GLP-1 agonists are the most significant thing to happen in obesity medicine in decades — why is coverage so bad?

Semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound) are producing results in clinical trials that no previous obesity intervention has matched — 15-22% body weight reduction sustained over 1-2 years, with cardiovascular outcome data that's compelling (SELECT trial, SURMOUNT-MMO). The media coverage is almost entirely about celebrities and 'cheating' and cosmetic use. The serious discussion — about what it means that these drugs suggest obesity has a strong neurobiological component that willpower approaches were always going to fail against — is happening mostly in medical journals. The insurance coverage situation in the US is perverse: these drugs are covered for type 2 diabetes but often not for obesity, despite obesity being the pathway to type 2 diabetes and cardiovascular disease. Medicare Part D's explicit exclusion of weight loss drugs is a 1998-era policy that hasn't caught up with the science. SELECT trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2307563