As scientific advances open new frontiers in the fight against obesity, Medicare and other insurers are reconsidering whether the condition should be treated like other chronic diseases—with access to medical interventions that include medication. While the Medicare program has gradually expanded coverage for obesity treatment services, it remains statutorily barred from covering drugs used for weight loss. As medical understanding continues to evolve, the push to extend coverage to anti-obesity medications is likely to persist.
Early Views: Obesity on the Sidelines of Medicare
When Medicare was established in 1965, obesity was not recognized as a medical condition that warranted direct coverage. Program guidance stated that the “immediate cause [of obesity] is a caloric intake which is persistently higher than caloric output,” and therefore it did not fall within the program’s mandate to diagnose or treat illness. For decades thereafter, Medicare’s official manuals specified that “program payment may not be made for treatment of obesity” except when such treatment was part of addressing another covered condition, for example, obesity caused by hypothyroidism or exacerbating diabetes. In practice, this meant that weight loss interventions were covered only when they were “an integral and necessary part” of managing a separate illness. Treatment directed at obesity itself has not been considered “reasonable and necessary.” These early policies reflected prevailing attitudes in mid-20th-century medicine and society. The general public and many clinicians regarded obesity as a failure of personal responsibility or willpower rather than a disease. “Different types of obesity are associated with different types of psychiatric illness,” one doctor wrote in the mid-1900s, a stark illustration of the stigma-laden view of obesity in that era.
Rising Awareness and a Policy Turning Point
By the late 20th century, perspectives began to shift as obesity rates climbed and the health impacts of obesity became harder to ignore. Public health leaders sounded alarms about an “obesity epidemic.” In fact, the prevalence of obesity—defined as a body mass index (BMI) of 30 or higher—in American adults more than doubled from approximately 13% in the early 1960s to 31% in 2000. Increases in the prevalence of obesity-related conditions, including type 2 diabetes and heart disease, forced a reevaluation in both clinical understanding and policy.
Former Surgeon General Dr. David Satcher, was among those in the early 2000s to begin framing obesity as a significant public health problem, estimating hundreds of thousands of deaths and over $100 billion in annual costs attributable to obesity.
In 2001, the Division of Nutrition and Physical Activity in the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention requested that the Centers for Medicare & Medicaid Services (CMS) review its position on obesity. On July 15, 2004, the Department of Health and Human Services (HHS) formally removed the longstanding Medicare policy language that “obesity is not an illness.” HHS Secretary Tommy Thompson announced that Medicare would “be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese.”
It is important to note that CMS was specific in delineating the scope of its action. CMS did not affirmatively designate obesity as an illness, and the agency’s action was limited to rescinding prior language that had explicitly stated that it wasn’t.
Still, in practical terms, the decision meant that Medicare was opening the door to cover obesity treatments if they were proven effective, reversing its previous blanket exclusion.
Some critics argued that CMS based the decision on “unsound science,” suggesting that America had “a tremendously exaggerated fear of higher than average weight.” Nevertheless, health policy experts noted its symbolic importance: “This policy change is hugely important in terms of ratifying the idea that obesity is a medical condition… Once Medicare decides it is important to address this, it’s very difficult for the rest of the industry not to follow suit,” one Medicare policy observer noted at the time.
Expanding Treatment: Surgery and Counseling in Medicare
After 2004, Medicare gradually broadened coverage of obesity treatments in keeping with emerging clinical consensus. One of the first areas of expansion was bariatric surgery for severe obesity. In 2006, Medicare updated its national coverage determination to explicitly cover bariatric surgeries, such as gastric bypass and gastric banding, for beneficiaries with a BMI of 35 or higher and at least one obesity-related comorbidity, after other weight-loss attempts had failed.
This change made seniors or disabled individuals who were morbidly obese with health problems like diabetes or hypertension eligible for lifesaving surgical interventions under Medicare. In embracing bariatric surgery, Medicare acknowledged that, for the most severely affected patients, obesity treatment could be “reasonable and necessary” rather than a cosmetic choice.
In the 2010s, Medicare also added coverage for nonsurgical, behavioral weight management for the first time. In March 2012, CMS began to cover obesity screening and intensive behavioral therapy (IBT) for beneficiaries with a BMI of 30 or higher as a preventive service.
IBT allows patients to receive diet and exercise counseling from a primary care provider at no cost. Medicare pays for in-person counseling for up to one year. In covering IBT under Part B, Medicare that recognized clinician-guided lifestyle intervention as a legitimate and important treatment for obesity. This addition was influenced by growing clinical evidence and U.S. Preventive Services Task Force recommendations that behavioral interventions can help improve weight and reduce risk factors in adults with obesity. Counseling for weight loss was added to screenings for diabetes and cardiovascular disease in Medicare’s arsenal of covered preventive care.
These coverage expansions coincided with a broader evolution in how the medical community approached obesity. By 2013, the American Medical Association considered obesity a disease, urging that it “requires a range of medical interventions” and should be treated like other chronic conditions.
Clinicians increasingly advocated long-term management strategies for obesity, similar to those for managing hypertension or diabetes. At the same time, public attitudes were also slowly shifting. The term “obesity epidemic” was used widely, and there was growing public awareness of the role played by factors such as food environments and metabolic biology. However, patients continued to face bias, and debates continued about personal responsibility versus systemic responsibility for obesity.
It is important to discuss the role of Medicare Advantage (MA) plans in this era. MA plans are required to cover everything original fee-for-service Medicare covers, including bariatric surgery and obesity counseling. They also have the flexibility to offer additional weight management benefits. Starting in the 2010s, several MA plans began adding wellness perks to attract members, including benefits such as gym memberships, nutrition programs, and even healthy meal delivery services. Original Medicare does not cover fitness programs or meal services, but MA plans often provide gym access, weight-loss program memberships, or grocery allowances for healthy foods as supplemental benefits.
These extra offerings reflect an understanding that preventing and managing obesity can improve seniors’ health and potentially lower total program costs, even if such services fall outside traditional medical coverage. In this way, MA plans have at times been ahead of original Medicare in addressing obesity holistically, within the limits allowed by CMS.
The New Frontier: Obesity Drugs and Ongoing Debates
Recent years have introduced a new frontier: anti-obesity medications (AOMs). A new class of highly effective weight-loss drugs (such as the GLP-1 agonists Wegovy and Mounjaro) has shown unprecedented results, with clinical trials reporting average weight loss in excess of 15%–20% of body weight. For many obesity specialists, these drugs are game-changers that can help patients where lifestyle changes and surgeries are not suitable or sufficient. Yet, policy barriers codified in federal statute limit Medicare’s coverage of these drugs.
Under current law, Medicare Part D does not cover medications “used for weight loss.” This exclusion originates in Section 1860D-2(e)(2)(A) of the Social Security Act, which mirrors the Medicaid drug exclusion in Section 1927(d)(2). These provisions specify that “agents when used for anorexia, weight loss, or weight gain” may be excluded from coverage. While Medicare Part D plans must exclude drugs prescribed for weight loss, the restriction applies only to that specific use. The same drugs—such as GLP-1 receptor agonists—remain coverable under Medicare when prescribed for another approved indication, such as Type 2 diabetes.
These statutory restrictions date from the era when weight-loss medications were viewed primarily as cosmetic or lifestyle aids rather than medical treatments. Importantly, obesity is now classified as a chronic disease under ICD-10-CM diagnostic codes (E66 series), and the 2024 updates added specific severity levels.
Under the Biden Administration, CMS attempted to reinterpret the statute to permit coverage of anti-obesity medications for the treatment of obesity “when such drugs are indicated to reduce excess body weight and maintain weight reduction long-term for individuals with obesity.” However, the proposed rule was never finalized as the new administration transitioned into office shortly after.
Congressional Efforts to Modernize Coverage
In recent years, lawmakers have sought to update federal law to reflect the current medical understanding of obesity. The bipartisan Treat and Reduce Obesity Act, first introduced in both the House and Senate in 2023, would amend Medicare statutes to expand access to evidence-based care for obesity. The bill would broaden Medicare coverage of intensive behavioral therapy for obesity by allowing additional qualified providers to furnish it and remove the statutory exclusion that bars coverage of FDA-approved obesity medications.
The legislation would permit Part D plans to cover “drugs used for the treatment of obesity or for weight management” when prescribed to eligible beneficiaries. In 2024, the House Ways & Means Committee reported the bill favorably. But the bipartisan support stopped short of floor action. Senator Bill Cassidy (R-LA) was joined by senators from both sides of the aisle when he reintroduced the legislation this summer, saying, “Obesity shortens your life.”
Looking Ahead
Over the past sixty years, Medicare’s approach to obesity has traced the changing boundaries between medicine and policy. While the program now recognizes obesity as a disease and covers counseling, nutrition therapy, and surgery, statute continues to limit drug coverage when medications are used for weight loss. As scientific advances shape clinical options, access will ultimately depend on legislative action.