Policy Interventions to Enhance Medical Care for People With Obesity in the United States—Challenges, Opportunities, and Future Directions

Health policymakers have insufficiently addressed care for people with obesity (body mass index [BMI] ≥ 30 kg/m²) in the United States. Current federal policies targeting obesity medications reflect this unfortunate reality. Extant Medicare medication coverage provisions have erected a barrier between obesity and other seemingly “more legitimate” diseases. For instance, under sections 1860D-2 and 1861 of the Social Security Act (SSA), anti-obesity medications are excluded from the Medicare prescription drug benefit.^1-3 These sections of the SSA reflect broader trends in inadequate coverage of anti-obesity pharmacotherapeutics. Indeed, the 2018 assessment of phentermine, diethylpropion, phendimetrazine, benzphetamine, lorcaserin, phentermine/topiramate (Qysmia), liraglutide (Saxenda), and bupropion/naltrexone (Contrave) coverage across 34 states by Gomez and Stanford found only seven state Medicaid programs and only 11% of marketplace health insurance plans covered these medications.⁴

Relatively recently, the US Congress has been presented with an opportunity to alter the current obesity care paradigm through the Treat and Reduce Obesity Act of 2021 (TROA), which would extend Medicare coverage for the first time to anti-obesity prescription drugs and allow providers such as registered dietitians and behavioral psychologists to be reimbursed for intensive behavior therapy for treatment of obesity under Medicare.⁵ Despite initially garnering 154 bipartisan cosponsors, this initial legislation stalled in the US House of Representatives and has since seen no further legislative action. Somewhat promisingly, the legislation was reintroduced by a Republican representative from Ohio’s second congressional district in July 2023, but it has also since seen no further legislative action.⁶ This lack of federal-level support for medical care for people with obesity comes even as the medical literature continues to demonstrate the effectiveness of comprehensive anti-obesity therapy—including pharmacotherapy—on patient outcomes.⁷

On Friday, October 18, 2024, our co-author and Harvard College undergraduate Ryan H. Murdock died. We are heartbroken by his passing and dedicate this article posthumously to him. Ryan was a budding scholar, studying Earth and Planetary Sciences and Government, and was interested in environmental issues, public health, and human rights law. We will miss Ryan dearly but are eternally grateful for the opportunity to collaborate with him on this important piece of scholarship.

References

1. Jolin JR, Stanford FC. More to obesity than what meets the eye: acomprehensive approach to counteracting obesity stigma. Postgrad Med J.2023;99(1171):367-369. https://doi.org/10.1136/pmj-2022-142082
2. Prescription Drug Benefits, 42 USC §1395w-102 (2018).
3. Definitions, 42 USC §1395x (2020).
4. Gomez G, Stanford FC. US health policy and prescription drug coverage ofFDA-approved medications for the treatment of obesity. Int J Obes (Lond).2018;42(3):495-500. https://doi.org/10.1038/ijo.2017.287
5. Treat and Reduce Obesity Act of 2021, HR 1577, 117th Cong (2021-2022).March 4, 2021. Accessed March 6, 2023. https://www.congress.gov/bill/117th-congress/house-bill/1577
6. Treat and Reduce Obesity Act of 2023, HR 4818, 118th Cong (2023-2024).July 20, 2023. Accessed November 10, 2023. https://www.congress.gov/bill/118th-congress/house-bill/4818
7. Abbasi J. FDA green-lights tirzepatide, marketed as Zepbound, for chronicweight management.JAMA. 2023;330(22):2143-2144. https://doi.org/10.1001/jama.2023.2453