For Black Women, Accessing Weight-Loss Drugs Is a Difficult Journey

For many Black women facing or in the obesity index, it can often feel like there's no way out when it comes to weight gain. But now, weight-loss drugs like Zepbound, Mounjaro, Ozempic, and Wegovy are offering a promising solution. Deemed a saving grace for better health, these drugs were originally designed for patients with type 2 diabetes and have since been approved for obesity and heart disease, two chronic conditions that disproportionately affect Black people due to disparities in income and education, as well as less access to health insurance, housing, and healthy food.

These drugs are not the magic solution for weight loss, but rather a solid foundation and agent that work in conjunction with a well-balanced diet, exercise, and sleep. However, for many Black women, health insurance either doesn't cover them or the upfront costs are out of their price range. Some don't have insurance at all — leaving them out of an equation that could significantly improve their health.

According to the Food Research and Action Center, 54.8 percent of Black women in America are obese, compared to 38 percent of white women. Even though white folks are diagnosed for diabetes at a rate that's 40 percent lower than that of Black people, they are four times more likely than Black people to receive a prescription for weight-loss drugs, according to CNN. In other words, those whose health could benefit most from significant weight loss are the least likely to get the high-ticket medications.

To find out more about why these discrepancies exist — and uncover other frustrations Black women face in their weight-loss journeys — we spoke to women currently on weight-loss drugs as well as medical experts who work with Black women patients undergoing this journey.

Alicia Shelly, MD, is diplomate of American Board of Obesity Medicine and host of the "Back on Track: Achieving Healthy Weight Loss" podcast.

Akua K. Boateng, PhD, LPC, is a licensed psychotherapist and founder of Boateng Psychotherapy & Consultation.

Jessica Wilson, MS, RD, is a registered dietitian and author of "It's Always Been Ours: Rewriting the Story of Black Women's Bodies."

According to Alicia Shelly, MD, a board-certified physician and obesity medicine specialist, certain insurance programs like Medicare and specific state Medicaid plans don't cover anti-obesity medications. (Fifty-three percent of Black people were on Medicaid in 2022.)

Ozempic, approved for people with diabetes and prescribed off-label for weight loss, and Wegovy, which is approved for weight loss, can cost more than $1,000 a month. Both drugs are not covered for weight loss by most insurance plans and have to be paid out of pocket. Both Dr. Shelly and Akua K. Boateng, PhD, LPC, a licensed psychotherapist, say many patients can't afford to pay these steep prices each month, especially for medications they need to be on indefinitely.

For Ebony Powers Watermann, senior account director of client services at BMF Media, it took multiple attempts with her insurance to get approved for Wegovy. "After taking several different medications that didn't work for me, my doctor had to submit a business justification letter, including my full medical history, gym memberships, prescriptions, proving that I was actively trying to lose weight," Watermann says, adding that she eventually used her husband's insurance for coverage.

Her journey echoes the reality a handful of Black women face: long wait times, even if they can afford to pay out-of-pocket prices. "I have been jumping through hoops for months and just started on Wegovy last week," shares Tess, a woman based in Delaware who is being identified by a pseudonym to protect her privacy. She turned to anti-obesity drugs after a failed weight-loss surgery. "It was hard to get approved. Even with excellent insurance that I pay a lot for and a Black female doctor who I pay concierge rates for, it's been an exceptionally hard process."

But even when Black women are able to get prescriptions, they have to contend with the shame associated with weight-loss drugs. "There is a stigma about drugs being an easy way out or even cheating," Dr. Shelly says. "When in reality, for some people, lifestyle interventions are not enough to get to a healthy weight. Some people need more help to lose weight, because obesity is a chronic disease."

Weight-loss drugs could drastically improve the lives of individuals — average weight loss for lifestyle interventions is five to 10 percent, versus the 15 to 20 percent with injections — and society and family ties should respect that instead of talking down to it. "I've never been a size 0 — I'm not built that way," Tess says. "But being a professional woman, I carry my weight as best as I can, and I'm not ashamed to admit that I'm taking every path allowed to me so I can get this off of me."

Indeed, there's a lot of pressure for Black women to subscribe to beauty standards, given how much misogynoir is at play in our society. For so long, Black women have been conditioned to fit into a smaller clothing size, no matter the cost. And these new waves of anti-obesity drugs have only furthered that obsession. "The conversations about weight loss today completely disregard the last four centuries of messaging about bodies and the way today's pressure to be thin originates in anti-Blackness," says Jessica Wilson, MS, RD, a registered dietitian.

Wilson believes that diet culture exists because of our historical values of purity, virtuousness, and thinness. "When we go to the doctor's office, we're told to lose weight, to eat less and exercise more," she adds. "But rarely do people talk about environmental racism, environments generally, trauma — all the things that actually impact our health and our weight."

When it comes to dealing with healthcare systems and a society at large that's racist and sexist, the two patients and all three professionals stressed the importance of being your own advocate. "I'm not afraid to get a second opinion," Watermann says. "From my parents' age, they were afraid to get second opinions. They trusted the doctors they were with for years and whatever they said was law. But for me, it's really being an advocate for myself. If I'm not hearing something I want to hear in terms of my care, I'm going to get another opinion or another doctor."

And equally as important, they encourage seeking out culturally competent care and having someone in your corner that can go to battle for you. Tess says she's had doctors in the past who haven't taken her pain seriously, and that's why she prefers Black women doctors — as she puts it, they "don't just hear me, they listen to me."

"It wasn't until I went to my current Black female doctor who was able to position my struggle with weight as a disease, instead of something that's because of poor willpower or laziness," Tess continues. "That helped me put things into perspective and decide that these weight-loss drugs were right for me. Working with my doctor has helped me to decide what the right path is for me and has been vital in getting the care I need."

Natasha Marsh is a freelance writer who writes about fashion, beauty, and lifestyle. Prior to freelancing, she held styling staff positions at The Wall Street Journal, Burberry, Cosmopolitan Magazine, British GQ, and Harpers Bazaar.