This post is the second in a series of three centering obesity as a health equity issue for older adults. ASA published a series of fact sheets to inform and educate the aging services network on prioritizing obesity care for older adults, which were distributed to congressional offices during ASA’s Hill Day on April 3, 2025, in Washington, DC, to advocate for the health and well-being of older Americans, including ensuring greater access and options to the full continuum of obesity care and treatment for older adults.
When I was first tasked with leading ASA’s latest obesity-centric project through the lenses of chronic diseases and health equity, I thought the universe is playing a joke. Since my pre-teen years, I have struggled with my weight. My father taught me about weight-shaming when he started calling me by the nickname, “Heavy.” While he may have meant it as a term of endearment, it was the beginning of a complicated weight stigma and body image journey. A journey that has taken me to the highs and lows of weight loss through the latest fad diets to the disappointment that any pounds lost were short-lived. It’s a journey that continues to this day at age 60.
Like the millions of Americans who have been struggling with obesity for a lifetime, I tried all the different lifestyle modifications, multiple diets, and sometimes experienced success. But I have struggled with weight regain and often felt a sense of personal failure as the pounds came back—that self-blaming and the internalized misconception that obesity is simply due to a lack of willpower. I have repeatedly confronted the mental exhaustion that comes from a lifetime spent trying to lose weight, only to plateau and then gain more back.
When assigned the obesity project last summer, I was in a “gain back” phase after a period of successful treatment with a GLP-1 medication prescribed in 2020 by my primary care physician for pre-diabetes and high cholesterol. After a change in my employer-sponsored health insurance coverage, the new pharmacy benefit manager denied continuation of the GLP-1. After my PCP exhausted the multi-step appeal pathway, I was forced to stop treatment abruptly. This was particularly disheartening as I experienced positive results on the medication—not only my body mass index but also lower A1-C, blood pressure, LDL cholesterol and triglycerides, thus potentially reducing my risk for heart disease and other chronic conditions.
My experience obtaining prescribed GLP-1 medication after an insurance change is not unique. Health insurance plans are restricting or eliminating coverage for GLP-1 medications due to rising costs. This trend is impacting both commercial insurance and publicly funded programs like Medicare and Medicaid. Many older adults are losing access to anti-obesity medications upon Medicare enrollment which is setting them up to experience worse health outcomes as they age.
Addressing obesity in the older adult population
requires a shift away from blame-based narratives toward structural solutions that promote healthy aging for all.
My initial reservations and ambivalence about working on an obesity project soon gave way to a newfound way of knowing, both as an individual and as a social researcher. Through a better understanding of the causes and consequences of obesity for older adults, I stumbled into a new professional interest in how applied gerontological research can address health disparities and promote healthier aging, ultimately contributing to a more equitable society. But the most fundamental take-a-ways are about the power of personal meaning-making and the importance of self-definition. I have learned that obesity is not a choice—my weight has never really been my fault nor under my control—my body simply needs something that others have naturally to support a healthy weight. There is something truly liberatory in knowing that I did not choose obesity, no one does!
In my research for this project, I learned that obesity is a complex disease with many causes and contributors. In the factsheets I wrote—Prioritizing Obesity Care for Older Adults—I center obesity in older adults as a health equity issue shaped by social, economic, and environmental disparities. Many older adults face barriers to obesity prevention and treatment, including limited healthcare access, food insecurity, financial constraints, and systemic ageism and weight stigma. Addressing obesity in the older adult population requires equitable policies, community-based interventions, and a shift away from blame-based narratives toward structural solutions that promote healthy aging for all.
Why Disparities Matter in Obesity and Aging
Obesity is not evenly distributed among older adults. Disparities in obesity rates and prevalence reflect historical and ongoing inequities in income, access to care, neighborhood environments, racism, and ageism. These inequities compound over time and influence who gets the opportunity to age healthfully.
- Racial and Ethnic Health Inequities: Higher obesity rates among Black, Hispanic, and Indigenous older adults due to historical inequities and structural racism across the life course, socioeconomic factors, and disparities in healthcare access. The rates of diagnosis and treatment for obesity among marginalized groups are lower and there are cultural barriers to accessing weight management programs tailored to diverse populations.
- Socioeconomic Barriers: Low-income older adults often live in food deserts, with limited access to fresh produce and healthy options. Affordable weight management programs, medications, and gym memberships are often out of reach. Economic precarity and financial limitations can magnify food insecurity and limit care seeking that makes transportation to healthcare facilities, nutrition counseling, and physical therapy difficult.
- Gender and Caregiving: Older women, especially women of color, face higher rates of obesity, stigma related to aging and body size, and are less likely to receive obesity treatment. Women are more likely to be caregivers, leaving less time for self-care and weight management. Stigma against aging bodies often discourages older women from seeking care and results in underdiagnosis and having their obesity dismissed by providers.
- Geographic and Rural Health Inequities: Rural older adults experience higher obesity rates and have fewer healthcare and fitness resources. Long distances to clinics, grocery stores, and senior centers limit access to obesity treatment. Healthcare workforce shortages further limit care in geographically isolated regions. Telehealth and mobile health services remain underfunded in rural areas.
Systemic Barriers to Obesity Care in Older Adults
Systemic barriers are rooted not just in individual behavior and choices, but in larger institutional, policy, and cultural structures that limit access to care and support for older adults living with obesity, especially those from marginalized communities.
- Weight Bias and Ageism in Healthcare: Older adults with obesity often experience discrimination in medical settings. Doctors may dismiss weight concerns as a “normal part of aging” or assume that treatment will not be effective. Medical education rarely covers obesity care for older populations, leading to poor treatment recommendations.
- Inadequate Provider Training and Bias: Most primary care providers receive minimal training in obesity management or geriatrics. Weight bias and stigma in clinical settings discourage older adults from seeking care or lead to dismissive interactions. Providers to older adults may focus solely on comorbidities (e.g., diabetes, heart disease) without holistically or respectfully addressing weight.
- Limited Medicare Coverage for Obesity Treatment: Medicare has limited coverage for evidence-based obesity treatments. It does not fully cover obesity medications, or structured weight-loss programs. Bariatric surgery is only covered in extreme cases, despite its potential benefits for certain patients. Intensive behavioral therapy has strict conditions. Advocacy is needed to expand insurance coverage for weight management services.
- Food and Nutrition Insecurity: Many older adults struggle to afford or access nutritious food due to fixed incomes or mobility limitations. Federal food assistance programs like SNAP and Meals on Wheels are underfunded and difficult to access for many older adults. Gentrification and urban displacement push elders away from grocery stores and into food deserts.
- Lack of Age-Friendly Exercise Opportunities: Many fitness programs are not designed for older adults with mobility issues or chronic conditions. Parks and sidewalks are often unsafe or inaccessible, limiting opportunities for walking and outdoor activity. Gyms and wellness centers may be cost-prohibitive or lack programming for older populations.
- Western Medicine Fails to Acknowledge/Integrate Culturally Relevant Care: Western medicine often treats obesity as a purely biomedical issue at the individual level, leading to a cultural disconnect in behavioral and clinical interventions with Indigenous Elders and diverse older adults. This manifests in ignoring cultural meanings attached to food, body image, and aging. As a result, providers too often miss how social stigma, trauma and cultural norms shape behavior and leave little space to engage with personal narratives or culturally-rooted health beliefs.
Advancing Health Equity in Obesity Care for Older Adults: A Call to Action
As a Black older woman living with obesity, I know I am not alone. I often hear the experiences of far too many older adults—especially women and people of color—who enter later life having endured a lifetime of systemic disadvantage that shapes our health and body weight. I am hopeful that my research and advocacy here at ASA and the contributions of other organizations in the aging milieu (e.g. NCOA and GSA) are leading us on the pathway toward equity-centered obesity care for older adults. Older adults—especially those who are low-income, racialized and marginalized, rural, LGBTQ+, disabled, or aging with HIV—face higher risks of obesity and greater barriers to care. An equity-centered obesity care framework will shift the focus from individual blame to systemic opportunity.
Below are my personal thoughts on a preliminary framework grounded in justice, aging and systems change to better support aging with obesity. It responds to systematic gaps and ensures care is accessible, respectful, and tailored to the lived experience of older adults.
Equity-Centered Obesity Strategies Across Systems for Older Adults
| System | Equity-Centered Action |
| Clinical Care | Provide weight-inclusive, non-stigmatizing care; screen older adults for obesity with respect and consent; provide culturally responsive obesity care for older adults to improve health outcomes, patient engagement, and healthcare utilization |
| Public Health | Fund culturally tailored, community-based obesity prevention and intervention programs for older adults; address the social drivers of obesity including isolation, mental health, and food insecurity |
| Policy | Pass the Treat and Reduce Obesity Act to expand Medicare coverage for obesity services; expand funding for telehealth and mobile care units, especially in underserved and rural areas |
| Community | Invest in age-friendly walkability, food access, and group-based movement programs |
| Workforce | Train healthcare providers in geriatric obesity care; train providers in ageism, weight bias, and intersectional stigma reduction |
| Research | Prioritize older adults—especially those from marginalized backgrounds—in obesity research and clinical trials |
The time is now to Shift the Narrative on Obesity in Aging! We, each and every one of us, must move away from blame-based, individualistic approaches and recognize the structural causes of obesity. This means we center functional health and quality of life rather than weight loss alone, and we promote body-positive, inclusive approaches to aging and health.
Health equity means every older adult—no matter their ZIP code, skin color, income, gender, sexual orientation, (dis)ability, or body size—has the support to thrive!
Patrice L. Dickerson, PhD, is ASA’s Senior Equity Strategy Director.
Photo credit: Shutterstock/Luis Fernando Davila
