Treat obesity before complications set in

A 19-year-old patient in Massachusetts exemplifies the complex challenges of treating obesity, even when patients diligently follow medical advice. Despite adopting healthier habits like walking to school daily and improving her diet with her grandparents' help, her weight remained unchanged. Her quiet exhaustion was palpable as she asked if there was anything else that could be done.

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Yet the number on the scale hadn’t moved. She asked, quietly and with exhaustion, if there was anything else we could try.

The path to effective treatment, however, proved difficult. Before MassHealth, the state's Medicaid program, would consider authorizing GLP-1 medications, it mandated a six-month trial of phentermine, a stimulant drug. This requirement persisted despite 2026 American College of Physicians guidelines recommending GLP-1s as the preferred first-line treatment for obesity due to their superior efficacy and tolerability.

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This step-therapy trial was required despite the 2026 American College of Physicians guideline recommending GLP-1s as the first-line treatment for obesity, ahead of phentermine, on the basis of both superior efficacy and toleration.

After completing the phentermine trial with no weight change, the patient was finally approved for the more effective medication. However, MassHealth announced it would cease covering GLP-1s for obesity entirely starting July 1, 2026. This decision mirrors a broader trend, with an estimated 12 million Americans losing coverage for popular GLP-1 drugs like Zepbound and Wegovy between 2025 and 2026. Only 13 state Medicaid programs were covering these medications for obesity at the start of 2026, a decrease from the previous year.

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And that’s when we heard that MassHealth would stop covering GLP-1s for obesity entirely, effective July 1, 2026.

This reduction in coverage is creating a dangerous vacuum. Patients unable to access prescribed medications are turning to compounded versions of semaglutide, which are cheaper but unregulated and produced outside the FDA approval process. Between November 2023 and November 2024, up to 2 million Americans reportedly used these compounded drugs. The FDA has received over 455 adverse event reports linked to them, including dosing errors that led to hospitalizations. The FDA has proposed a rule to close the legal pathway for large-scale compounded GLP-1 production, further limiting options for patients who are now facing disappearing markets, rationing doses, or discontinuing treatment altogether, leading to rapid weight regain.

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Up to 2 million Americans received compounded versions of semaglutide, cheaper, unregulated copies produced outside the FDA approval process, between November 2023 and November 2024.