in the United States. Diabetes Metab Syndr Obes. 2020;13:2049-2055. Published 2020 Jun 17. doi:10.2147/DMSO.S245486
6. Cawley J, Biener A, Meyerhoefer C, et al. Direct medical costs of obesity in the United States and the most populous states. J Manag Care Spec Pharm. 2021;27(3):354-366. doi:10.18553/jmcp.2021.20410
7. Hall KD, Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. Med Clin North Am. 2018;102(1):183-197. doi:10.1016/j.mcna.2017.08.012
8. McNicholas WT, Pevernagie D. Obstructive sleep apnea: transition from pathophysiology to an integrative disease model. J Sleep Res. 2022 Aug;31(4):e13616. Doi: 10.1111/jsr.13616. Epub 2022 May 24. PMID: 35609941; PMCID: PMC9539471.
9. Phillips, B. G., Kato, M., Narkiewicz, K., Choe, I., & Somers, V. K. (2000). Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. American journal of physiology. Heart and circulatory physiology, 279(1), H234–H237. https://doi.org/10.1152/ajpheart.2000.279.1.H234
10. Young, T., Shahar, E., Nieto, F. J., Redline, S., Newman, A. B., Gottlieb, D. J., Walsleben, J. A., Finn, L., Enright, P., Samet, J. M., & Sleep Heart Health Study Research Group (2002). Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Archives of internal medicine, 162(8), 893–900. https://doi.org/10.1001/archinte.162.8.893