Misinformation, Stigma, Bias and Costs

“I’ve had patients come to me vehemently opposed to the medication, though sometimes those opinions grow out of confusion,” said Kimberly Narain, M.D., a physician and researcher at the University of California Los Angeles Hospital. “One patient thought the GLP-1 medications actually caused diabetes, rather than preventing it. Others want the medication, but they cannot handle the cost.” Co-pays can be $1,000 a month or more and Medicaid coverage has different requirements in each state. (See this state-by-state Medicaid guide.)

Dr. Narain, who conducted a pioneering study of the barriers people face when attempting to access GLP-1s, added that society’s attitudes toward weight loss are also part of the problem.

“There are people who are doing everything right and they still cannot lose weight, but that is not because they are ‘lazy.’”

— Kimberly Narain, M.D.

Physician and researcher at the University of California Los Angeles Hospital

“There’s a lot of societal and internalized stigma,” she said. “In some ways, we have done a disservice to our patients by telling people you just need to eat less and exercise more. The body fights that. Your metabolism slows. There are people who are doing everything right and they still cannot lose weight, but that is not because they are ‘lazy.’ That’s not supported by the data.”

“I was tired of fighting of my body; honestly I was thinking about surgery,” Cooper said. “I was just crying, I was so fed up.”

“I was drinking the water. I was working it out — tracking the food, I didn’t know what else to do,”

Dr. Narain said that some women who may benefit from GLP-1s might be ashamed to try the drugs, because “these medications are seen as the easy way.”

“Society does not understand that weight challenges can begin in utero or be linked to genetic risks.” For Black women, our higher rates of obesity are also linked to social disadvantages.

As Dr. Narain’s research shows, cost, coverage and other issues leave Black women 49% less likely to access GLP-1s, even when they medically qualify for the treatment. “We found that Black individuals were about half as likely to use these medications as white people, even after we controlled for education levels, insurance status and other factors,” she said. As with other types of medical care, racial bias may also play a role. Recent data shows that physicians are much less likely to prescribe GLP-1s for Black patients.