Obesity across America: Geographic Variation in Disease Prevalence and Treatment Options

More than 4 in 10 adults in the US are affected by obesity, defined as experiencing an accumulation of body fat higher than what is considered healthy for a given height. Obesity is associated with increased risks for serious health conditions such as type 2 diabetes, hypertension, stroke, and various cancers. People of all genders, of all races and ethnicities, and in all geographic areas experience obesity. This report examines existing data and research to comprehensively describe the scope and prevalence of obesity and available obesity treatments in the US. We look at the current state-level prevalence of obesity and changes in state-level obesity prevalence from 2011 to 2020. We also examine current county-level obesity prevalence and which counties have the highest and lowest levels of obesity and related comorbidities. Then, we describe insurance coverage for four obesity treatment options (screening and counseling, nutritional counseling, pharmacotherapy, and bariatric surgery) for four insurance plans (fee-for-service Medicaid, Medicaid managed care, state employee health plans, and state essential health benefits benchmark plans). Our main findings include the following:

• State obesity rates range from 24.2 percent in Colorado to 39.7 percent in Mississippi, and county obesity rates range from 15.7 percent in Boulder County, Colorado, to 50.1 percent in Holmes County, Mississippi.
• Obesity rates increased in all states from 2011 to 2020.
• Preventive screening and counseling services are covered by all types of insurance nationwide under the Affordable Care Act.
• Coverage for other obesity treatment options varies substantially across the country. Fifteen Medicaid programs cover antiobesity medications in fee-for-service Medicaid, and only four additional programs cover antiobesity medications under at least one Medicaid managed-care plan. Only two states cover antiobesity medications in benchmark Marketplace plans, and 16 state employee plans offer such coverage.
• Forty-eight states cover some form of bariatric surgery under Medicaid, as do 23 state benchmark plans and 42 state employee plans.
• Only 26 fee-for-service Medicaid programs and 28 managed-care Medicaid programs cover specific nutritional counseling to support modified diets. Nutritional counseling is covered in 37 state benchmark plans and in 13 state employee health plans.
• Pharmacotherapy is the least-covered treatment option across all types of insurance coverage.