Access to life saving medications matters – that includes obesity

I carried a naïve, simplistic view for years: if only one would choose a better diet, exercise more and make better lifestyle decisions, one can avoid and treat obesity. Only during my training in endocrinology, diabetes and metabolism did I really start to understand all the factors that contribute to a person having obesity.

Obesity was classified as a disease by the American Medical Association in 2013. I was halfway through my medical training then and already had developed an implicit bias that being overweight or obese was a personal failing. Having obesity is anything but that. Social factors, genetics and, yes, diet and lifestyle all contribute to obesity. I remember the first time I heard the term ‘metabolic adaptation.’ This describes how, regardless of the method of weight loss, most people will regain that weight, according to studies. I explain that to my patients now. I know and completely believe that my patients are trying their best, but despite their best efforts, the weight keeps coming back. This is because people with obesity have a ‘broken thermostat,’ where the weight keeps setting to a higher number as your steady state.

My day-to-day clinical work over the last 20 years has focused on the care of people with diabetes and obesity. I have done a lot of unlearning of old biases and have gained a better understanding of metabolic disease. Access to healthy food and the ability to have time and space to engage in a healthy lifestyle are not available to everyone, all factors that contribute to obesity, along with genetic predisposition.

At least 1 in 4 adults across all U.S. states and territories has obesity. Obesity reduces life expectancy, driving mortality through cardiovascular disease, diabetes and cancer. It is the second leading cause of preventable death, second to smoking. For a long time, the medications we had available for obesity could not deliver significant weight loss that was comparable with surgical options for weight loss.

The first GLP medication (exenatide) was approved for clinical use in 2005 for diabetes, a novel medication first studied and isolated from the venom of the Gila monster, after scientists were fascinated by its glucose metabolism. This venomous lizard can consume more than 30% of its body weight in a single meal and survive on only a couple of meals a year. Newer GLP medications are now household names (semaglutide, tirzepatide) approved by the FDA for obesity and its complications (diabetes, high blood pressure, fatty liver, sleep apnea, high cholesterol, osteoarthritis of the knee, to name a few). The weight loss from GLPs now approaches that of bariatric surgery.

So, we have a solution to this deadly disease. Yet it remains inaccessible. Many employer-based health insurance plans will exclude this group of medications from their formulary. When they are covered, copays are exorbitant. Often, any intervention for the indication of ‘obesity’ is excluded from many insurance plans and remains inaccessible due to cost. Direct-to-consumer sales and cost-saving programs have brought GLP costs down slightly in the last couple of years, but $449/month for higher doses of Tirzepatide, as an example, is still close to 10% of the average American’s monthly income of $5,174 as per U.S. Bureau of Labor Statistics 2025 data. That doesn’t leave much for groceries, mortgage/rent and other essential expenses. Health insurance companies should not be able to deny these lifesaving medications.

I believe a shift is needed, to bring down not only costs but also in how we view obesity medications. GLPs are considered vanity medications by many, a perception fueled by their indiscriminate use by people who can afford it, in whom it may not be indicated (those without obesity). They are also viewed as a shortcut by many, even medical professionals. I have patients who don’t want to admit to their friends or family that they are on a GLP for fear of being judged for being too lazy to diet or exercise. Obesity is the result of multiple genetic and socio-economic factors.

GLPs are like any other medication for chronic disease, like blood pressure or asthma medication. For good health, it is not medicine OR lifestyle, it can be both. We should advocate for improved access to these effective medications and for improving non-medical determinants of health together to effectively treat obesity.

By Dr. Sarah Nadeem, assistant professor at Baylor College of Medicine in the Department of Medicine Section of Endocrinology, Diabetes and Metabolism and vice chair of the American Association of Clinical Endocrinology, Diabetes State Network