When Weight Loss Is No Longer Personal: Medicaid, Injections, and the New Path to American Health Care

For decades, obesity was viewed as a consequence of unhealthy lifestyles—a “personal problem.” But modern medicine is changing that. Obesity is now viewed as a chronic disease with complex biological mechanisms that requires intensive treatment, sometimes with drugs—including injectable GLP‑1 drugs . And in low-income populations, where the burden of obesity is much higher than the national average, Medicaid may be the key to accessing this new medical solution.

From “self-blame” to treatment

Millions of Americans are living with obesity without knowing that it can be treated like any other chronic disease. For them, losing weight is not just a personal effort, but a long series of failures that take a heavy toll on their physical and mental health. However, with the advent of GLP‑1 injectables like Wegovy , Saxenda , or Mounjaro , they are starting to have real hope – provided they have support from the healthcare system.

Medicaid, the insurance program for low-income people, has played a crucial role in providing access to modern therapies for this population. But reimbursement policies have not kept pace with actual needs.

GLP‑1: A turning point in obesity treatment

Unlike the “crash pills” of the past, GLP‑1 drugs are the result of more than a decade of rigorous research. They work biologically: they mimic the natural hormone GLP‑1, slowing digestion, increasing feelings of fullness, and regulating hunger signals in the brain.

As a result, people naturally eat less, are not haunted by hunger, and improve blood sugar control – a vital factor for overweight people at risk of prediabetes or type 2 diabetes.

In clinical studies, Wegovy helped patients lose an average of 14-16% of their weight after 68 weeks of treatment. With Mounjaro, weight loss can exceed 20% in some cases.

Medicaid: Solution or Limitation?

Despite their proven effectiveness, cost remains the biggest barrier. At $1,200–$1,500 per month, GLP‑1 injections are largely out of reach for most Americans without high-end insurance. That’s where Medicaid—the public insurance system that covers more than 80 million Americans—comes into play.

However, reimbursement policies for GLP‑1 drugs for pure weight loss purposes have not yet been agreed:

  • Only about 14 states , including California, Massachusetts, Illinois, and New York, have approved coverage for Wegovy or Saxenda through Medicaid, if patients meet certain eligibility criteria.

  • 20 other states only support GLP‑1 if the patient has a diagnosis of diabetes (Ozempic, Mounjaro), not if used solely for weight loss.

  • The remaining 16 states still completely reject injectable weight-loss drugs.

A troubling fact: the states with the highest obesity rates are often among the states that do not provide treatment through Medicaid.

Accessibility: Not easy

Getting approved for injectable weight loss medications through Medicaid is often not easy. Patients need to:

  • Have a BMI of 30 or higher (or 27 or higher with underlying medical conditions such as diabetes, sleep apnea, etc.)

  • Tried and failed with non-drug weight loss methods for at least 6 months

  • Have treatment prescribed by a specialist

  • Participate in a behavior modification support program if required by the state

  • Go through a prior authorization process, with complete medical records, follow-up plan

Additionally, many states have policies that limit the duration of treatment, or require periodic reviews to continue receiving the medication.

A mindset shift is taking place

In recent months, health organizations like the American Heart Association, the Endocrine Society, and the Obesity Society have all called for expanded GLP‑1 coverage for obesity, arguing that early treatment can reduce long-term health costs—from diabetes to heart disease to liver damage.

Also in 2025, several states such as North Carolina, Virginia, and Colorado are beginning to test limited GLP‑1 reimbursement programs, using an “outcomes-led” payment model – meaning continued support is only provided if patients achieve their initial weight loss goals.

This may be a practical approach, balancing cost and clinical effectiveness.

Advice for Medicaid Patients

If you are living with obesity and have Medicaid, take these steps to find out about access to weight loss injections:

  1. Check your state’s Medicaid policy – ​​each state has its own formulary.

  2. Make an appointment with your doctor to assess your overall health, BMI, and any underlying medical conditions.

  3. Please advise on a comprehensive treatment plan including medication, nutrition and exercise.

  4. Ask your doctor to help you prepare a prior authorization request.

  5. Be prepared for a lengthy review process and the possibility of initial rejection – this is not unusual.

Conclusion: From Individuals to Policy

Access to injectable weight-loss drugs is more than a personal choice—it’s a matter of policy, awareness, and health equity. Medicaid has the potential to be an extension of modern medicine to people living in poverty. But making that happen will require more than individual success stories. It will require a system-wide change in thinking, from doctors to policymakers.

If you are looking for a way to treat your obesity, don’t overlook the possibility of Medicaid. It could be the start of a new life – a healthier, more active, and more sustainable one.