Guest Letter: A Path Forward: What’s Possible for Obesity Care in 2026

This month's author is, Cristy Gallagher, the Associate Director of Research and Policy at the STOP Obesity Alliance. A version of this essay was originally published in RealClear Health. 

Last month, the administration delivered another critical victory: a landmark Medicare and Medicaid price negotiation deal for the GLP-1 medications Wegovy and Zepbound. The announcement also included an agreement to launch a new Centers for Medicare and Medicaid Innovation demonstration project expansion that would cover obesity medications for Medicare and Medicaid. This crucial agreement to cover the cost of these effective treatments is a powerful, long-overdue acknowledgment by the federal government that obesity is a chronic disease requiring comprehensive, affordable treatment. 
 
More than 2 in 5 American adults live with obesity, a chronic, complex disease that is far too often misunderstood and undertreated. Yet, Medicare has not covered the full range of evidence-based obesity treatments. The statutory exclusion preventing Medicare Part D from covering “weight loss” medications remains a major roadblock, leaving millions of older Americans without access to the obesity care they need. 
 
Policymakers must ensure that this demonstration project becomes the foundation for broader, permanent access. To fully secure this progress and deliver comprehensive, evidence-based care for older Americans living with obesity, Congress must codify this policy into law by passing the Treat and Reduce Obesity Act (TROA).
 
Significant health improvements can be achieved by investing in comprehensive obesity treatment. The combination of medical evaluation, nutritional counseling, physical activity, intensive behavioral therapy, judicious medication prescribing, bariatric and metabolic surgery, and long-term support can lead to substantial savings. Several programs and organizations have already demonstrated the effectiveness and cost-savings of comprehensive obesity care. These models highlight that when treatment is integrated, coordinated, personalized, and focused on adherence, the health benefits are significant for both patients and payers. 
 
One real-world model is the State of Connecticut’s Comprehensive Obesity Care (COC) program, a pilot with FlyteHealth, that treats approximately 300,000 state employees and retirees. Unlike single-disease or medication-only programs, the COC program delivers lasting outcomes with high adherence, measurable improvements across weight and cardiometabolic markers, and proven reductions in total cost of care. An independent analysis by Milliman found the Connecticut COC program achieved an 86 percent adherence rate among new GLP-1 users and avoided up to $3.6 million in annual costs by improving patients’ overall cardiometabolic health, leading to reductions in blood pressure, glucose levels, and other key health metrics. After six months, the State of Connecticut expanded and extended the program through a multi-year agreement.
 
Other states are also charting promising paths forward. In Delaware, the State Employee Benefits Committee approved coverage for FDA-approved obesity medications in March 2023. Employees must meet specific criteria to be eligible, such as having a diagnosis of obesity, completing a diet and exercise trial, and demonstrating a clinical response. 
 
Wilmington, DE’s self-funded program covers roughly 3,000 employees, retirees, and their families. The city incorporated federal initiatives like the National Diabetes Prevention Program (NDPP) and “We Go HARD for Health; ” these have produced tangible results: among 61 participants, an average 5 percent weight loss is projected to generate approximately $151,000 in savings. These programs illustrate how targeted, localized interventions can achieve measurable health improvements while managing costs.
 
The landmark announcement by the administration demonstrates strong administrative will. But we still need Congressional approval to codify the policy. Giving older adults guaranteed access to proven obesity treatments is not only the standard of care, but also a critical investment in their health and the financial sustainability of the healthcare system.