Few health insurance programs cover the medications when prescribed to help people reach and maintain a healthy weight. Federal law requires that weight loss drugs be excluded from basic coverage in Medicare Part D plans, and as of early 2023, only 10 states included an antiobesity medication in the formularies for their Medicaid programs.

"If everybody had equal access, then this would be a way to help," said Dr. Rocio Pereira, chief of endocrinology at Denver Health. "But without equal access — which is what we have now — it's likely this is going to increase the disparity we see."

U.S. obesity rates have been rising for decades, and they're consistently higher for Black and Latino Americans. Among adults 20 and older, 49.9% of Black Americans and 45.6% of Hispanic Americans have a body mass index of 30 or greater, compared with 41.1% of white American adults and 16.1% of Asian American adults, according to age-adjusted data from the Centers for Disease Control and Prevention.

Obesity rates are also associated with income. In 2022, the age-adjusted rate was 38.4% for adults with household incomes between $15,000 and $24,999, compared with 34.1% for those with household incomes of $75,000 or more.

The two are related, said Pereira, who studies health disparities in diseases related to obesity. Black and Latino Americans are more likely to live in lower-income neighborhoods, where fast food is usually cheaper and more convenient than grocery stores.

"If you look at a map of the U.S. and plot out the neighborhoods where there's no grocery store within a mile and there's a high percentage of people who have no car, those are the areas where there's the highest rates of obesity," she said.

There's also the time factor, she said: "Can you afford to cook your own meals, or do you have to work two jobs?"

An unusual experiment by the Department of Housing and Urban Development demonstrated the degree to which physical surroundings can influence obesity risk, Pereira said. In the 1990s, hundreds of mothers who were living in public housing were offered housing vouchers they could use only in wealthier neighborhoods. Ten to 15 years later, the women randomly assigned to receive the windfall had significantly lower rates of severe obesity (14.4%) than women in a control group who weren't offered vouchers (17.7%). They were also less likely to have a body mass index of 35 or higher (31.1% vs. 35.5%).

The American Medical Assn. recognized obesity as a disease in 2013. People with the chronic condition are at heightened risk of cardiovascular disease, Type 2 diabetes, 13 types of cancer, osteoarthritis, asthma and other health problems. Researchers have pegged the annual medical costs associated with obesity at $174 billion in the U.S. alone.

Some people with obesity are able to lose weight by changing their diets and burning more calories through exercise. But that doesn't work for people who have developed resistance to leptin, a hormone that suppresses appetite.

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