With Obesity on the Rise, Why Are Treatments So 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.