Obesity is a chronic disease affecting 40.3% of adults in the U.S. alone.¹ And its consequences go well beyond physical appearance. People who carry extra weight are at risk for heart disease, stroke, and type 2 diabetes, according to the Centers for Disease Control and Prevention (CDC). In one study, older adults aged 65-74 were found to have lower health-related quality of life scores due to increased body mass index (BMI).² 

Obesity is linked with added costs, too. One study found the total medical costs of obesity among U.S. adults to be $260.6 billion.³

Obesity is a treatable chronic disease

While obesity is a serious issue in older adults, the good news is that it’s treatable. If you are living with obesity, you should know there is a treatment option that’s right for you. Treatment includes a range of interventions such as lifestyle and behavior changes, pharmacotherapy, and surgical weight loss procedures.

Medicare does cover some obesity treatments, such as Intensive Behavioral Therapy and bariatric surgery, but it does not cover anti-obesity medications. Coverage also depends on what kind of Medicare plan you have.

What does Medicare cover for obesity?

The Medicare Part B program recently took a major step forward in encouraging doctors and patients to view obesity as a major health problem. Through its Intensive Behavioral Therapy for Obesity initiative, beneficiaries with a BMI of 30 or higher can receive no-cost obesity screenings and behavioral counseling.

These services must be provided by a physician, nurse practitioner, physician’s assistant, or clinical nurse specialist and may include:

• An initial assessment to determine BMI
• A nutritional evaluation
• Ongoing counseling to promote long-term weight loss through dietary changes and exercise

With the Intensive Behavioral Therapy program, Medicare only covers appointments that take place in a primary care setting. If your provider refers you to another specialist (i.e., a registered dietitian nutritionist), you’ll have to pay for those services out of pocket.

Some Medicare Advantage (Part C) plans provide enhanced coverage that can support your weight loss efforts. These coverages may include gym memberships and subscriptions to fitness programs such as SilverSneakers® GO™—a fitness app designed for older adults. Certain Medicare Advantage plans may also cover healthy home meal delivery for a limited time.

In cases of severe obesity (BMI of 35 or higher), Medicare covers bariatric surgery if it’s determined by your doctor to be medically necessary. In order to secure coverage, you'll typically need to have a qualifying BMI and at least one underlying obesity-related health condition, such as diabetes or heart disease. You must also show you've tried to lose weight in the past through dieting or exercise and have been unsuccessful.

The types of bariatric surgery covered by Medicare include:

• Sleeve gastrectomy
• Adjustable gastric banding
• Vertical gastric banding
• Roux-en-Y gastric bypass
• Biliopancreatic diversion with duodenal switch

Some bariatric procedures are specifically excluded by Medicare, such as open sleeve gastrectomy and gastric balloon. It's important to know that even with a covered bariatric procedure, you'll still be responsible for standard costs such as co-payments for doctor's visits and unpaid deductibles.

What obesity treatments are not covered by Medicare?

Many common weight loss interventions are not fully covered by Medicare. These include:

• Weight loss programs such as Weight Watchers (WW) or Nutrisystem
• Weight loss meal delivery services
• Cosmetic procedures, such as liposuction

Anti-obesity medications (AOMs), or pharmacotherapeutics, are also not covered by the Medicare Part D prescription drug benefit. This is despite the fact that these medications are increasingly recognized as an effective option for some people. AOMs are especially suitable for people who carry significant excess weight and have not been able to lose weight through lifestyle and dietary changes alone.

Why should Medicare cover weight loss drugs?

In 2013, the American Medical Association (AMA) officially recognized obesity as a disease. Anti-obesity medications are not used exclusively for the purpose of shedding pounds; they serve to treat a serious chronic condition. Obesity puts older adults at risk for complications like high blood pressure, high cholesterol, heart disease, and type 2 diabetes—all of which can affect their well-being and lifespan.

Drug therapy is a key treatment component for certain groups of older adults living with obesity. It can be used to complement other treatment approaches covered by Medicare and enhance the person’s success. Medicare’s non-coverage of AOMs creates a gap in the continuum of care. It also limits treatment choices for beneficiaries, which can pose challenges for patients with low income.⁴

Expanding Medicare coverage for adults with obesity

Including FDA-approved medications and other anti-obesity treatments in Medicare coverage would help more older adults actively reduce their health risks. Providing access to broad therapy options is an essential part of effective, person-centered care delivery.

Certain advocacy groups, such as the Obesity Action Coalition (OAC), are working on legislation to broaden access to treatment options for Medicare beneficiaries affected by obesity. For example, the Treat and Reduce Obesity Act (TROA) is a bipartisan bill designed to enable CMS to clarify that FDA-approved anti-obesity medications may be covered under Part D. Recently, though, a new proposed rule by the Centers for Medicare & Medicaid Services (CMS) would no longer exclude AOMs under Medicare Part D and would "require Medicaid programs to cover these medications when used to treat obesity."

According to the November 2024 announcement from CMS: "This proposal would provide more Americans access to these transformative medications, improving the health and quality of life for millions of people who have obesity."

Want to do more to advance Medicare treatment for obesity?

Learn about the Obesity Bill of Rights, a set of eight patient-centered principles established to ensure people with obesity are screened, diagnosed, counseled, and treated according to medical guidelines. It aims to eliminate widespread weight bias and ageism within the health care system or exclusionary coverage policies by insurers and government agencies.

Launched on Jan. 31, 2024, the Obesity Bill of Rights is endorsed by nearly 50 national obesity and chronic disease organizations. Find out more at right2obesitycare.org.

Sources

1. Centers for Disease Control and Prevention. Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023. September 2024. Found on the internet at https://www.cdc.gov/nchs/products/databriefs/db508.htm

2. Reinbacher et al. The Impact of Obesity on the Health of the Older Population: A Cross-Sectional Study on the Relationship between Health-Related Quality of Life and Body Mass Index across Different Age Groups. Nutrients 2024.  Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10780898/

3. Crawley et al. Direct medical costs of obesity in the United States and the most populous states. J Manag Spec Pharm. March 2021. Found on the Internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10394178/

4. Coverage of Anti-Obesity Medications is Consistent with the Medicare Part D Statute (White Paper).