(Image via Pixabay by Clker-Free-Vector-Images)

MIDWAY THROUGH ITS second season, “The Pitt” provided a window into what patients living with obesity can experience when they seek care. Soon after one of the characters in the HBO Max series, Howard Knox, arrived at the emergency department, he learned he would have to go to another hospital for a CT scan with a machine that could accommodate his size and weight.

A student doctor suggested the zoo would have the right equipment. He then peppered Howard for explanations about his obesity.

From equipment barriers to hurtful comments, the show illustrated challenges that I too have encountered as a person living with severe obesity. There were also examples of appropriate, dignified care – particularly when another character stated they could best help Howard by figuring out why he was in the ED and treating him with respect.

Howard’s story reminds us that despite a growing understanding of what obesity care should look like, biases still influence our health care system to patients’ detriment. Unfortunately, policy decisions in Massachusetts are contributing to the stigma so artfully portrayed on “The Pitt.”

Financial losses prompted the Commonwealth’s largest private health insurers last year to announce they would no longer cover GLP-1 medications for obesity. MassHealth, the state Medicaid program, followed suit with cuts to its fiscal 2027 budget, causing 22,000 people to lose access to their treatments in early July. The commission that manages health insurance for 460,000 state employees hastily voted to do the same.

These decisions reflect the same misperceptions of obesity that Howard navigated at the fictional Pittsburgh Trauma Medical Center. Obesity is not a lifestyle choice. It is not something that just goes away with enough hard work, diet, and exercise. It is a chronic disease caused by complex factors that are unique to each patient and often out of their control.

Cutting treatments that manage this disease, and the many health risks it can lead to, ignores that reality. Calling it a “cost-saving measure” promotes the idea that GLP-1 medicines are superficial and not critical for keeping many people healthy. Worse yet, it signals to a community of patients that those responsible for protecting their health are OK with them getting sicker if it protects the bottom line.

All of this adds to the stigma obesity already carries. It’s not by chance that Howard repeatedly apologizes to his medical team as they figure out how to help him. People living with obesity are blamed for being a burden on our health care system. But that system fails to provide an adequate level of care when the equipment doesn’t work, when diagnoses are missed because of weight bias, or when insurance refuses to cover proven medications.

When patients stop using GLP-1s, they are likely to regain weight, putting them at risk for complications. More than 200 chronic conditions are connected to obesity. If someone develops diabetes after losing access to treatment, that comorbidity is there to stay.

This is especially worrisome for patients insured through MassHealth, who are disproportionately affected by obesity. Even if the coverage lapse is brief, there are also no guarantees that resuming a prior GLP-1 dosage will work as effectively. I experienced this when a judge granted my appeal to reinstate my GLP-1 coverage after nearly six months without it.

Severe health problems stemming from untreated obesity will bring greater expenses down the road. Massachusetts already struggles with unnecessary trips to the emergency department and avoidable hospital costs. Insurers have even cautioned that premiums will still rise despite these cuts. After diseases worsen and costs add up, I fear the blame will once again be cast toward people whose care was taken away.

Years ago, when I was living in Ohio, coverage for obesity care through Medicaid helped me get my health back. It allowed me to get my first professional job. I often say Medicaid saved me. However, the attitudes toward obesity emerging from recent policies in Massachusetts do not reflect the state that led the country in providing insurance coverage to nearly all its residents.

Creative approaches exist for states to maintain obesity treatments at sustainable costs. Medicare just launched a pilot program opening GLP-1 access to eligible patients for a $50 copay. MassHealth recipients should not be forgotten, nor should anyone who needs these medications to treat their chronic disease.

Policymakers and local leaders must work with insurers and GLP-1 manufacturers to make sure these life-changing therapies remain accessible. Blanket denials of coverage will harm patients, invite long-term costs, and worsen the stigma we should be fighting against.

Sarah Bramblette is a senior advocacy manager at the Obesity Action Coalition.