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Reducing Obesity, the Primary Comorbidity in the Fight against COVID-19

Photo of Representative Alma Hernández

Rep. Alma Hernández (AZ), sponsor

Sponsored by Rep. Alma Hernández (AZ)

Reported to the Caucus by the NHCSL Healthcare Task Force
Rep. Louis Ruiz (KS), Chair

Ratified by the Caucus on December 11, 2020

WHEREAS, a study of 17,000 patients hospitalized with COVID-19 in the US found that 29% were overweight and 48% had obesity;[1] and,

WHEREAS, a meta-analysis of peer-reviewed papers covering 399,000 patients found that people with obesity who contracted COVID-19 were 113% more likely than healthy, non-obese people to be admitted to the hospital, 74% more likely to end up in the ICU, and 48% more likely to die;[2] and,

WHEREAS, nearly 72% of Americans are overweight or obese[3] and certain demographic and socioeconomic groups, like Hispanic Americans, African Americans, and the impoverished are impacted disproportionately by obesity; and,

WHEREAS, the U.S. Department of Health & Human Services Office of Minority Health reports that in 2018, Hispanic Americans were 1.2 times more likely to be obese than non-Hispanic whites[4], and 4 out of 5 African American and Hispanic American women are likely to be obese or overweight;[5] and,

WHEREAS, we previously addressed the prevention and mitigation of the disease[6] of obesity in Resolution 2013-02, Addressing the Obesity Epidemic in America;[7] and,

WHEREAS, analysis by the Centers for Disease Control and Prevention of COVID-19 deaths from May to August 2020 found deaths among Hispanic Americans increased from 16.3% in May to 26.4% in August while deaths of non-Hispanic whites and African Americans dropped during the same time period;[8] and,

WHEREAS, the disproportionately negative effects of COVID-19 on Hispanic Americans and African Americans have shined a light on the social determinants of health (SDH) and the health inequities long experienced by communities of color;[9] and,

WHEREAS, Hispanic Americans are more likely than non-Hispanic whites to be uninsured at 19% versus 8%;[10] and,

WHEREAS, inequities in access to and quality of care lead to poorer health overall and many chronic illnesses, such as diabetes and obesity, that influence their chances of getting COVID-19; with obesity having shown to be one of the strongest predictors for COVID-19 and its severity;[11] and,

WHEREAS, additional critical health inequities include Hispanic Americans and African Americans being more likely to hold jobs that are considered essential or cannot be done from home; for example, they are more likely to be employed in the service industry (24%) than non-Hispanic whites (16%),[12] putting them at risk of exposure if they continue to work in those positions; and,

WHEREAS, characteristics of communities in which Hispanic Americans often reside may place them at greater risk for developing chronic illnesses, such as lack of affordable and healthy foods or safe places to play or exercise outdoors; and,

WHEREAS, the Food and Drug Administration (FDA) has approved a number of pharmaceuticals as safe and effective for the treatment of obesity; and,

WHEREAS, progress in the development of lifestyle modification therapy, pharmacotherapy, and bariatric surgery has led to new options with improved patient outcomes; and,

WHEREAS, the Medicare program currently covers obesity screening and counseling and certain bariatric surgery procedures for morbidly obese beneficiaries, but the Medicare law prohibits Part-D coverage of prescription drugs to treat obesity;[13] and,

WHEREAS, according to a study by the Obesity Society, while most states cover bariatric surgery under Medicaid,[14] only a small number of state Medicaid programs provide some coverage for medication-based obesity treatment.[15]

THEREFORE, BE IT RESOLVED, that the National Hispanic Caucus of State Legislators (NHCSL) recognizes that health inequities in communities of color have led to a disproportionate impact of COVID-19 and that states must address the high rates of obesity to improve the health of racial minorities and prepare for the next public health epidemic; and,

BE IT FURTHER RESOLVED, that NHCSL calls on Congress to eliminate the barriers to coverage of FDA-approved anti-obesity medications in the Medicare Part-D program; and,

BE IT FINALLY RESOLVED, that the NHCSL encourages legislators to take steps to address obesity in their own states to encourage healthier lifestyles, raise awareness and ensure their constituents, including those using Medicaid, have access to the full continuum of treatment options for obesity, including FDA-approved anti-obesity medications.



[1] “Why COVID-19 is more deadly in people with obesity—even if they’re young”. ScienceMag. Available at: https://www.sciencemag.org/news/2020/09/why-covid-19-more-deadly-people-obesity-even-if-theyre-young#:~:text=The%20largest%20descriptive%20study%20yet,%25)%20or%20obese%20(48%25).

[2] “Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships”. Obesity Reviews. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/obr.13128

[3] Centers for Disease Control and Prevention, “Obesity and Overweight”. Available at: https://www.cdc.gov/nchs/fastats/obesity-overweight.htm

[4] Available at: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=70

[5] Available at: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=70


[6] American Obesity Treatment Association, “IRS Recognizes Obesity as a Disease”. https://www.americanobesity.org/irsObesity.htm. Pollack A. “A.M.A. Recognizes obesity as a disease”. 2013. The New York Times. Available from: http://www.nytimes.com/2013/06/19/business/ama-recognizes-obesity-as-a-disease.html. Garvey, W Timothy et al. “American association of clinical endocrinologists and American college of endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease.” Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists vol. 20,9 (2014): 977-89. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962331/. “Overview of the Endocrine Society's Guideline on Obesity Medications”. https://www.endocrineweb.com/professional/obesity/overview-endocrine-societys-guideline-obesity-medications

[7] Available at: https://nhcsl.org/resources/resolutions/2013/2013-02/index.html

[8] Centers for Disease Control and Prevention, “Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 — United States, May–August 2020”. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6942e1.htm

[9] Centers for Disease Control and Prevention, “Health Equity Considerations and Racial and Ethnic Minority Groups”. Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html

[10] “Changes in Health Coverage by Race and Ethnicity since the ACA, 2010-2018”. KFF.org. Available at: https://www.kff.org/racial-equity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/

[11] Centers for Disease Control and Prevention, “Obesity Worsens Outcomes from COVID-19”. Available at: https://www.cdc.gov/obesity/data/obesity-and-covid-19.html

[12] U.S. Bureau of Labor Statistics, “Labor force characteristics by race and ethnicity, 2018”. Available at: https://www.bls.gov/opub/reports/race-and-ethnicity/2018/home.htm#:~:text=The%20employment%E2%80%93population%20ratio%20was,and%2063.2%20percent%20for%20Hispanics.

[13] Gomez, G, and F C Stanford. “US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity.” International journal of obesity (2005) vol. 42,3 (2018): 495-500. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082126/

[14] All states except Alabama and Montana cover bariatric surgery under Medicaid. See Jannah et al., “Coverage for Obesity Prevention and Treatment Services: Analysis of Medicaid and State Employee Health Insurance Programs”. 2018. Obesity Society. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22307

[15] The states that offer pharmacotherapy coverage under Medicaid are Alabama, Arizona, California, Delaware, Hawaii, Idaho, Kansas, Louisiana, Michigan, New Hampshire, New Jersey, North Dakota, Rhode Island, South Carolina, Virginia, and Wisconsin. (The study could not determine the medication coverage in Oregon and Arkansas.) See Jannah et al., “Coverage for Obesity Prevention and Treatment Services: Analysis of Medicaid and State Employee Health Insurance Programs”. 2018. Obesity Society. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22307