Treating Obesity is Not Optional. It is Essential Medicine
For 13 years as a physician treating patients with obesity in California, I’ve watched the devastating health outcomes that occur when obesity goes untreated. What simply begins as elevated weight often progresses into Type 2 diabetes, hypertension, heart disease and a litany of other conditions that diminish quality of life and ultimately cost our healthcare system in the long run, far more than early intervention ever would.
This experience, and that of my patients, is why I’m urging California legislators to reinstate Medi-Cal (California Medicaid) coverage of GLP-1 medications for the treatment of obesity.
This isn’t just a nice thing to do. These medications are medically necessary and economically sound. Reinstating coverage will not only make Californians healthier, but it will save the state money in the long-term.
Far too often, obesity is only seen as a lifestyle choice or a failure of willpower. But it’s a complex, chronic disease recognized as such by the American Medical Association, the World Health Organization, and every major medical organization. It sits at the intersection of nearly every chronic condition I treat daily.
When we treat obesity effectively, we not only reduce weight, but we also decrease insulin resistance and diabetes, and prevent potential blindness, kidney failure, amputations, and cardiovascular disease that can follow untreated diabetes. Obesity also increases the risk of hypertension, stroke, certain cancers, sleep apnea, fatty liver disease, and osteoarthritis. These aren’t separate conditions requiring separate treatments. Rather, they share a common root cause and throughline that modern medicine now has effective tools to address.
I have seen several patients grow frustrated by weight regain and experience setbacks in their health goals. One patient who has obesity, PCOS and who lost dozens of pounds on a dual GIP/GLP-1 agonist cannot even get coverage of older anti-obesity medications because her BMI is now normal. Patients who qualify for continuing a GLP-1 agonist due to FDA indicated medical conditions such as metabolic dysfunction-associated steatotic liver disease (MASLD) or sleep apnea are also being denied. We don’t take away someone’s statin or antihypertensive medication once they reach goal numbers; similarly we cannot take away treatment for obesity because they have reached a normal BMI or think that the medication is too expensive.
A woman in her early 40s lost 46 lbs and her BMI normalized. When I tried to continue her medication by using the diagnosis of MASLD, she was told that her liver fibrosis was not severe enough to qualify for a GLP-1. In what other disease do we wait until it worsens to treat it?
Today’s obesity treatments, including evidence-based medications like GLP-1 receptor agonists, represent genuine medical breakthroughs. For example, clinical trials demonstrate weight loss of 15-20% or more, with corresponding improvements in cardiovascular outcomes, kidney function and metabolic health. These medicines are disease-modifying therapies that address root causes and enhance quality of life rather than just managing symptoms.
Despite the mountain of research supporting these interventions, stigmas and biases remain. Too many Californians face denials, excessive prior authorization requirements, or complete lack of coverage for these treatments. Reinstating funding for GLP-1 medication coverage in Medi-Cal would help our most vulnerable populations live healthier lives.
Obesity treatment deserves the same insurance coverage standards as any other chronic disease.
The fiscal argument for coverage is equally compelling. Diabetes alone costs the state of California billions annually in direct medical costs and lost productivity. Treating obesity preventatively exponentially lowers costlier downstream complications. A patient who achieves sustained weight loss and diabetes remission requires fewer medications, fewer emergency room visits, fewer hospitalizations and fewer specialist consultations. The return on investment is clear: for patients, and for the state.
California has an opportunity to lead on evidence-based medicine and health equity. As physicians, we took an oath to do no harm. Withholding effective treatment for chronic disease devastates lives and drives up healthcare costs.
California’s policymakers must base coverage decisions on medical evidence, not outdated stigma or short-term budget pressures. Doing so begins with making sure the patients I see every day in clinic get the care that they deserve.
Because their lives depend on it.
Karen R. Studer, MD, MPH, MBA is a Chair of a Department of Preventive Medicine at Loma Linda University. She also teaches public health and works clinically, practicing lifestyle and preventive medicine. She is passionate about teaching medical students and residents about preventive medicine and lifestyle medicine. She is board certified in preventive medicine, obesity medicine, integrative medicine and lifestyle medicine.
The opinions expressed are her own and she does not speak on behalf of her employer.