In MO, roughly 1/3 of adults and 1/6 of children are obese, with the main drivers being poor diet and lack of physical activity (CDC 2021).
Behavioral and dietary changes are the primary methods for prevention of weight-gain and weight-loss. Since 2013, several medical soci-eties have recommended pharmaceutical and surgical interventions for body mass indices (BMI) higher than 30 (obese) that do not achieve at least 5% weight loss after 6 months (Sombra 2022; Cornier 2022).
The Food and Drug Administration (FDA) has approved 6 weight loss medications. Table 1 lists the drugs/type, intended patient populations, efficacy of at least 5% weight loss after 1 year (Idrees 2022; Mayo Clinic 2022; Haqq 2022).
Nutritional counseling includes behavioral therapy and lifestyle plan-ning with registered dieticians to achieve weight loss or management.
Obese individuals who have not achieved 5% weight loss within 6 months are candidates for surgical intervention.
Liposuction removes and contours small amounts of under-the-skin fat, and is neither an overall weight-loss treatment nor covered by insurance (Mayo Clinic 2021).
Only screening and behavioral counseling for obese patients must be covered under the Affordable Care Act (CMS n.d.).
As of 2022, 18 states covered pharmaceuticals, 48 states covered bariatric surgeries, and 26 states covered nutritional counseling through Medicaid (Figure 1).
As of 2021, fewer than 2% of obese patients in the U.S. had been treated with an anti-obesity drug due to strong side effects, low prescription rates, low insurance coverage, and/or need for prior behavioral changes (Nordmo 2020).
Individuals with a BMI over 40 who lose at least 5% of their body weight can save medical and insurance costs by over $2,000 per year (Cawley 2014).
Treatments that lead to a 5-10% weight loss are associated with lower out-of-pocket costs for individuals of other pharmaceuticals, including: