Marginalizing People with the Greatest Need for Obesity Care

The STOP Obesity Alliance released new data Friday from an exhaustive analysis of access to obesity medicines in Medicaid programs across the United States. It’s not a pretty picture. It gives us more data to show how we are marginalizing people with the greatest need for obesity care.

No state fully covered all forms of obesity care – nutrition counseling, behavioral support, medicines, and surgery. For individual components of care, the coverage varied. Only four covered surgery and medicines without restrictions. Total exclusions were the most common for medicines (37 states), followed surprisingly by exclusions for nutrition counseling in 22 states.

STOP’s Cristy Gallagher and OAC’s Tracy Zvenyach summed up the significance of their findings:

“Our analysis is the first to investigate levels of coverage for obesity treatments. Even when coverage existed in the policy documents, we found limitations and restrictions that likely make treatments difficult to access, effectively making them not covered.”

Limited, Uneven Progress

We note that some progress is evident, though it is uneven and inadequate. In Pennsylvania, for example, the state Medicaid formulary went from a total exclusion of obesity medicines to putting them on the statewide Preferred Drug List in 2023. This was big progress.

Gallagher and Zvenyach note the movement in a positive direction:

“State Medicaid programs have increased their focus on obesity treatment coverage. Some states have passed legislation to update obesity treatment coverage and other states are using regulatory pathways to modernize coverage policies. We expect to see more states to undertake reviews of their obesity treatment coverage. ”

Economic, Social, Racial, and Ethnic Disparities Intersect

But the disparities run deeper than the economic issues alone that Medicaid programs aim to address. Stat News dug into this over the weekend with a story about the experience of Black Americans on access to obesity medicines. Though they face greater risks from obesity, they their access to obesity care is severely limited. Obesity medicine physician Fatima Cody Stanford reflects on data showing large disparities in access to obesity medicines:

“I think the conversation is definitely missing the Black community. We hear the privileged white voice in the community because that’s usually who can afford it and who gets the access and care.”

Endocrinologist Mopelola Adeyemo worries that disparities in access to these medicines will serve to widen health disparities:

“I think providers and researchers need to keep an eye on if we are going to see a disproportionate burden of obesity, diabetes, and heart disease later on because of a disparity in prescribing these medications.”

So it seems likely that disparities in access to obesity care are marginalizing people with the greatest need for it. Will we take this cue to demand better equity?

Click here for the report from STOP and OAC, here for the report from Stat News.

Castor and Pollux, painting by Roger de La Fresnaye / WikiArt

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June 3, 2024