In a disheartening struggle with her weight for over four decades, Della McCullough's hopes for effective treatment have been met with disappointment. Despite trying various methods such as supplements, diets, and exercise, the 53-year-old semi-retired school bus driver from Colorado remains trapped in a cycle of weight gain and unhappiness. McCullough is now interested in exploring new blockbuster drugs that aid in weight loss, but finds herself facing an unexpected hurdle due to her Medicaid coverage.

The medication she has her sights set on is Wegovy, an obesity medicine manufactured by Novo Nordisk. While Wegovy contains the same active ingredient as Novo Nordisk's Ozempic (a diabetes drug), it is specifically approved for weight loss and obesity treatment. Unfortunately, Colorado's Medicaid plan does not cover Wegovy or similar weight-related medications due to a decades-old law that excludes treatments for anorexia, weight gain, and weight loss from mandatory coverage.

As someone on state assistance, McCullough finds herself frustrated by the inadequate support Medicaid provides for individuals with obesity. She believes that the stigma surrounding her condition contributes to the lack of comprehensive coverage. This sentiment is echoed by Robin Feldman, a professor at the University of California Law. Feldman explains that when the law excluding weight-related drugs was passed in the 1990s, society widely held the belief that weight loss could be achieved through willpower and dedication.

While 16 state Medicaid programs currently offer coverage for weight loss drugs, many others cite cost as a limiting factor. Wegovy, with a list price exceeding $1,300 per month, poses a significant financial burden even with potential discounts. Medicaid programs must carefully evaluate the cost-effectiveness of such investments, considering competing priorities such as maternal health and children's health issues.

The debate surrounding Medicaid coverage for weight loss drugs is a complex one. Some states, like Minnesota, are required by state law to cover Wegovy, while others, like Louisiana, do not cover it at all, opting instead for an older and less effective weight loss medication called Orlistat. In North Carolina, there is hope that Wegovy will be covered by the Medicaid program by this summer, pending the necessary policy processes.

Advocates argue that excluding treatments for weight loss perpetuates the misconception that obesity is solely a result of personal choice rather than recognizing it as a chronic disease driven by complex biology. Tracy Zvenyach, director of policy strategy and alliances at the Obesity Action Coalition, emphasizes the need for expanded access to evidence-based treatments for obesity.

For McCullough and others like her, the lack of Medicaid coverage for weight loss drugs feels personal, highlighting the unequal treatment of individuals with obesity compared to those with other health conditions. While Colorado's Medicaid plan recently started covering Wegovy for reducing the risk of cardiovascular events in certain patients, McCullough does not meet the criteria and remains caught in a system that fails to align with current scientific understanding.

As the science behind obesity advances, McCullough and countless others hope that Medicaid policies will catch up, providing them with the support and treatments they desperately need to break free from the grips of obesity.