Mass. residents who take GLP-1 drugs for obesity tend to be white and affluent. But who needs them most?

Boston Globe

12-05-2025

Obesity, which
White people account for about 68 percent of Massachusetts residents with obesity but make up 82 percent of patients taking the drugs, according to the analysis, which relied on tens of thousands of insurance claims and data on assets.
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Women make up 51 percent of the state's obese residents but about 71 percent of GLP-1 users. And nearly one-third of people taking the medicines have household incomes of $200,000 or more.
Meanwhile, Black, Hispanic, Asian, and low-income residents are underrepresented among people taking GLP-1s, based on their obesity rates. (In Massachusetts,
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A variety of factors appear to contribute to the disparities, not the least of which is the cost of the self-injected drugs. GLP-1s have list prices of $1,000 or more a month, and insurance coverage of the medications varies widely.
The disparities worry health experts, who say the medicines have the potential to narrow differences in obesity rates among demographic groups, but may in fact be widening them.
'These drugs are very important for everyone to have access to,' said Jonathan Rossman, a senior analyst for Real Chemistry, 'not just the ones who have the means to pay for it.'
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Among those who have struggled to afford GLP-1 drugs is Jordan, a 37-year-old Cambridge resident and manager of a nonprofit that mentors high school students.
Jordan is Black, uses they/them pronouns, and only wanted to be identified by their first name because of privacy concerns. Weighing 285 pounds at their peak, Jordan first tried the daily drug Saxenda in mid-2022. They shed 40 pounds but then plateaued. In January of last year, they switched to the weekly drug Wegovy. In both cases, Jordan had a modest monthly co-pay of $20 through their insurance.
'It's been extremely meaningful,' Jordan said of losing weight. It helped to relieve asthma and back pain, they said, and had 'mental effects, like being on the subway and not worrying about whether I can squeeze into the seat.'
But when Jordan began working for the nonprofit last July, they said, their new insurance plan at CVS Caremark wouldn't cover Wegovy. It would cost $1,500 a month out of pocket, which was unaffordable.
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So Jordan switched to a copycat version of the drug available online from a compounding pharmacy for $500 a month. However, the Food and Drug Administration has cracked down on copycat GLP-1s, saying in March that they 'can be risky for patients' because they haven't been approved by regulators. Jordan isn't sure what to do if the drug becomes unavailable; they have lost a total of 92 pounds since they began taking GLP-1s.
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Experts say some demographic groups aren't as aware of the medications as others. Some patients of color are more skeptical of medical care than white patients because of harm they historically suffered during such episodes as the infamous Tuskegee syphilis study. Black and brown patients may also
face greater challenges in finding a primary care physician to prescribe GLP-1s, or have
difficulty getting time off from work to see a doctor.
Cultural ideals about appearance may also play a role in the disparities between groups.
'That's basically the demographic that faces the most societal pressure for fitness, so they'd be the ones seeking the prescriptions most urgently,' she said. Anekwe sees about 20 patients a week with obesity, she said, and roughly 70 percent are white women.
To qualify for the medications, private and public insurers have generally required patients to have a body mass index of at least 30, or 27 if individuals have a weight-related medical condition such as cardiovascular disease or high blood pressure. (Someone who is 5 feet 7 inches tall and weighs 192 pounds has a BMI of 30.)
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Traci Haddock, who works for a biotech in the Fenway area, said she first began taking GLP-1s about 18 months ago after her primary care doctor said her blood sugar levels indicated she was prediabetic. She weighed 330 pounds at the time.
Haddock, who is white, said she had struggled to lose weight all her life but didn't feel societal pressure to take a GLP-1 – just the opposite.
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'I feel like there's a bit of stigma against taking the medication, like it's the easy way out,' said Haddock.
She first used Saxenda, which her husband, Chris Angelli, a Somerville High School science teacher, takes for obesity. Haddock lost 25 pounds but then regained it. In December, she switched to Zepbound. She has lost 25 pounds again and says her cravings, or 'food noise,' have disappeared.
Haddock, whose annual household income exceeds $200,000, said she has a co-pay of $60 a month under her insurance plan from Harvard Pilgrim Health Care and can easily afford the treatment.
'We're very fortunate,' she said. 'I will pay $15 a week to lose one to two pounds a week, no problem.'
Traci Haddock and her husband, Chris Angelli. Haddock said she has a co-pay of $60 a month under her insurance plan from Harvard Pilgrim Health Care and can easily afford Zepbound.
John Tlumacki/Globe Staff
A new study by researchers from the Yale School of Medicine found similar disparities in prescriptions for GLP-1s written nationwide that the Globe analysis identified for prescriptions written in Massachusetts.
The Yale researchers examined electronic health records of 277 million patients from more than 280 US health care systems between July 2020 and October 2024. The team found more than 39 million adults qualified for GLP-1s to treat obesity, but only 2.3 percent of them obtained prescriptions for semaglutide (the active ingredient in Ozempic and Wegovy) or tirzepatide (the active ingredient in Mounjaro and Zepbound).
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Again, male patients were less likely than female patients to obtain prescriptions, and Black, Hispanic, and Asian patients were underrepresented, based on their obesity rates, according to the study published late last month in JAMA Network.
'We want to make sure these powerful drugs can reach the patients who need them most, but when we look at the obesity prevalence, there's a disparity there,' Yuan Lu, an assistant professor of medicine and the senior author of the study, said in an interview.
Although affordability appears to be fueling disparities in Massachusetts, the state actually has one of the more generous public insurance programs for lower-income residents seeking GLP-1s.
Massachusetts is one of 15 states that cover the cost of GLP-1s to treat obesity in patients on Medicaid, the federal health care program for people with low incomes, according to former Massachusetts Public Health Commissioner Christine Ferguson. Her firm, Leverage Global Consulting, tracks coverage of GLP-1s by public and private insurers.
MassHealth,
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'At least in Massachusetts, our Medicaid program works against disparity,' said Dr. James Morrill, a primary care physician and medical director at the MGH Charlestown HealthCare Center who prescribes GLP-1s several times a week.
In addition to treating diabetes and obesity, GLP-1s are being studied by scientists as potential treatments for disorders ranging from
Scientists have known for years that the drugs lessen the rewarding effects of addictive drugs, including alcohol, nicotine, and opioids, in laboratory rodents.
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'There are, like, 60 different disease states that GLP-1s are being studied for in various clinical trials,' said Rossman, of Real Chemistry. 'It's an amazing class of drugs.'
Jonathan Saltzman can be reached at