Medicare and Obesity – HealthyWomen



For millions of people living with obesity, the class of weight-loss medications known as GLP-1 agonists have been game-changers (think Wegovy and Zepbound). Studies show that people on these medications can lose more weight than they can with just lifestyle changes alone.

But for one group of Americans — people on Medicare — at least some of these drugs have been off-limits because Medicare is not allowed to cover medications prescribed for the sole purpose of weight loss. With ample evidence that obesity itself increases numerous health risks and new indications that these drugs lower risks of heart disease and stroke, those limits may be changing.

A bipartisan bill, the Treat and Reduce Obesity Act (TROA), moving through Congress would allow Medicare to cover weight-loss medications for the first time.

Experts argue it’s about time.

“The passage of the Treat and Reduce Obesity Act (TROA) is crucial for protecting women’s access to obesity care as they transition to Medicare,” said Fatima Cody Stanford, M.D., M.P.H., M.P.A., associate professor of medicine and pediatrics at Harvard Medical School and obesity medicine physician-scientist in the Massachusetts General Hospital Weight Center.

Stanford explains that TROA improves comprehensive coverage while improving equitable access to care.

“The TROA aims to expand Medicare coverage to include a wider range of obesity treatments, including FDA-approved medications and intensive behavioral therapy. This ensures that women can continue their established treatment regimens without interruption,” she said. “The TROA addresses disparities in healthcare access, ensuring that all women, regardless of their financial situation, can receive the necessary treatments to manage their obesity effectively.”

The costs of obesity

For 31 million women over age 65 (and another 4 million younger women who qualify for Medicare because of long-term disabilities), Medicare’s lack of obesity care coverage creates risks. Approximately 10,000 Americans turn 65 every day, more than half of whom are women. With obesity rates reaching 43% in people over age 60, losing access to obesity treatments can be especially detrimental.

“When women transition from private insurance to Medicare at the age of 65, they often face a significant loss in coverage for obesity treatments,” Stanford said. “When women who have been receiving consistent obesity treatment, including medications, behavioral therapy and nutritional counseling, experience an abrupt halt in their care, this can lead to weight regain and worsening of obesity-related conditions.”

Experts recognize obesity as a chronic medical condition. According to the CDC, 2 out of every 5 American adults are living with obesity. Almost 6 out of 10 of them also have high blood pressure, which raises their risks for heart disease. Nearly 1 out of 4 also have diabetes. Obesity is also known to increase the risks of certain cancers, pregnancy and fertility problems, and mental health issues, among other conditions.

“Obesity is a chronic disease that requires ongoing management,” said Alicia Shelly, M.D., obesity medicine physician. “Without Medicare coverage for obesity treatment, women are at increased risk for serious health issues like heart disease, diabetes and cancer. Long-term support is essential to help prevent these life-threatening conditions.”

Obesity is also a serious economic issue. People with obesity have nearly $2,000 more in annual medical costs than people without obesity. Overall, those costs add up to nearly $173 billion in extra medical costs each year in the U.S.

And that’s just direct medical costs associated with obesity. Add to that lost productivity that results when employees miss work, are less productive at work due to obesity complications, or prematurely die or leave the workforce due to disability. The CDC estimates that obesity-related missed work alone costs between $3.38 and $6.38 billion each year.

TROA is one way to reduce these costs.

“By providing coverage for obesity treatments, the TROA supports preventive health measures, reducing the incidence of obesity-related diseases and lowering long-term healthcare costs,” Stanford said.

In women’s own voices

In a HealthyWomen survey of 1,000 women ages 35 to 64, nearly one-quarter reported having been diagnosed with obesity, and 79% said they were trying to lose weight or lower their BMI. Another 8% of respondents said they are caregiving for someone living with obesity.

Nearly two-thirds of women living with obesity reported dieting or considering doing so, and one in five said they’re taking or considering taking an anti-obesity medication (AOM).

The survey results show that 8 out of 10 women who consult a nutritionist said their insurance covers all or part of those costs, but only 6 out of 10 said the same about insurance coverage for AOMs.

Women living with obesity said that achieving their desired weight would have the biggest positive impact on their physical and mental health, self-confidence, and daily activities. But 11% of survey respondents who reported that they will turn 65 in the next six months (or are caregiving for someone who will) will not have access to AOMs under the current rules. Seven percent of women said they have a plan that will no longer cover their AOM next year or that they’re caring for someone in that situation.

The survey also revealed racial and ethnic health disparities. Nearly one-third of respondents said they have been diagnosed with obesity or would be if they went to a healthcare provider (HCP) who would assess their weight. And Black respondents were twice as likely than Hispanic/Latina respondents to categorize themselves this way.

Insurance status also showed important differences. People on Medicaid, the public insurance program for Americans with lower incomes, were more likely to say they had been diagnosed with obesity (31%) compared with 20% of those with job-based insurance and 17% with other private coverage. Among survey respondents with Medicare coverage, 13% said they care for someone with obesity and 26% are living with obesity.

Fighting for coverage

“The sudden lack of support and resources can have a detrimental effect on mental health, leading to feelings of helplessness, frustration and depression,” Stanford said. “This can further exacerbate the challenges associated with managing obesity.”

Stanford recommends that women transitioning onto Medicare be proactive about their care, such as reviewing various Medicare plan options to find the most comprehensive obesity coverage available and/or adding supplemental coverage (known as Medigap). She also recommends consulting HCPs to plan for the transition in advance and get their help navigating coverage or finding alternative treatments.

“I recommend developing a plan that outlines the available and affordable obesity treatments,” Shelly said. “Currently, Medicare does not cover weight loss medications, so it’s important to prioritize optimizing your nutrition and physical activity to support weight maintenance.”

More broadly, anyone who is or may someday be covered by Medicare can use their voice to advocate for coverage. Write letters to elected officials, call or visit their offices, or even request meetings to express support for TROA.

“Stay informed about legislative changes like the Treat and Reduce Obesity Act and advocate for their passage,” Stanford said. “Engaging with patient advocacy groups can amplify your voice and help drive policy changes.”

This educational resource was created with support from NovoNordisk, a HealthyWomen Corporate Advisory Council member.

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Facts About Digital Therapeutics – HealthyWomen



If you’re sick of hearing about all the ways technology is bad for us, here’s some good news to consider: Prescription digital therapeutics (PDTs) are among the latest digital health products helping to increase access to quality healthcare.

PDTs and digital therapeutics in general are used to help prevent, treat and manage a range of mental and physical conditions via mobile devices like your smartphone. The difference between PDTs and other health apps is that PDTs are authorized by the Food and Drug Administration (FDA) and require a prescription from your healthcare provider (HCP).

PDTs offer unique options not traditionally seen during your typical office visit. Some PDTs provide custom treatments such as a video game for ADHD and a wearable device that uses vibrations to interrupt nightmares. Other PDTs use cognitive behavioral therapy (CBT) to help with conditions such as insomnia or irritable bowel syndrome. The evidence-based treatments backed by clinical research can be used alone or in combination with other treatments.

The current PDTs approved by the FDA apply to both mental and physical conditions. These include:

PDTs may be especially helpful for women and people assigned female at birth considering many of these health conditions affect more women than men. For example, women are nearly twice as likely to be diagnosed with depression compared to men. The latest PDT approved by the FDA in April treats major depressive disorder.

Through the app, people are asked to identify and compare emotions displayed on a series of faces as part of cognitive-emotional training. Research shows this type of therapy may help stimulate the parts of the brain involved in depression and have antidepressant effects.

Read: The Life-Changing Hope of New Treatments for Clinical Depression >>

PDTs may also be particularly beneficial for people with substance use disorder. A recent study of people with opioid use disorder, mostly women, found that those who used a PDT had significant reductions in medical care visits, including inpatient stays and trips to the emergency room.

Benefits of prescription digital therapeutics

In addition to unique treatment options, PDTs can offer benefits including:

  • Convenience. You can access treatment on your schedule wherever you want.
  • Access. People who have a difficult time getting to in-person office visits can still get the care they need.
  • Equality: Digitized therapies that rely on a standard, evidence-based format ensure that people who use them receive the same quality and level of care.
  • Privacy: PDTs offer an option for people who feel stigma or shame about their health condition.

Although PDTs can help increase access to quality care, health insurance coverage for PDTs can vary and insurance may not cover them at all. And despite the FDA stamp of approval, some experts say more research is needed before making PDTs a mainstay in the healthcare system.

If you’re interested in PDTs, talk to your HCP about your options.

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Coping with the Cost of Cancer Treatment



Finances are not always the first thing people think of when they get diagnosed with cancer. Top questions may be, What’s the prognosis? What are the treatment options? And who are the best specialists?

But more and more, you also have to grapple with the cost of cancer alongside the physical and emotional aspects of cancer. Those costs can truly add up, often catching people by surprise.

Different types of cancer-related costs

Unfortunately, cancer costs come in many forms.

If you have health insurance, you might expect it to cover all your cancer care costs — and it should cover a lot of them. Direct medical costs include tests, medications, procedures, surgeries and some medical supplies. Insurance is likely to cover these costs if they’re considered “medically necessary.” In other words, if your treatment is in line with standard guidelines for your particular cancer and your healthcare providers (HCPs) believe you need it, it’s more likely your insurance will pay for it.

Yet even if your insurance covers direct medical costs, you may have to get their approval in advance (called “prior authorization”). Getting that approval can be its own headache. If your treatment plan is less common or you want to see an HCP who isn’t in your insurance network, you may not get approval.

Beyond the direct medical costs of your cancer treatment, you may come across many other types of expenses. For example, special foods or nutrition supplements may be important, but insurance doesn’t typically pay for them. Or, while medical care may be covered, home health may not be.

If you have to travel to get your care, across town or far away, you need to factor those costs in, too. Whether you have to pay for parking at a downtown hospital or travel to get specialized care away from home, travel costs can be challenging.

If you’re living with cancer, you may need extra help caring for your children, your parents or your pets. You may need more help in your home or doing errands that you may not be able to do yourself for a time. Caregiver costs can be substantial, and for many, may be out of reach.

Cancer costs may be even harder to manage thanks to “opportunity costs,” the missed opportunities to earn money. If you’re in treatment, you may not be able to work or you may have to scale back your hours. Lost wages or the loss of job-based health benefits can turn financial strain into a crisis. In a 2022 Cost of Cancer study conducted by HealthyWomen and CancerCare, nearly half of people in active treatment experienced some financial setback, and 6% lost their job altogether.

Coping with the stress of cancer-related financial challenges

The first step in managing the very real stress of cancer-related costs is to recognize that you are not alone. HealthyWomen’s Cost of Cancer report showed that paying for cancer costs was stressful for 6 out of 10 people surveyed. Nearly 1 of 2 patients with cancer reported feeling stress, worry and a sense of being overwhelmed because of the direct and indirect costs of cancer care.

It’s also important to ask for help — or allow people to help when they offer. The people in your life very likely want to help, but they may need you to tell them what would be most helpful. Perhaps a neighbor can run errands for you, or a close friend can help you with household chores. These gestures can spare you the cost of hiring someone and give you the comfort of knowing you’re not alone.

The emotional strain of a cancer diagnosis is real. The financial parts of cancer only add to those challenges. If you feel anxious, depressed or generally overwhelmed, seeking therapy or other mental health care may also help.

Easing cancer-related financial burdens

Without health insurance, the direct costs of cancer can be crushing. But if you are uninsured, there are ways to get coverage.

If you don’t have health insurance from your job, is there someone in your household who may be able to add you to their coverage? If not, visit the federal Marketplace (Healthcare.gov) or the Marketplace in your state. If you’ve lost your benefits recently, you may be able to sign up even if it’s not during open enrollment. If you have low or no income, you may qualify for generous subsidies.

Depending on your income and the rules in your state, you may qualify for Medicaid, the state-operated health insurance for people with very low incomes. Similarly, depending on your age and condition, you may be able to sign up for Medicare. These programs offer good coverage and a lot of consumer protections, often for free or with very low costs.

With or without insurance, if you’re struggling to pay for medical care, you may qualify for financial assistance from your hospital or clinic. Hospital financial counselors can often help you navigate the hospital’s financial aid process, which may include a formal application. If your application is denied, you may be able to appeal. Medical facilities will also usually set up a payment plan that lets you pay small amounts over time, sometimes without interest. Be honest about what you can comfortably afford.

If you can’t get financial relief from the hospital or medical center itself, the financial counselor may still be able to help. They might help you get support from local community or religious organizations, or from drug maker co-payment relief programs. Some nonprofits will also help you advocate for yourself or negotiate bills on your behalf.

Finally, many people turn to crowdfunding campaigns to raise the money they need. Whether you launch a formal campaign or seek financial help informally, there’s no denying the power of your community to help you cope with the emotional and financial challenges of cancer.

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Lidiar con el costo del tratamiento contra el cáncer



Las finanzas no siempre son lo primero en lo que piensan las personas cuando reciben un diagnóstico de cáncer. Las preguntas principales podrían incluir, ¿cuál es la prognosis? ¿Cuáles son las opciones de tratamiento? Y ¿quiénes son los mejores especialistas?

Pero cada vez más, también deben considerarse los costos del cáncer además de sus aspectos físicos y emocionales. Esos costos pueden sumar montos importantes y frecuentemente las cuentas suelen sorprender a los pacientes.

Varios tipos de costos relacionados con el cáncer

Desafortunadamente, los costos del cáncer son de varios tipos.

Si tienes un seguro médico, podría esperarse que cubra todos tus costos relacionados con el cáncer, y muchos de ellos deberían estar cubiertos. Los costos médicos directos incluyen pruebas, medicamentos, procedimientos, cirugías y algunos suministros médicos. El seguro médico probablemente cubre estos costos si se considera que son “necesarios desde el punto de vista médico”. Es decir, si tu tratamiento concuerda con las pautas estándar de tu cáncer específico y tus proveedores de atención médica (HCP, por sus siglas en inglés) creen que los necesitas, es más posible que tu seguro los pague.

Sin embargo, incluso si tu seguro cubre los costos médicos directos, puede que tengas que obtener su aprobación de antemano (denominada “autorización previa”). Obtener esa aprobación puede ser un dolor de cabeza. Si tu plan de tratamiento es menos común o si deseas mantener consultas con un proveedor de atención médica que no es miembro de la red de tu seguro, es probable que no obtengas la aprobación.

Aparte de los costos médicos directos de tu tratamiento contra el cáncer, podrías tener muchos otros tipos de gastos. Por ejemplo, alimentos o suplementos nutricionales especiales podrían ser importantes, pero los seguros comúnmente no los cubren. O, aunque la atención médica esté cubierta, servicios médicos proporcionados en el hogar podrían no estarlo.

Si debes viajar para obtener tu atención médica, al otro lado de la ciudad o a una gran distancia, también debes considerar estos costos. Ya sea que debas pagar por el parqueadero de un hospital en el centro de la ciudad o que tengas que viajar para obtener atención especializada lejos de tu hogar, los costos de viajes pueden ser un desafío.

Si vives con cáncer, podrías necesitar ayuda adicional para el cuidado de tus hijos, de tus padres o de tus mascotas. Podrías necesitar más ayuda en tu hogar o con mandados que tú no podrías hacer durante algún tiempo. Los costos de cuidadores podrían ser considerables y, para muchos, impagables.

Los costos del cáncer podrían ser incluso más difíciles de manejar debido a los “costos de oportunidad”, es decir, las oportunidades que se pierden para ganar dinero. Si estás teniendo un tratamiento, es posible que no puedas trabajar o que tengas que recortar tus horas laborales. La pérdida de salarios o de beneficios médicos de tu trabajo podría transformar una dificultad financiera en una crisis. En un estudio del costo del cáncer de 2022 realizado por HealthyWomen y CancerCare, casi la mitad de personas que recibían tratamiento activamente experimentaron algún tipo de pérdida financiera y el 6% incluso perdieron sus trabajos.

Lidiar con el estrés de las dificultades financieras relacionadas con el cáncer

El primer paso para manejar el estrés muy real de los costos relacionados con el cáncer es reconocer que no estás sola. El informe de los costos del cáncer de HealthyWomen mostró que pagar por los costos del cáncer era estresante para 6 de cada 10 personas encuestadas. Casi 1 de cada 2 pacientes con cáncer reportó sentir estrés, preocupación y presión debido a los costos directos e indirectos de la atención contra el cáncer.

También es importante pedir ayuda o permitir que personas ayuden cuando ofrecen hacerlo. Las personas en tu vida muy posiblemente desean ayudar, pero es posible que ellos necesiten que les digas que sería lo más útil para ti. Tal vez un vecino pueda encargarse de mandados o un amigo cercano podría ayudarte con quehaceres del hogar. Estos gestos podrían ahorrarte el costo de contratar a alguien y podrían darte una sensación de seguridad al saber que no estás sola.

El desgaste emocional de un diagnóstico de cáncer es real. Los aspectos financieros del cáncer solo dificultan más esos desafíos. Si te sientes angustiada, deprimida o generalmente abrumada, obtener terapia u otro tipo de atención de la salud mental también podría ser útil.

Mitigar las cargas financieras relacionadas con el cáncer

Sin un seguro médico, los costos directos del cáncer pueden ser devastadores. Pero si no tienes un seguro médico, hay formas en las que puedes obtener cobertura.

Si no tienes un seguro médico de tu trabajo, ¿hay alguien en tu hogar que pueda agregarte a su cobertura? Si no es así, visita el mercado virtual federal de seguros médicos(Healthcare.gov) o el de tu estado. Si perdiste tus beneficios recientemente, podrías inscribirte incluso si no es durante el período de inscripciones abiertas. Si tus ingresos son bajos o inexistentes, podrías cumplir con los requisitos para subsidios generosos.

Dependiendo de tus ingresos y de las regulaciones de tu estado, podrías cumplir con los requisitos de Medicaid, el seguro médico que maneja tu estado para personas con muy pocos ingresos. Asimismo, dependiendo de tu edad y de tu condición, podrías inscribirte en el programa de Medicare. Estos programas ofrecen buenas coberturas y muchas protecciones para los consumidores, frecuentemente gratis o a costos muy bajos.

Con o sin seguro, si tienes dificultades para pagar por atención médica, podrías cumplir con los requisitos para recibir asistencia financiera de tu hospital o clínica. Asesores financieros del hospital frecuentemente pueden orientarte en el proceso de asistencia financiera del hospital, la cual podría incluir una solicitud formal. Si rechazan tu solicitud, es posible que puedas apelar dicha decisión. Las intervenciones médicas usualmente también establecerán un plan de pagos que te permita pagar montos pequeños cada cierto tiempo, a veces sin intereses. Sé honesta acerca de lo que puedes pagar en forma cómoda.

Si no puedes obtener asistencia financiera del hospital o del centro médico, es posible que el asesor financiero pueda proporcionar otro tipo de asistencia. Podría ayudarte a que recibas apoyo de alguna comunidad local o de organizaciones religiosas, o incluso, de programas de asistencia de copagos del fabricante del medicamento. Algunas organizaciones sin fines de lucro también te ayudarán a defender tus derechos o a negociar cuentas por ti.

Finalmente, muchas personas recurren a campañas de financiamiento colectivo para recaudar el dinero que necesitan. Ya sea que simplemente sea una campaña formal o que trates de obtener asistencia financiera en forma informal, no se puede negar el poder de tu comunidad para ayudarte a lidiar con las dificultades emocionales y financieras relacionadas con el cáncer.

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The Importance of Obesity Treatment



It’s always a successful day at the office for
Fatima Cody Stanford, M.D., M.P.H.,M.P.A., when she can look at a patient’s chart, see a diagnosis of diabetes, high cholesterol or hypertension, and see progress in their health or resolution of a health concern.

Shanna Tucker, M.D., an obesity medicine specialist at NYU Langone Health, has a similar standard. If she can reduce the dosage or stop prescribing medication for one of these diseases, she knows her patient is on the right track.

When
obesity medicine specialists help patients with weight loss, their overall goal is far greater than achieving lower numbers on the scale. By treating a patient’s obesity, specialists are also helping patients manage and resolve other chronic conditions that threaten their overall health.

“Most of my patients have been with me for a decade or longer, so this is a lifetime commitment to their chronic disease that is obesity,” said Stanford, an associate professor of medicine at Massachusetts General Hospital and an obesity medicine physician-scientist. “I want to help them delete diagnoses from their chart — from their obesity itself to diseases associated with their obesity.”

Obesity can
reduce life expectancy because it generally increases the risk of other conditions and chronic diseases, including diabetes, heart disease, kidney disease and liver disease. And it can also contribute to sleep problems, joint pain, mental health issues and some cancers. It was also found to be a top risk factor for Covid-related hospitalization and death.

Growing rates of obesity have created a significant public health issue in the U.S. More than
1 in 3 adults and 1 in 5 children are living with obesity, and the U.S. spends more than $147 billion a year on obesity-related healthcare.

Tucker said many patients come to her in frustration because they’re already eating well and exercising. They’ve lost some weight, but they can’t seem to lose any more or their weight has started climbing. They’re also struggling with chronic health conditions made worse by obesity.

“Not enough medical providers may understand that sometimes additional treatment is necessary for many patients,” Tucker said.

The benefits of anti-obesity medications

Obesity medicine specialists tailor plans for patients that can include a combination of lifestyle management, medication and, in some cases, surgery.

Anti-obesity medications (AOMs) have been getting a lot of attention in the media, with many public figures attributing their weight loss to the use of these medicines. While anti-obesity medications aren’t new — the FDA first began
approving them in 1959 — the current class of GLP-1 medications like semaglutide have become household names (Ozempic/Wegovy and Mounjaro/Zepbound) for their ability to help people achieve significant weight loss.

While the weight loss achieved through GLP-1 medications makes headlines, obesity medicine specialists have a broader view of the medications’ benefits and see how they can offer quicker resolution to chronic diseases. A
meta-analysis (a review of many studies) shows that anti-obesity medications can contribute to a significant reduction in cardiovascular events, like heart attacks and strokes, and hospital admission for heart failure in people with Type 2 diabetes.

Tucker said people living with obesity don’t have to lose a lot of weight to see results. Even just a
5%–10% drop in weight can help improve high cholesterol or high blood pressure. Weight loss can also be important for quality-of-life improvements, such as allowing people to move more easily, sleep better, experience less joint pain and have more energy.

“I know a lot of people don’t want to start a new medication, but by treating obesity, I’ve had patients who’ve had a significant amount of weight loss and were able to start decreasing the dose of their diabetes medication or even stop their high blood pressure or high cholesterol medications,” Tucker said. “I say to keep the big picture in mind about the potential benefits of anti-obesity medication.”

Barriers to obesity treatment

Although effective obesity treatment can improve health outcomes and yield substantial savings for the nation’s healthcare system, many Americans don’t have access to obesity care.

Not enough healthcare providers are trained in obesity medicine, Tucker said, and the cost of the medications themselves can prevent patients from being able to get them. There’s also no guarantee that the medication will be covered by insurance or available to Medicaid and Medicare recipients.

“I think we’re really doing a disservice to these patients,” Tucker said. “They’ve already sought help and have made an appointment and come into my office. To get that far and not be able to prescribe a medication because of insurance is very disappointing.”

Since each state Medicaid plan has its own policies for obesity treatment coverage, many people don’t have access to anti-obesity medications. And, at the federal level, Medicare Part D still prohibits coverage of AOMs for most patients, even though people covered under the Veterans Affairs/Department of Defense and Federal Employee Health Benefits plans do have access to the full continuum of care for obesity. Stanford said she’s hoping the Treat and Reduce Obesity Act, first introduced in Congress in 2012 and reintroduced each session since, will become federal law to help expand coverage for Medicaid and Medicare patients.

Watch: Congressional Briefing: Ensuring Patient Access to Effective Treatments for Obesity >>

Stanford said she’s seen older adults who’ve made significant progress getting rid of chronic conditions through treatment lose all of their progress when they enroll in Medicare and can no longer afford their medication if they lose coverage for their medication.

Stanford also pointed out other disparities in who’s most likely to have access to treatment.

“The populations most likely to benefit, particularly racial and ethnic minority populations here in the U.S., are struggling to get these meds,” Stanford said. “We have to get past the idea that people just need to eat less and exercise more, which is founded not on science. I want to change that narrative. We can do better to help those who need it.”

Still, for people who are struggling with obesity and other chronic health conditions, Tucker said it’s worth talking to your healthcare provider to see if some type of obesity treatment can help.

“I know some patients may want to avoid the topic, and I can understand why for many reasons,” Tucker said. “There’s a lot of obesity bias or weight bias in the medical community. I do encourage people to at least ask their [healthcare provider] what resources are available if they’re interested in losing weight so they have all the information and resources to help them make the best next step.”

Help Us Increase Access to Obesity Treatment >>

This educational resource was created with support from Novo Nordisk, a HealthyWomen Corporate Advisory Council member.

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