Tag: obesity

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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Webinar: Advancing Employee Wellness and Access for Women Living with Obesity


Obesity is a chronic disease that’s linked to over 200 other serious health conditions such as heart disease, stroke, diabetes and certain cancers. Women deserve access to the full continuum of treatment options for obesity. Watch as our experts explain the science of obesity as a chronic disease and why expanded coverage for all obesity care is critical to healthy outcomes.

Opening Remarks

Beth Battaglino

Beth Battaglino, RN-C
President and CEO, HealthyWomen

Moderator

Panelists

Deb Gordon

Deb Gordon
Co-Founder and CEO of Consumer Health Advocacy, Inc.

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Is the BMI BS? – HealthyWomen



Are we saying goodbye to BMI?

Body mass index (BMI) — the measure of body fat based on height and weight — has been around for decades. For years, your BMI has been used to determine whether you’re in a “healthy” weight range based on guidelines set by the World Health Organization.

Since it was created in 1972, BMI has been a standard measure of health and a screening tool for diseases including obesity. It’s also used to track population-level trends among public health.

But it turns out there are some serious issues with using BMI as an indicator of health — especially for women and people assigned female at birth.

BMI limitations

Fatima Cody Stanford, M.D., M.P.H.,M.P.A., an associate professor of medicine at Harvard Medical School and an obesity medicine physician-scientist, said BMI has been flawed from the start considering it’s based on measurements of white men. “We are not men,” Stanford said. “I really see that as problematic for us to just assume that men are the baseline and standard because we do have differences.”

For example, women tend to have more body fat compared to men with the same BMI, but BMI doesn’t assess body fat percentage, which can have an impact on your health.

Stanford noted that women also experience changes in hormones throughout life that can affect body fat distribution. And she finds it frustrating that the differences between women and men aren’t being considered.

For women of color, the history of BMI becomes even more problematic. So much so that the American Medical Association (AMA) recently issued a policy change regarding BMI as a measure of medicine because of “its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations.”

Under the new policy, the AMA recommends that healthcare providers take into account the different body shapes and composition across race/ethnic groups, sexes, genders and ages in addition to other risk factors. Considering about 6 out of 10 Black women are living with overweight or obesity in the U.S., and BMI is the sole indicator for diagnosis for the disease, this can have a major impact on the way providers approach diagnosis and health conditions — everything from treatment options to insurance costs.

Read: The Importance of Making Obesity Treatment Accessible >>

“I’ve been one of these people who are really trying to raise the alarm on BMI as a solo measure,” Stanford said. “BMI is not a health indicator — it just tells us height and weight. It doesn’t give me anything about the health of an individual.”

The “M” doesn’t stand for muscle

Another major flaw is that BMI does not take into account body fat vs. muscle. And muscle weighs more than fat. For example, research shows Black people may have less body fat and more lean muscle mass than white people at the same BMI.

This can also pose an issue for people who are athletes and carrying more muscle, and muscle carries more weight, which makes the BMI an inaccurate measure of health.

Recently, you may have seen American rugby star Ilona Maher taking on the issue of BMI on social media. In a viral TikTok video, Maher responds to a commenter who criticized her weight, saying that Maher has a 30 BMI, which would put her in the obesity category by BMI standards.

Maher responded that she’s been labeled “overweight” her entire life despite being an athlete. “BMI doesn’t tell you what I can do. It doesn’t tell you what I can do on the field. How fit I am. It’s just a couple of numbers put together,” Maher said in the video. “It doesn’t tell you how much muscle I have, or anything like that.”

A few days later, Maher and the U.S. women’s rugby team won a historic bronze medal at the Olympics. So it seems the current and future plans changing the way we look at BMI couldn’t start soon enough.

New guidelines for BMI

Currently, BMI is the only way to diagnose obesity. Stanford is one of the experts on a commission that is working on a clinical definition for obesity and updated guidelines for diagnosing and treating the disease.

Read: Is Obesity a Disease? Yes — and the Medical Community Is Finally Recognizing That >>

She said she’s dedicated her life and career to helping people who are living with obesity, and BMI just doesn’t work on an individual level. “People have been so married to this idea that this one number tells me about your health without delving beneath the surface,” Stanford said.“What is the cholesterol that goes with that number — what is the blood pressure that goes with that number?”

Stanford said the new recommendations from the commission, which should be out in September, put little emphasis on BMI and offer a more comprehensive look at the actual science behind obesity, which is key to treating the disease.

“Here we are in a place in 2024 where medicine does need to take an active stance and actually think about health and that’s what we’re doing,” Stanford said. “Obesity is a chronic disease and we should treat it as such.”

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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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Is Obesity a Disease? Obesity Is Being Recognized as a Disease.



Michelle,* a 42-year-old mother of two, has been living with overweight or obesity her entire life. Around third grade, Michelle said she remembers a shift in her parents’ attitude toward her eating habits: They went from bribing or forcing her to eat to questioning whether she really needed seconds.

Her mother, though smaller than Michelle, was never happy with her own body, always dieting and complaining about her weight. When Michelle compared her relatively bigger body to her mother’s, it seemed even more problematic. Michelle went on her first diet and tagged along with her mother to Weight Watchers around age 11.

“I started learning not to trust my body because I was always being told what to do or what not to do,” Michelle said.

Obesity is a common medical condition

An estimated 4 out of 10 women in the United States are living with obesity. And the obesity rate is even higher — nearly 6 out of 10 — among Black women.

Obesity has historically been defined by a body mass index (BMI) of at least 30. However, this simple height-to-weight ratio is not necessarily the best way to predict health complications from obesity. Hormones, genetics, psychology and environmental factors can all contribute to obesity-related health risks. Although obesity was once thought to be a problem of will power, it is now understood that obesity is, in fact, a complex disease.

“Women are especially prone to obesity due to hormonal influences, such as puberty, contraceptive methods, treatments for infertility and menopause,” said Holly F. Lofton, M.D., director of the Medical Weight Management Program at the NYU Grossman School of Medicine and a member of HealthyWomen’s Women’s Health Advisory Committee.

Lofton noted that obesity is associated with more than 200 conditions. Many of these affect women and people assigned female at birth much more than men and people assigned male at birth. These conditions include:

Obesity has also been linked to fatty liver disease, digestive problems, osteoarthritis, anxiety and certain types of cancers. Obesity can pose risks to pregnant women, women trying to get pregnant and babies born to women with obesity.

Changing treatment guidelines for obesity

Treatment guidelines for obesity typically start with reducing calories and increasing exercise or activity. But obesity treatment needs to be more well-rounded than that, according to Lofton. And studies have shown that people who use anti-obesity medications (AOMs) in combination with lifestyle changes like nutrition and exercise programs tend to lose more weight than those who make lifestyle changes alone.

The American Gastroenterology Association strongly recommends medication in addition to lifestyle changes for adults with a BMI of at least 27 who also have weight-related conditions and for people with a BMI of 30 or more without any other medical conditions.

“We have seen a shift in the types of medications prescribed for weight management,” Lofton said. “We are moving from treating obesity with appetite suppressants to combination therapies and hormonal therapies, which target not only appetite regulation but optimize signals from the brain, intestines and [fatty] tissue as well.”

Current clinical guidelines recommend surgery for people with BMIs of 35 or more who also have other medical conditions or people with a BMI of 40 and up with no other conditions. According to Lofton, these guidelines are being reviewed and may shift to include people with lower BMIs.

“Just as in hypertension, or even cancer treatment, there is no one-size-fits-all model for obesity as a disease,” she said. Given how complicated obesity is, Lofton said more research is needed to find even more treatment options.

Michelle’s experience illustrates the importance of new and varied obesity treatments. She has tried countless diets, which worked — until they didn’t anymore. Despite being active — walking, swimming and doing water aerobics and strength training — Michelle said she typically gains the weight back and more.

Recently, Michelle has not been able to lose any weight, no matter how active she is or how few calories she eats. And her weight has started to affect her health. She is living with joint problems, high cholesterol, high blood pressure, acid reflux, pre-diabetes and fatty liver disease. Because she has a family history of heart disease, Michelle finally started taking medication to treat her obesity.

“I’m more on the cusp of all these terrible things happening, and so I’m trying to get control of it now,” she said.

For Michelle, medication seems to be working. After taking an AOM for the past four months, Michelle estimated that she’s lost 25 pounds, or a little more than a pound a week. She said she hasn’t dieted but just feels less interested in food. Though she has experienced side effects like nausea and fatigue, she’s noticed that her symptoms of irritable bowel syndrome (IBS) have gone away, and she’s less achy. Her blood pressure has improved and she’s waiting for new liver function tests.

Access barriers to obesity treatment

Despite evidence that AOMs and surgery work better than lifestyle changes alone, many women struggle to access comprehensive obesity treatment. Even with a diagnosis of obesity, there can be a wide variety of differences in coverage depending on what type of insurance you have. Many insurance companies require women to meet certain criteria before approving needed treatment. For example, patients often must demonstrate that they have other medical conditions that are a result of their obesity before their insurance company will pay for nutrition counseling. Anti-obesity medications are often not covered because many plans still do not recognize the fact that obesity is a chronic disease. Because of that lack of acknowledgment, they prohibit coverage of “weight-loss” agents instead of recognizing AOMs as necessary medications that have been FDA-approved to treat the disease of obesity. And most women also need their insurance company’s approval before getting surgery.

“As we bring more attention to obesity as a chronic disease, we still have a lot of work to do in the United States with increasing access to care,” Lofton said.

Not everyone who needs medication or surgery is able to get it, according to Lofton. In fact, people with the greatest need for obesity treatment may have the most trouble accessing it.

For women living with obesity, Lofton recommends partnering with their healthcare provider to review treatment options, which she said are constantly improving.

“It is essential to remember that this is a chronic disease,” Lofton said. “It is present even when one’s weight is considered normal or under control.” For women living with obesity, Lofton recommends partnering with their healthcare provider to review treatment options, which she said are constantly improving.

If you would like to talk to someone about how your weight may be impacting your overall health, you can find an obesity care provider through the Obesity Action Coaltion’s Obesity Care Providers search tool.

Help Us Increase Access to Obesity Treatment >>

*Name has been changed for privacy.

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

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Trying an Anti-Obesity Medication Changed My Life


As told to Jacquelyne Froeber

When my sister turned 13, I bought her a ring that said, “I hope you dance.”

I cried the first time I heard that song. The lyrics said everything I wanted for my sister. I want her to be confident and strong. I want her to take chances and live with no regrets.

I want her to dance.

This idea resonated with me because I’ve always wanted the same for myself. As a woman living with obesity, I’ve worked hard — very hard — to feel confident in my skin and love myself. But when I turned 40, the weight started to feel different.

One night I was getting ready to go out with my husband and our friends and I started dancing to the song “Work Bitch” by Britany Spears. Before I could say, “Look hot in a tankini,” I was sweating my makeup off. I was so out of breath I had to sit down. Perched on the edge of the bed — sweat pooling in my cleavage — I realized my body no longer worked like it did when I was in my 20s and 30s. Before I could sing and jump around. Now I couldn’t make it to the chorus.

Panic started to creep up my neck, and I tried my best to push the realization away. But I didn’t push too far. I needed to remember not to dance. Not in public. Maybe never again. And that stirred a restlessness within me.

A few weeks later, I went to my doctor for a routine visit. He asked me very casually if I wanted to try a new medication for weight loss. He explained the drug would help my stomach digest food more slowly and it also would signal to my brain that I was full.

At that time, I’d heard a few rumors about celebrities taking weight-loss drugs, but anti-obesity medications (AOMs) weren’t a household name then.

To be honest, it sounded too good to be true, but I was game. I’d tried many fad diets and weight-loss programs over the years in an effort to be healthier. I knew extra weight wasn’t good for me — I knew it wasn’t good for anyone. But when nothing really helped, I had to move forward and accept that I was living in a larger body. And that was OK.

But leaving the office with the prescription, I felt the restlessness dial back in my chest. Maybe this was the change I needed.

The next day my insurance company called and told me they wouldn’t cover the medication. My heart sank. I felt like a fool — a completely devastated fool. The detached voice went on to say that I could, however, buy it without insurance for about what I pay for my mortgage each month.

And that was that. I hung up and cried. I cursed myself for feeling like something could change. I cursed myself for thinking I should change. I cursed myself for telling my husband about it. Now both of us were stuck on this roller coaster.

Like everyone else on the planet, I turned to TikTok to distract myself. I was only a few swipes in when I saw it: a coupon for the medication. Was it real? I did a quick calculation, and if the discount was legit, and there was more than one coupon, I could afford it. I called my doctor, confirmed the coupons were real, and started taking the medication that night.

Jessi in her hometown of Fenton, Michigan (2024)Jessi in her hometown of Fenton, Michigan (2024)

It felt like Christmas morning when I woke up the next day. I was excited and nervous to see what the day would bring. I didn’t feel bad in any way, so that was good. I went about my morning and forgot about the AOM until I made a breakfast sandwich. After eating about half the sandwich, I realized I didn’t want to eat anymore. “That’s weird,” I thought. Then it hit me: The medication worked. I felt full and satisfied. I wasn’t starving. Another upside: I also had lunch. I wrapped up the rest of the sandwich and took it with me to work.

That was the first day I started to realize how much of my time revolved around food. I’m someone who gets excited about meals and trying new foods and restaurants. But looking back, I was always thinking about food and/or planning to eat. I never stopped. My husband once told me that he didn’t think about food constantly like I did. I didn’t really understand what that meant until I started taking the AOM. Don’t get me wrong, I still get excited about food, but now it’s more of an occasion vs. obsession.

Every day, I wake up grateful for the medication. But I know not everyone who is living with obesity has access to an AOM. Without the coupons, I may never have been able to get the treatment I needed.

I’ve been taking an AOM for more than a year now and I’ve lost a significant amount of weight. The other day, I asked my husband what’s changed the most about me since I started taking it. He said I dance more. Of course it was a cute answer — I love my husband — but it was a dagger to my heart. It was a sad realization that I spent a lot of time not dancing and not moving because my body wouldn’t let me. I think it’s hard for people not living with obesity to understand that there may be things you can’t physically do even though you want to. That’s why I’m so thankful for the medication. It’s given me the chance to turn that restlessness into rhythm. Now I dance all the time.

I hope you dance, too.

HealthyWomen does not endorse getting medical advice from social media.

This educational resource was created with support from Eli Lilly and Company, a Corporate Advisory Council member.

Have a Real Women, Real Stories of your own you want to share? Let us know.

Our Real Women, Real Stories are the authentic experiences of real-life women. The views, opinions and experiences shared in these stories are not endorsed by HealthyWomen and do not necessarily reflect the official policy or position of HealthyWomen.

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Why Are Obesity Treatments Hard to Get?



When Oprah Winfrey announced in late 2023 that she’s taking weight-loss medication, it raised a lot of questions: Which drug is she taking? How long will she take it? What role should medicines play in reducing obesity?

How to pay for the drug was not likely a concern for the billionaire media mogul. But for many Americans living with obesity cost is a central concern when it comes to treatment.

Treatment for obesity has a long history, with a range of options, from preventive services and nutrition counseling to medications and surgery. Insurance coverage for this full range of obesity treatments varies by state, as do Medicaid benefits designed for people with lower incomes.

Watch: Obesity Is a Complex Disease with a Variety of Treatments >>

What’s behind rising obesity rates?

According to the most recent CDC data, 4 out of 10 adults in the U.S. are living with obesity, a rate that’s up from 3 out of 10 two decades ago.

The trends are even worse for some marginalized groups, like people with lower incomes, people living in rural areas and Black and Latinx communities. In addition to genetics, social determinants of health play a large role in determining risk of obesity.

“In underserved communities where toxic chronic stress and access to cheap, salty, sugary food are high, whether they have access to these medications or not, addressing obesity is challenging without policies to support healthier living in these neighborhoods,” according to Lisa Fitzpatrick, M.D., MPH, MPA, professorial lecturer at the George Washington University Milken School of Public Health.

Read: Social Determinants of Health, Health Disparities and Health Equity >>

Food is Medicine policies, designed to improve access to healthy food and reduce food deserts, are important and should be expanded, according to Fitzpatrick. But she points to challenges that include uneven access, limited awareness, and lack of structured long-term ways to figure out what the impact of these policies will be on chronic health conditions such as diabetes and heart disease.

“If you provide periodic food for people, is this enough to improve their health and keep them healthy?” Fitzpatrick asked.

Along with the nation’s increasing weight is a growing recognition among medical professionals that obesity is a medical condition that increases health risks, such as heart disease, diabetes, liver disease and some cancers, among other conditions.

At the same time as these shifts, newer anti-obesity medications (AOMs) have gained attention — and gotten FDA approval for use as a weight-loss treatment, not just treatment of diabetes or other diseases. Combined with lifestyle changes, AOMs can reduce body weight by as much as one-third. And research has shown that AOMs combined with lifestyle changes result in more weight loss than lifestyle changes alone.

But the promise of obesity medications can run into a brick wall: health insurance.

Barriers to access to obesity treatments

Health insurers don’t always cover weight-loss medications or other treatments for obesity. When they do, they often impose limitations and hurdles, such as having to prove that other treatments have failed before they’ll approve a new medication.

If you lose or switch your health insurance because of a job change, you’ll likely have to start the process all over again, which can keep you from being able to access medication or other needed services. If you become eligible for Medicare at age 65, you may lose access completely because Medicare does not cover weight-loss medications, except when prescribed specifically to prevent specific conditions, a recent coverage change.

Even with coverage, patients typically have to pay a share of the cost through copayments or coinsurance, which can be a few hundred per month. Without insurance coverage, AOMs can cost patients as much as $30,000 per year out-of-pocket.

Joy Tashjian, RN, BSN, has insurance but it doesn’t cover weight-loss medications.

She’s lost 25 pounds — about 1.5 pounds per week — since starting tirzepatide last November. Tashjian pays $550 out-of-pocket each month for the medicine.

“I’m very grateful that I’m able to afford it,” she said. “I can’t tell you what a difference the drug has made.”

Tashjian said she’s been overweight since age 5. She’s tried many diets since, starting at age 7, but only ever lost about a pound a month. This medication lets her lose weight without feeling intense hunger or experiencing constant “food noise.”

Though Tashjian does not have high blood pressure or cholesterol, diabetes, or other physical health issues associated with obesity, she said she has complex PTSD as a result of her weight.

“I was bullied, constantly receiving negative feedback from adults, teachers and supervisors — through my adult life, too,” she said. “I keep wondering how different my life would have been if this drug was available when I was growing up.”

Rachel*, 52, has health insurance coverage for her AOM because she has a diabetes diagnosis, a condition her medication is approved for. But she faces other challenges as a result of insurance rules.

Rachel’s health plan won’t let her re-order the drug until she uses the last injection. When she reorders, she bumps into supply shortages, leading to weeks of delay between doses. She said she’s gained weight back after initial losses, which her doctor thinks is because of her uneven access to the medicine.

According to experts, these medications are not designed for intermittent use. Once people stop taking an AOM, they can expect to regain the weight they had lost in relatively short order.

Fitzgerald said she worries that most people are unlikely to be able to take AOMs for life, which may be necessary to get the benefits. The risk of interrupted access to drugs points to an even greater need to pair medications with strategies such as a healthy diet and exercise.

“The medications should be seen as an [addition] to a lifestyle plan to prevent chronic health conditions, not just obesity,” Fitzpatrick said. “My hope is that many who benefit from these medications will simultaneously embrace lifelong prevention strategies, which admittedly is tough to do in our society. This way, if for some reason the medication is no longer available or tolerated for some reason, the person has a foundation to support continued healthy living.”

Another obstacle to obesity treatment is a healthcare provider shortage. Not only are specially trained obesity medicine specialists few and far between, more than 100 million Americans do not have access to a regular source of primary care.

“As with most health issues, primary care providers are the gateway to healthcare access so [obesity treatment] can be added to a long list of services for which people struggle with inadequate access,” Fitzpatrick said.

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

*Name has been changed for privacy.

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