For the approximately 100 million adult Americans living with obesity and the millions of others with Type 2 diabetes, GLP-1 medications such as Wegovy, Zepbound and Ozempic have transformed the conversation around weight management and obesity care.
Originally developed to treat diabetes, the medications are now, according to the Cleveland Clinic, also prescribed to treat obesity and reduce the risk of heart disease. Researchers are studying whether they may also help treat conditions ranging from kidney disease and sleep apnea to addiction, making them one of the most significant pharmaceutical breakthroughs in recent years.
Besides increasing diabetes risk, according to the American Cancer Society, obesity —clinically defined as having a body mass index of 30 or higher— is also linked to several types of cancer. And obesity is connected to elevated blood pressure, a heightened risk for cardiovascular disease, and other illnesses.
The World Health Organization says obesity is a “complex, relapsing disease based on many factors.” It is a costly disease, with obesity-related spending hitting $173 billion annually, according to the Centers for Disease Control and Prevention (CDC). But the burden is not shared equally: CDC data show non-Hispanic Black adults (49.9 percent) and Hispanic adults (45.6 percent) have the highest rates of obesity compared with a rate of 41.4 percent among white adults. The differences reflect longstanding inequities in access to healthy food, safe places to exercise, preventive care and other social determinants of health.
Against that backdrop, America’s approach to obesity is undergoing a significant transformation, with obesity being increasingly viewed by physicians as a disease that is influenced by genetics, biology, environment and social conditions.
The emergence of GLP-1 medications has accelerated that shift, offering new treatment options for millions of people. The science has advanced rapidly. Access has not. The result is a growing divide over who can benefit from one of the biggest advances in obesity treatment in decades.
Barriers in access
Yet as demand grows, so does a new question: Who can get them?
While the medications have become more widely available, access often depends less on medical need than on a person’s insurance coverage, where they live and, increasingly, their income.
Federal law requires Medicaid programs to cover GLP-1 medications when prescribed for Type 2 diabetes and certain other FDA-approved conditions. However, states generally are not required to cover the drugs when prescribed solely for obesity, leaving access largely dependent on state Medicaid policy. As of early 2026, only a limited number of state Medicaid programs covered GLP-1 medications for obesity treatment, and many require prior authorization or impose additional restrictions.
Nearly four in 10 adults enrolled in Medicaid have obesity, according to KFF, meaning millions of lower-income Americans could potentially benefit from treatment. Yet the medications’ high price tag has made many state Medicaid programs reluctant to expand coverage.
KFF reports that Medicaid prescriptions for GLP-1 drugs increased from about one million in 2019 to more than eight million in 2024, while gross spending rose from roughly one billion to nearly nine billion over the same period.
Those numbers highlight a growing policy dilemma.
If obesity contributes to heart disease, stroke, kidney disease and other chronic illnesses, should insurers pay for treatment before those complications develop—or wait until patients become sicker?
More coverage, more access
For one Memphis woman, employer-sponsored insurance made access relatively straightforward.
“I work full time, and I am a caregiver, too, so I am constantly stressed. I gained about 50 pounds because I wasn’t taking care of myself, and I was having a hard time losing the weight. I knew I was pre-diabetic, and I didn’t want to become diabetic,” said Jalissa Payne, a Memphis, Tenn., resident. “So, when my employer offered a weight loss program, I signed up. My doctor put me on Zepbound, and I have been able to lose 30 pounds so far,” said Payne, who has comprehensive employer-sponsored insurance.
Payne’s experience illustrates how comprehensive employer health insurance can open doors that remain closed for Americans with different or no coverage.
Patients with private insurance may receive coverage for obesity treatment, while Medicaid beneficiaries with identical medical needs may not, depending on where they live. In some cases, patients qualify for coverage only after developing diabetes or another chronic illness.
Supporters of broader coverage argue that expanding access could help prevent costly chronic diseases while improving quality of life. Others point to the medications’ high upfront costs and questions about how long patients remain on treatment.
The affordability challenge extends beyond Medicaid.
National polling by KFF found that more than half of people taking GLP-1 medications reported difficulty affording them, including roughly one in four who described the costs as “very difficult” to manage.
As researchers continue discovering new medical uses for GLP-1 medications, access is increasingly becoming a question of health equity. And while medical innovation has moved quickly, insurance coverage has not.
For now, for many Americans, the ability to benefit from one of the most promising advances in obesity and diabetes treatment may depend as much on the insurance card in their wallet as the prescription written by their physician.
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