The U.S. healthcare system is at a critical juncture with rising obesity and chronic disease coupled with skyrocketing GLP-1 costs. Three in four (76.4%) U.S. adults have at least one chronic condition, and over half (51.4%) have two or more.
At the same time, spending on GLP-1 treatments has surged by more than 500% between 2019 and 2024. Growth is expected to continue, especially with the introduction of the Bridge program, which offers GLP-1 access for obesity with comorbidities under Medicare and Medicaid. Experts predict the number of people in the U.S. using GLP-1s could reach 25 million by 2030 (rising from 10 million in 2025).
While the health need is great, the near-term financial pressure feels unsustainable. Plans across government and employers are pulling back support. This month, MassHealth announced it would cease covering the medication, a move that will impact 22,000 Massachusetts residents but save the state an expected $15 million per year. Last month, Cigna became the latest organization to cease access for its employees. More may follow – research from the Business Group on Health found 10% of companies that now cover GLP-1s for weight-loss plan to drop them by 2027.
Too many states and employers are viewing this through a binary lens between those who want unfettered access and those that reject coverage. We need to get off this roller coaster, where access and affordability are pitted against each other, and move toward a financially sustainable treatment approach that actually enables progress on chronic disease. GLP-1s can make a significant dent in the obesity epidemic and reduce downstream costs of treating diabetes, chronic kidney disease, liver disease, musculoskeletal conditions, and more. The answer isn’t to reach for a hammer and eliminate GLP-1 coverage entirely. It’s to use a smart scalpel to target the right population at the right time with unique, data-driven care plans.”
Individualized treatment that moves beyond just GLPs
With so much of the U.S. facing metabolic disorder, the magnitude of the challenge – and the cost of treating it – can feel overwhelming.
One of the problems we’ve had in treating obesity is the lack of data on it within our healthcare system. Obesity wasn’t considered a disease until a decade ago, meaning that most physicians are not trained in this area and it remains woefully underrepresented in claims data.
With the breakthrough of GLP-1s, doctors now have access to powerful medication but are still unequipped with the skills, experience, or infrastructure to prescribe them effectively. We have a treatment that can work, but neither the delivery system to support meaningful health outcomes nor the budget to cover it. We need to move away from binary decisions about medication access toward an individualized approach to treatment selection and support.
The good news is, we now have both the treatment and analytical tools to do that. With a data-informed approach, we can identify and prioritize those in greatest need and match individuals to treatments from across the full care spectrum, including intensive behavioral therapy, non-GLP medications, GLPs, and bariatric surgery.
Getting treatment for the high-acuity right early delivers outcomes for those with the greatest disease burden. It also has the greatest impact on existing clinical costs, creating a pathway to self-sustaining coverage. From that population, we can broaden our focus to population health, identifying rising risks and emerging diseases. Intervening earlier requires an even greater focus on appropriate treatment matching to optimize care and to sustain economic value. The challenge is meaningful – particularly in the context of a culture that still questions what obesity is and reaches for simple definitions and quick fixes. At the same time, the potential to transform the health, wealth, and well-being of the United States is unprecedented.
Optimizing clinical care to drive outcomes
We will only make this unprecedented change if we can also change our mindset. We’re not looking for the next juice cleanse or exercise fad. The goal cannot be to drop 10lbs in 20 days. We have to reorient our approach to prioritize health and well-being.
We also have to stop our system-by-system treatment approach. Obesity is linked to 200+ conditions and affects nearly every system in the body, and must be treated as one of the most chronic diseases we face. Effective obesity care needs to be multidisciplinary, combining medical treatment with broader support for nutrition, physical activity, and behavioral change. In many populations, obesity treatment also needs to be done in the context of socio-economic and family dynamics, with real support for the social determinants of health.
The outcomes of this care will include weight loss – because when you are dealing with significant obesity, weight is a leading indicator – but it cannot stop there. We need to track the impact to improvements in biomarkers and to the better health of the heart, kidneys, and liver. It also needs to be tracked to physical improvements, to reductions in pain, and an increase in activity. Finally, we should track improvements to mental health and wellbeing. At Ilant, the start-up Elina founded, we have observed improvements across these areas, including reductions in loneliness.
A new era of obesity care
We need to be much braver if we are to solve both the affordability and access questions around obesity care. These problems are solvable if we get the balance right. And the wider potential to transform the health, wealth, and well-being of the United States is unprecedented.
There isn’t a silver bullet for obesity treatment because it’s a complex, chronic condition that requires empathy, multidisciplinary, evidence-backed care, and sustained support. We can build a much healthier society at a price we can afford if we use data to target individuals with the greatest need, provide treatments that include (but are not exclusive to) GLPs, adopt a multidisciplinary approach that considers far more than just medical treatment, and track progress to ensure treatment works.
The time to make a change is now – the recently launched Bridge program is an 18-month program without a viable successor. We have a unique opportunity to change the course of health in the U.S., and we hope others will join us to make the changes needed.
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