New obesity treatments aren’t reaching enough Americans who need them

Despite significant gains in obesity research, new treatments and scientific advances, a substantial gap remains between scientific evidence and implementation in clinical practice for effective weight management, according to a 2024 scientific statement from the American Heart Association.

A near-record number of Americans are obese, but according to the statement, significant barriers remain to receiving proper weight-loss care. Obesity is a major risk factor for heart disease and stroke, yet widespread discrepancies exist between the latest research and which treatments patients can access.

Dr. Deepika Laddu, chair of the statement writing committee, said obesity researchers have made great strides in understanding its multiple causes. However, impediments such as lack of insurance and knowledge about proven lifestyle interventions prevent people from getting adequate weight loss care.

“Major gaps remain between what we know and what happens in the doctor’s office,” said Laddu, who is also an associate professor of preventive medicine at Northwestern University Feinberg School of Medicine. The consistency of care also varies greatly among health care professionals and institutions.

“Health care professionals and health care systems need to find better ways to put what we know about obesity into action so more people can get the right support and treatment,” she said.

Obesity rates have risen in the U.S. and worldwide for nearly 30 years. Almost 42% of U.S. adults live with obesity, according to the Centers for Disease Control and Prevention.

Treatment advances have created more strategies for lifestyle modifications, medication therapy and weight loss surgery, but each option carries challenges.

For example, newly approved medications, such as glucagon-like peptide-1 (GLP-1) agonists that include high-dose semaglutide and tirzepatide, have been linked to weight loss. However, while half of U.S. adults meet the criteria for a prescription, they are not being widely prescribed.

The primary barriers to increased use of these obesity medications have been a lack of insurance coverage and high out-of-pocket costs.

Medicare and Medicaid do not cover GLP-1 agonist medications for the treatment of obesity. Currently, Medicare covers GLP-1 agonists only for the treatment of diabetes. Some state Medicaid programs have opted to cover weight-loss medications, but most do not.

Advances in weight loss surgery over the past several decades have made it a more viable option for some, with improvements to safety and studies showing evidence of numerous health benefits, such as lowering the risk for cardiovascular disease and other obesity-related conditions. However, challenges with cost, resources and social support mean not everyone who could benefit from this surgery can access it.

“Adopting new technologies and telemedicine, making referrals to community-based weight management programs to encourage behavioral change, providing social support and increasing reach and access to treatments are just some of the promising methods we could implement to unlock successful evidence-based obesity care,” Laddu said.

The report highlights the need to consider how social drivers of health, such as insurance coverage, household income, race and ethnicity, health literacy and access to resources, affect a person's likelihood of receiving proper treatment. It also calls for educating health care professionals about the complex origins and clinical consequences of obesity.

The statement “emphasizes the importance of a comprehensive approach across different levels of health care delivery and public policy, along with the adoption of feasible, evidence-based strategies in clinical settings,” Laddu said. “It also underscores the need for future research and policy changes to improve current patient care models and ensure equitable access to obesity-related care for people in underrepresented groups.”