I was 101 lbs in kindergarten, coming from generational obesity. Now in adulthood, despite reducing my BMI from 69 to 24 (245 lbs lost), I still carry the expensive diagnosis of obesity. I’ve used pharmacotherapy, surgical interventions, mental health care, and more to achieve the combination of treatment needed to maintain healthy body weight, but not without cost. From self‑paying $14,000 for my first bariatric surgery in 2009, the bills have continued as other needs have surfaced. With obesity, the financial impact is unending, but I do know one thing: I am worthy of care.

I have exceptional employer-based health insurance that covers the treatment of obesity. In 2021, my total healthcare costs to my insurance were $143,927. I paid $1,723 out‑of‑pocket on top of my $2,298 in total premiums for family coverage. Still, this isn’t my most expensive year to date. The CDC estimates the annual medical cost of obesity in the U.S. was $147‑billion in 2008. Medical costs for people living with obesity were $1,429 higher than those without. The impact of obesity on my body and budget is‑unending.

People living with obesity continue to advocate for U.S. government‑led insurance (Medicare) for affordable obesity care, including anti‑obesity medications. Currently, Medicare has zero anti‑obesity medication coverage, leaving our most vulnerable without access. An estimated 33% of Medicare recipients have diabetes, with excess weight being the highest risk factor in type II (90-95% cases). Out‑of‑pocket costs quadrupled between 2007 and 2017 to $984 million for people living with diabetes who were on Medicare. Unaffordable obesity treatment ripples through our health and economy, and a coalition of voices living with NCDs keeps asking: why must we be sick before we get treatment?

Bias contributes to insufficient care and care avoidance. This puts people living with obesity at‑risk to develop additional NCDs. Coverage for treatment, like bariatric surgery for obesity, is inconsistent with roughly 40% of the U.S. population lacking coverage. Surgery is the most effective obesity treatment available, reducing healthcare costs an average of 29% within 5 years, and contributing to the remission of other NCDs at staggering rates: 92% of type II diabetes, 75% of hypertension, and 58% of cardiovascular disease. It saves lives and money, but all treatments for any NCD care should be affordable and universal.

To ensure all people living with NCDs have affordable healthcare, we must:

• Call for action to ensure that insurance plans pay for the treatment of a wider range of conditions, including obesity, by covering comprehensive science‑based interventions.
• Call on decision-makers within the health system to listen to and amplify the voices of people affected by NCDs to break the asymmetry of quality and affordability.
• Call on decision-makers within the health system to eliminate medical bankruptcy by structuring the system around people’s need for care and not their ability to pay.

Healthcare is a human right. The lives of people living with NCDs depend on it.