Patients With Obesity Face Higher Financial Burden, Food Insecurity

Americans with obesity face almost double the financial hardship as their peers without obesity, according to a study published in Annals of Internal Medicine that highlighted not only elevated out-of-pocket health spending but also higher rates of food insecurity and skipped medications due to costs.¹

These findings are based on National Health Interview Survey data from more than 143,000 adults between 2019 and 2023. Excluding patients deemed underweight, researchers stratified patient data into 3 groups based on body mass index (BMI): normal weight (18.5 to 25 kg/m²), overweight (25 to 30 kg/m²), and obesity (≥ 30 kg/m²).

Burdens by BMI

Adults with obesity were more likely to report difficulty paying medical bills (14.2% vs 8.2%) and experience food insecurity (9.5% vs 5.6%) than their peers in the normal BMI range. Interestingly, there was a larger gap in reported burdens between adults with overweight and obesity compared with overweight and normal weight; among those with overweight, 9.2% reported financial hardship and 6% reported food insecurity.

After adjusting for socioeconomic factors, obesity was still associated with a nearly 4 percentage point increase in financial hardship and a 1.7 percentage point increase in food insecurity compared with individuals with normal weight.

“One limitation of this study is recall bias, given self-reported weight and financial burden variables,” the authors noted. “The absence of data on obesity-related costs also limits our ability to precisely characterize financial burden.”

Affordability Issues Drive Nonadherence

Patients taking prescription medications who had available cost-related medication nonadherence (CRM) data were more likely to have obesity, have Medicare coverage, and be female and/or White compared with those without CRM data. Among this group, 9.2% of adults with obesity reported CRM, significantly more than those with overweight (6.4%) or normal weight (6.1%). Even after accounting for insurance coverage, education, and income, the risk of CRM remained more than 2 percentage points higher in patients with obesity compared with those with normal weight. Again, there was a smaller gap between adults with overweight and normal weight, with just a 0.63-percentage point difference between the 2.

These findings come amid growing concern over the affordability of obesity care in the US. As demand for antiobesity medications like semaglutide and tirzepatide increases, limited insurance coverage has left many patients paying out-of-pocket for drugs that can cost up to $16,000 a year.

This doesn’t even account for health system expenses. Findings presented at Obesity Week 2024 showed that initiation of semaglutide 2.4 mg in patients with overweight or obesity and either heart failure or atherosclerotic cardiovascular disease (ASCVD) led to significant reductions in annual medical costs, even after accounting for the high price of the medication.² These reductions included fewer inpatient admissions, outpatient visits, and emergency department use, with total yearly medical costs falling by as much as 37%. However, with total annual costs averaging $22,152 per patient with heart failure and $15,957 per patient with ASCVD, these data highlight the financial burden these patients still face after initiating semaglutide.

Cost being a barrier to obesity treatment is not news. In a recent interview, Hamlet Gasoyan, PhD, researcher for the Center for Value-Based Care Research at Cleveland Clinic, explained that nearly half of the patients in a real-world study stopped taking antiobesity drugs due to high costs or insurance-related barriers, with adverse effects and drug shortages also being major players.³ According to Gasoyan, patients often encounter issues with prior authorizations after the first medication fill or no longer have a manufacturer co-pay coupon they had at first, making continued therapy financially unsustainable for them.

“In this nationally representative study, nearly 1 in 6 adults with obesity had trouble affording health care,” the current authors said.¹ “In unadjusted and multivariable analyses, obesity was independently associated with difficulty paying medical bills, food insecurity, and skipping medication because of cost.”

References

1. Bajaj SS, Jain B, Sabet CJ, et al. Association of overweight and obesity with financial burden. Ann Intern Med. Published online June 24, 2025. doi:10.7326/ANNALS-24-03161
2. Grossi G. Semaglutide linked to reduced health care expenses for patients with obesity, HF, ASCVD. AJMC^®. November 6, 2024. Accessed June 24, 2025. https://www.ajmc.com/view/semaglutide-linked-to-reduced-health-care-expenses-for-patients-with-obesity-hf-ascvd
3. Klein HE, Gasoyan H. Cost and coverage issues drive GLP-1 discontinuation: Hamlet Gasoyan, PhD. AJMC. June 17, 2025. Accessed June 24, 2025. https://www.ajmc.com/view/cost-and-coverage-issues-drive-glp-1-discontinuation-hamlet-gasoyan-phd