The Rocky Path from Weight Loss to Obesity Care
It is undeniable that obesity is a complex, chronic disease. When we gather people from all over the world who understand obesity, this is the number one thing everyone can agree upon. And yet, when we sit down to talk about models for health systems delivering obesity care, it is more likely that folks who make policy and run the systems are thinking in terms of acute care – short-term weight loss. Clearly, the path from weight loss to obesity care is rocky and we have a long way to go.
The evidence for this kind of thinking shows up everywhere. FDA still labels drugs for obesity as weight loss drugs. Not for the treatment of obesity. Health plans like Blue Cross capriciously stop covering treatment. Scammy lifestyle programs promise people an “off-ramp” for chronic medicines that are helping people control obesity or put it into remission. Basically, they are telling people to stop taking something that’s working for them.
Can we imagine doing this for cancer care? Or diabetes care? Or cardiovascular care?
No, this behavior of health systems in dealing with obesity reflects an implicit bias that this is an acute problem with an easy solution. Eat less, move more, and lose the weight.
Dropping Coverage
A prime example of this kind of thinking is playing out in Massachusetts. Blue Cross Blue Shield of Massachusetts has announced it will drop coverage for GLP-1 medicines “for weight loss” starting in 2026. They will keep paying for these drugs to treat diabetes. But for obesity, the only option is lifestyle change. Their announcement makes it plain that they view this as a behavioral problem. In this line of thinking, the solution is simple: lose weight.
In the CommonWealth Beacon, Joseph Zucchi sums it up. “Blue Cross dropping coverage of anti-obesity drugs sacrifices long-term health for short-term savings.”
At the heart of their explanation for this move, payers are embedding a lie: “Costs are rising,” they say. But in fact, the net costs of these drugs are coming down rapidly. They started at a list price of $1,300 per month and are now less than $500 per month after discounts freely available to everyone. The trend toward further price cuts is clear.
But the trouble is that people use the list price (which no one should be paying) to concoct inflated budget-busing scenarios. In one recent formulary discussion for a major health plan, we were told, “Those discounts don’t matter. The money goes to a different budget.”
For diabetes, somehow they manage the costs.
Chronic Diseases Require Chronic Care
The path to real healthcare systems for obesity care is rocky for one simple reason. It’s tough to get there when everyone is thinking only in terms of acute weight loss. Even when they know better, people act as if it’s an easy behavioral problem to solve. Just lose weight.
It’s not. It is every bit as challenging as overcoming diabetes, cancer, or heart disease. It takes persistent hard work and good, ongoing medical care. Our healthcare systems must reflect this. We have work to do.
Click here for Zucchi’s excellent commentary and here for more on the challenges for implementing a chronic care model in obesity.
Rocky Shore and Sea, painting by Edward Hopper / WikiArt
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June 12, 2025
