With Nearly Half of all Black and Hispanic Americans Combating Obesity, Legislation Would Significantly Expand Medicare Coverage of Obesity Treatment for Communities of Color Disproportionately Impacted by the Obesity Epidemic

WASHINGTON, D.C. — Today, the Health Equity Coalition for Chronic Disease (HECCD) applauded congressional leaders in the U.S. Senate and House for introducing the Treat and Reduce Obesity Act (TROA) — landmark healthcare legislation that will help modernize obesity policy, address racial inequities within the healthcare system, and help remove barriers to obesity care and treatment for communities of color. The obesity epidemic is among the worst public health crises in the U.S. and one that disproportionately burdens communities of color — with 60% of Black women and nearly half of all Black and Hispanic Americans impacted.

The bill would significantly expand coverage under Medicare for obesity screenings, treatment, and FDA approved therapies such as anti-obesity medications, eliminating barriers for millions of Americans living with this chronic disease. The bill’s introduction comes as momentum for updating obesity policy is rapidly growing among the nation’s leading health advocates, racial equity leaders, and medical experts — who have been calling on congressional and administration leaders to take immediate action to expand access to comprehensive obesity care for communities of color being disproportionately impacted by the obesity epidemic. 

Dr. Elena Rios — President and CEO of the National Hispanic Medical Association and Co-Chair of the Health Equity Coalition for Chronic Disease — released the following statement: 

“The Health Equity Coalition for Chronic Disease applauds the U.S. Senate and House for introducing the Treat and Reduce Obesity Act, which is a critical first step to address our country’s escalating obesity epidemic and its disproportionate impact on communities of color. Our current healthcare policies deny millions of people of color from accessing the care they need to treat this chronic, deadly disease — perpetuating health inequities and preserving roots of systemic racism that have put access to health care out of reach for millions of Black and Brown Americans. The Treat and Reduce Obesity Act is vital to begin updating and modernizing obesity policy to ensure that we’re removing barriers to care and treatment for communities disproportionately shouldering the burden of this disease. We urge the Senate and House to pass this legislation without delay.”

TROA is the first meaningful step taken by congressional leaders to stem the obesity crisis since the introduction of the Health Equity Accountability Act last year. Bipartisan Members of Congress have recognized the importance of this coverage, and hundreds of members of Congress have signed onto the legislation as co-sponsors when it was introduced in previous legislative sessions. 

In discussion with the Obesity Action Coalition last year, Rep. Raul Ruiz, M.D. (D-CA) — an original cosponsor of TROA — said, “In order for us to be better prepared for pandemics, in order for us to reduce health care costs, in order for us to reduce the rates of diabetes, hypertension, and other illnesses that can lead to other morbidities, addressing obesity now in our country is a smart investment.” Rep. Brad Wenstrup, M.D. (R-OH) also remarked last year, “Tackling obesity means that less Americans will progress to diabetes, perhaps, and other health conditions. What we saw during the height of COVID was that more vulnerable patients were those with diabetes and with obesity. This is a major health problem in the United States and we can’t just look at it as something to stigmatize.”

Obesity’s Impact on Communities of Color Prompting Momentum for Action

The obesity epidemic is one of the worst public health crises in the U.S and continues surging to unprecedented levels — with 60% of Black women and nearly half of all Black and Hispanic Americans now living with obesity. This puts communities of color at a greater risk for other serious chronic diseases — Black Americans are 77% more likely to be diagnosed with type II diabetes and are likely to have high blood pressure more than any other population group. American Indians and Alaska Natives are also 50% more likely than white Americans to live with obesity, and those numbers are growing across the board. The American Medical Association designated obesity a chronic disease in 2013, and the number of states with high rates of adult obesity more than doubled since 2018. 

Despite this dangerous surge, Medicare continues to exclude FDA-approved anti-obesity medications from Medicare Part D coverage, which has prompted national leaders this year to speak out and press for immediate action. Among the national health advocates, racial equity leaders, and medical experts calling for action this year include:

The Health Equity Coalition for Chronic Disease issued a white paper in June laying out what’s at stake for communities of color — making the case that the “clock is ticking” and “now is the time to change policies” to provide comprehensive care and treatments for individuals suffering from the disease of obesity — and joining with 30 national health equity leaders and obesity advocates to urge CMS to expand access to obesity care for communities of color. 

The American College of Physicians (ACP) announced in April a new initiative aimed at advancing equitable access to obesity care. ACP plans to utilize physician education, advocacy, and partnerships to advance a stigma-free culture in which patients and clinicians collaborate to prevent and manage this increasingly common chronic condition, to ensure equitable access to care for patients and to help counter public misinformation about the causes of obesity, the stigma around it and the equity issues around how it’s treated. 

The American Medical Association sent a letter to CMS in January, urging coverage for anti-obesity medications in Medicare Part D coverage: “These treatment services and programs should be considered “essential” under the ACA’s mandated 10 EHB categories. For example, self-measured blood pressure devices and lifestyle change programs should fall under the broad “preventive and wellness services and chronic disease management” category and fixed-dose combination hypertension drugs and anti-obesity medications should be covered under the “prescription drug” category.” This followed the release of AMA’s comprehensive strategy to address obesity and reduce barriers to care. 

The American Medical Women’s Association released a white paper and call for action on obesity in December 2022, asserting: “Strategies for treating and addressing obesity are not one-size-fits-all. There is a need for a multi-pronged clinical approach to obesity … One big challenge is coverage … Anti-obesity medications are not covered by Medicare Part D, the insurance plan for most older Americans. Medicare policy currently omits therapies labeled as “weight loss” or “weight gain” agents. This can pose a significant challenge for patients covered through commercial plans who lose that coverage when they switch to Medicare. Lack of coverage also conveys the unspoken message that obesity treatment is not essential, even though studies have shown otherwise. … The lack of insurance coverage makes treatment out of reach for many patients, particularly those of lower socioeconomic status and who live in historically under-resourced areas.”

The American Diabetes Association kicked off their obesity treatment access initiative, including a series of new resources on their website. The ADA’s Chief Medical Officer highlighted ADA’s position in an op-ed in STAT News: “Medicare specifically prohibits covering reimbursement of obesity medications. As a result, health care professionals are left to treat patients without access to clinically proven and effective tools to promote weight loss, including FDA-approved pharmaceutical therapies to treat obesity.

The health care system and insurers need to take obesity seriously. To do so, they must start by ensuring patients and health care professionals have access to the full array of evidence-based, safe, and effective treatment protocols through comprehensive insurance coverage.”

Dr. Angela Fitch, the Associate Director of the Massachusetts General Hospital Weight Center and faculty at the Harvard Medical School, said during an event in June: “The biggest barrier to care today is actually access to care in two ways: One is the insurance coverage of care. And the second thing is the sheer volume of patients that are seeking care today. And so I think it’s complicated by both of those things. You know, it’s not just a one and done issue … We need to do something urgently to try to provide better access to effective treatment, because it really should not be allowed for people not to have access to them … We understand that there are cost implications to treating obesity, but there are also dramatic cost savings.”

Debra Fraser Howze, Founder of ChooseHealthyLife, made the case at an event in June that while 40% of Americans over 60 live with obesity, CMS doesn’t cover the full continuum of obesity care which is creating a healthcare disaster especially for aging Americans of color: “With tens of thousands of people aging into Medicare every day in America… all of us are coming onto the system, and the scary thing about this is, that we’re coming onto the system obese and ill. And the question is: If CMS does not address this, because it’s a Medicare issue, and all of these other health programs have access, what do we do?”

Daniel E. Dawes, the Executive Director of the Satcher Health Leadership Institute, in June made the case at the CMS Health Equity Conference how the obesity epidemic is rooted in systemic failures that continued to deny treatments to those who need it: “Obesity is a disease that contributes to many co-morbidities, is exacerbated by many of the social determinants of health that we think of, and disproportionately impacts individuals of color … In 2001, Dr. David Satcher’s Surgeon General report called attention to it and here we find ourselves in 2023, still discussing whether or not to classify obesity as a chronic disease and what levels of access to obesity fighting treatments are available … Those limiting decisions—how to classify the disease and who gets access to the treatments that will fight it—are the very political determinants of health that have the capacity to effectuate significant and lasting change.”

Dr. Fatima Cody Stanford, Associate Professor of Medicine at Harvard and one of the nation’s top obesity experts, made the case at the National Action Network’s convention in April that lack of access to obesity treatment is killing communities of color: “Obesity is the number one chronic disease in human history … But let’s talk about what’s really killing us every single day. Only 1% of us receive treatment with medications to treat our obesity.” 

Dr. Garfield Clunie, the President of the National Medical Association, argued in April that lack of access to obesity medications is creating a pandemic level crisis within communities of color: “The full range of treatment is met with significant barriers from health care providers, policymakers, insurers, and public opinion because people simply don’t believe obesity is a chronic disease. Many don’t recognize that lifestyle choices are not always effective, and they don’t realize the inequities in access to treatment. Medicare — which serves millions of Black and Hispanic Americans — denies coverage of anti-obesity medications.”

The National Council on Aging in February made the case that addressing obesity among older adults will require Medicare to cover the full continuum of treatments: “Obesity care also remains out of reach for tens of millions of older Americans because Medicare fails to recognize obesity as a serious disease—creating a gap in the full continuum of care for all older adults living with obesity. It’s time to recognize obesity as a serious, chronic disease so we can build a holistic and equitable approach to obesity prevention and management.”

Six U.S. organizations including The Obesity Society, the Academy of Nutrition and Dietetics (the Academy), American Society of Metabolic and Bariatric Surgery (ASMBS), Obesity Action Coalition (OAC), Obesity Medicine Association (OMA), and the Strategies to Overcome and Prevent (STOP) Obesity Alliance collaborated to develop a consensus statement on obesity, aiming to address the various roadblocks that the organizations face when addressing efforts to improve access to obesity treatment and reduce weight stigma and bias surrounding the disease. The statement makes clear: “Every person with obesity should have access to evidence-based treatment.”

Learn more about the Health Equity Coalition for Chronic Disease at www.HealthEquityAction.org.

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