For millions of people living with obesity, the class of weight-loss drugs known as GLP-1 agonists have been game-changers (think Wegovy and Zepbound). Studies show that people taking these drugs can lose more weight than they can with lifestyle changes alone.
But for one group of Americans — people on Medicare — at least some of those drugs were off limits because Medicare isn’t allowed to cover drugs prescribed for the sole purpose of weight loss. With plenty evidence that obesity itself increases many health risks and new clues that these drugs reduce the risks of heart disease and stroke, these limits may change.
A bipartisan bill, the Treatment and Reduction of Obesity Act (TROA)passage in Congress would allow Medicare to cover weight loss drugs for the first time.
Experts say the time has come.
“Passage of the Treatment and Reduction of Obesity Act (TROA) is critical to protecting women’s access to obesity care as they transition to Medicare,” she said. Fatima Cody Stanford, MD, MPH, MPA., associate professor of medicine and pediatrics at Harvard Medical School and obesity physician-scientist at the Massachusetts General Hospital Weight Center.
Stanford explains that TROA improves comprehensive coverage while improving equitable access to care.
“TROA aims to expand Medicare coverage to include a broader range of obesity treatments, including FDA-approved drugs and intensive behavioral therapy. This ensures that women can continue their established treatment regimens without interruption,” he said. “TROA addresses disparities in access to health care by ensuring that all women, regardless of their economic status, can receive the treatments they need to effectively manage their obesity.”
The cost of obesity
For 31 million women over age 65 (and another 4 million younger women who qualify for Medicare because of long-term disabilities), the lack of Medicare coverage of obesity care poses risks. About 10,000 Americans turn 65 every day, more than half of them are women. With obesity rates reaching 43% in people over 60, losing access to obesity treatments can be particularly damaging.
“When women switch from private insurance to Medicare at age 65, they often face a significant loss in coverage for obesity treatments,” Stanford said. “When women receiving stable obesity treatment, including medication, behavioral therapy, and nutritional counseling, experience an abrupt interruption in their care, it can lead to weight regain and worsening of obesity-related conditions.”
Experts recognize obesity as a chronic condition. According to the CDC2 out of 5 American adults live with obesity. Nearly 6 in 10 of them also have high blood pressure, which increases their risk for heart disease. Almost 1 in 4 also have diabetes. Obesity is also known for increase risks certain cancers, pregnancy and fertility problems, and mental health issues, among other conditions.
“Obesity is a chronic disease that requires ongoing treatment,” he said Alicia Shelly, MDobesity doctor. “Without Medicare coverage for obesity treatment, women are at increased risk for serious health problems such as heart disease, diabetes and cancer. Long-term support is essential to prevent these life-threatening conditions.”
Obesity is also a serious economic issue. People with obesity have nearly $2,000 more in annual medical expenses than people without obesity. In total, these costs add up to nearly $173 billion in additional medical costs each year in the US
And that’s just the direct medical costs associated with obesity. Add to this the lost productivity that results when workers lose jobs, are less productive at work due to obesity complications, or die prematurely or leave the workforce due to disability. THE CDC estimates that obesity-related work loss 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, TROA supports preventive health measures, reducing the incidence of obesity-related diseases and reducing long-term health care costs,” Stanford said.
In the voices of the women themselves
In a HealthyWomen survey of 1,000 women ages 35 to 64, nearly a quarter reported being diagnosed with obesity, and 79% said they were trying to lose weight or lower their BMI. Another 8% of respondents said they care for someone living with obesity.
Almost two-thirds of women living with obesity reported dieting or considering dieting, and one in five reported taking or considering taking an anti-obesity medication (AOM).
The survey results show that 8 in 10 women who consult a nutritionist said their insurance covers all or part of these costs, but only 6 in 10 said the same about insurance coverage for AOM.
Women living with obesity said that reaching their desired weight would have the greatest positive impact on their physical and mental health, self-confidence and daily activities. However, 11% of survey respondents who said they will turn 65 in the next six months (or care for someone who will) will not be able to access AOM under the current rules. 7 percent of women said they have a plan that will no longer cover their AOM next year or that they care for someone in that situation.
The research also revealed racial and ethnic health disparities. Almost a third of respondents said they have been diagnosed with obesity or would be if they went to a health care provider (HCP) to assess their weight. And Black respondents were twice as likely as Hispanic/Latino respondents to categorize themselves this way.
The insurance regime also showed significant differences. People on Medicaid, the public insurance program for lower-income Americans, were more likely to say they had been diagnosed with obesity (31 percent) compared with 20 percent of people with work-based insurance and 17 percent with other private coverage. Among survey respondents with Medicare coverage, 13% said they care for someone with obesity and 26% live with obesity.
Race for cover
“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 may further exacerbate the challenges associated with obesity management.”
Stanford recommends that women switching to Medicare be proactive about their care, such as looking at different Medicare plan options to find the most comprehensive obesity coverage available and/or adding supplemental coverage (known as Medigap). She also recommends consulting with HCs to plan the transition in advance and ask for their help navigating coverage or finding alternative treatments.
“I recommend developing a plan that outlines available and affordable obesity treatments,” Shelly said. “At present, Medicare does not cover weight loss medications, so it is important to prioritize optimizing your diet 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 Obesity Treatment and Reduction Act and advocate for their passage,” Stanford said. “Getting involved with patient advocacy groups can amplify your voice and help drive policy change.”
This educational resource was created with the support of NovoNordisk, a member of the HealthyWomen Corporate Advisory Council.
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