The Trump administration’s announcement this week represents a significant policy shift in the fight against obesity. By expanding Medicare and Medicaid coverage for drugs like Ozempic and Wegovy (Novo Nordisk) and Mounjaro and Zepbound (Eli Lilly), millions of Americans could gain access to medications that have shown remarkable results in clinical trials—with some patients losing 15-20% of their body weight.
On paper, this sounds like a public health victory. In reality, it may be solving only half the problem.
The Uncomfortable Truth About Adherence
Here’s what the headlines often miss: nearly half of patients who start these GLP-1 receptor agonists stop taking them. The side effects—nausea, vomiting, diarrhea, constipation, and abdominal pain—aren’t trivial inconveniences. For many users, they’re debilitating enough to abandon treatment entirely, regardless of the weight loss benefits.
This creates a troubling equation. We’re about to make it easier and cheaper for millions more Americans to access drugs that half of them won’t be able to tolerate long-term. Without addressing adherence, we risk creating a revolving door: patients start the medication, experience significant side effects, discontinue use, and potentially regain the weight—all while taxpayers foot an increasingly large bill for Medicare and Medicaid coverage.
The Generation Left Behind
There’s another glaring issue with framing obesity treatment primarily through the lens of these medications: it does virtually nothing for younger Americans, the very population where obesity rates are climbing most dramatically.
Childhood and adolescent obesity has tripled since the 1970s. Today’s teenagers and young adults are facing obesity-related health conditions—type 2 diabetes, fatty liver disease, joint problems—at ages that would have been unthinkable a generation ago. Yet Medicare doesn’t cover them (they’re not old enough), and Medicaid coverage varies wildly by state, often with significant restrictions for weight-loss medications in younger populations.
Even when coverage exists, the question remains: do we really want to put teenagers on medications they may need to take for life, with side effects that cause half of adult users to quit?
What’s Missing from the Conversation
Expanding drug access isn’t inherently bad policy. For some patients, particularly those with obesity-related comorbidities who can tolerate the medications, GLP-1 drugs can be genuinely life-changing. But treating this as the solution to America’s obesity crisis is short-sighted.
What we’re not hearing enough about:
Prevention over intervention. Why aren’t we investing equally in the policies that could prevent obesity in the first place? Better nutrition education, restrictions on marketing unhealthy foods to children, improved access to fresh produce in food deserts, urban planning that encourages physical activity—these don’t have the immediate gratification of a weight-loss injection, but they don’t have the side effects either.
Comprehensive support systems. If we’re going to expand coverage for these drugs, why not also mandate coverage for the nutritionists, therapists, and lifestyle coaches who could help patients manage side effects and maintain results? Medication without behavioral support is setting people up for failure.
Research into better formulations. With billions in potential revenue at stake, pharmaceutical companies should be pushed to develop versions of these drugs with more tolerable side effect profiles. If half your users quit, you have a product problem, not just a coverage problem.
The Real Question
The Trump administration’s announcement raises a question we should be asking more loudly: What kind of obesity treatment system are we building?
One that relies on a single class of medications that half of users can’t tolerate, while largely ignoring the prevention and comprehensive care that could help younger generations avoid needing these drugs in the first place? Or one that views these medications as one tool among many in a genuine public health strategy?
Making drugs cheaper and more accessible is important. But it’s not a substitute for addressing why so many Americans struggle with obesity, especially our youngest citizens. Until we’re willing to have that harder conversation—about food policy, urban design, healthcare system incentives, and the social determinants of health—we’re just treating symptoms, one discontinued prescription at a time.
