1. Overview: Obesity is No Longer a Personal Issue

Decades ago, obesity was often labeled as a “lack of personal discipline”. Today, medicine has proven that obesity is a chronic metabolic disorder, with genetic, endocrine, behavioral and social factors.

Obesity is directly related to:

• Increased risk of cardiovascular disease, type 2 diabetes, stroke

• Increased rates of breast, colon, liver and pancreatic cancer

• Mental disorders: depression, anxiety, reduced quality of life

• Increased public health burden with annual treatment costs of up to $190 billion

Therefore, obesity needs to be approached as a disease with a clear treatment regimen – in which, weight loss injections have been a big step forward in the last 5 years.

2. GLP‑1 Injections: Scientific Mechanism and Treatment Efficacy

Main drugs

• Semaglutide (Wegovy, Ozempic)

• Liraglutide (Saxenda)

• Tirzepatide (Mounjaro)

All belong to the group of GLP‑1 receptor agonists , which work by mimicking the hormone GLP-1 – a natural substance secreted from the intestine after eating.

Mechanism of action

• Slows gastric emptying → makes the patient feel full for longer

• Inhibition of the hypothalamus in the brain → reduces appetite

• Increased insulin secretion and glucagon inhibition → better blood sugar regulation

Thanks to these effects, users naturally consume fewer calories, do not feel intense hunger, and do not need to use strong willpower to control eating.

Clinical results

• Wegovy (semaglutide): average 14.9% body weight loss after 68 weeks

• Mounjaro (tirzepatide): reductions of up to 22.5% in some patient groups

• Improve blood lipid index, blood pressure, fatty liver and HbA1c (average blood sugar)

This effect far exceeds any weight loss drug previously approved by the FDA.

3. Medicaid: Payment Mechanism and State-to-State Diversity

The Role of Medicaid

Medicaid is a federal health insurance program for low-income people. However, implementation is governed by each state , leading to:

• Big differences in the list of supported drugs

• Approval procedures and eligibility requirements are inconsistent.

• The situation of “sick people – but not treated” is still very common.

Payment status statistics as of 2025

The irony is: many of the states with the highest obesity rates are in the non-paying category , such as Mississippi (40% obese population), Alabama, West Virginia…

4. Conditions for Medicaid Approval of Treatment

Even in states with coverage, patients still need to meet strict criteria:

• BMI ≥ 30 , or from 27 if accompanied by underlying disease (diabetes, high blood pressure, sleep apnea…)

• Documented failure of non-pharmacological treatment (diet, exercise)

• Prescription from a specialist with a specific follow-up plan

• Participate in a behavioral weight management program , if required by your state

• Submit prior authorization application with clinical data

Processing times can take anywhere from two to six weeks, and many patients are denied the first time if their application is incomplete.

5. Cost: A Huge Barrier for the Uninsured

• Wegovy (semaglutide): about $1,350 – $1,500/month

• Saxenda (liraglutide): about $1,200 – $1,400/month

• Mounjaro (tirzepatide): about 1,100 – 1,300 USD/month

For low-income people, these prices are unaffordable without insurance. Medicaid is the only way for vulnerable populations to access these modern methods.

However, many states have resisted, fearing it would inflate Medicaid budgets — even though studies have shown that investing in obesity treatment could save billions of dollars in long-term health costs .

6. Side Effects and Usage Recommendations

Although highly effective, GLP-1 injections are not for everyone. Some side effects include:

• Common: nausea, diarrhea, constipation, headache

• Rare but serious: acute pancreatitis, renal dysfunction, cholecystitis

• Contraindications: people with a history of medullary thyroid cancer or MEN2 syndrome

Therefore, every treatment plan requires close monitoring by a specialist, along with a nutritional – psychological – exercise regimen.

7. Accessibility Guidelines for Medicaid Patients

1. Verify Medicaid policy in state of residence (state Medicaid website or call directly)

2. Make an appointment with your doctor to evaluate your health and determine medical eligibility.

3. Perform tests and make detailed treatment plans

4. Submit a request for prior authorization

5. Combine medication with behavioral support programs to ensure long-term effectiveness

If denied, the patient may request an appeal of the decision with assistance from a physician or health insurance attorney.

8. Policy Recommendations: Action Needed at the National Level

To address the medical stratification in obesity treatment, it is necessary to:

• CMS (Centers for Medicare & Medicaid Services) Issues Federal Uniform Policy on Payment for GLP‑1 Drugs

• States need to update drug formularies based on modern medical evidence

• Implementing a “pay-for-performance” model – Medicaid only pays if patients achieve weight-loss goals

• Strengthen public education about obesity as a disease, not an individual fault

Conclude

Injectable weight loss drugs are a major step forward in treating obesity – but they won’t make sense if they only serve the population that can afford them. Medicaid is playing a key role in democratizing access to treatment for the tens of millions of Americans who are overweight or obese.

The question is not just whether to support or not to support, but whether America is ready to recognize obesity as the health crisis it truly is. Expanding coverage for GLP‑1 drugs through Medicaid is not just a budget issue – it is an ethical, humane, and long-term investment decision for the future of public health.