In 2023, obesity and excess weight cost U.S. businesses and employees $425.5 billion, according Global Data. If we are serious about tackling the obesity crisis in America, then we must start with the foundation: food. Nutritional well-being is not a luxury—it is a prerequisite for lasting health. And yet, far too often, our healthcare system treats nutrition as an afterthought, not a cornerstone of care.
Medical Nutrition Therapy (MNT), delivered by registered dietitian nutritionists, is an evidence-based intervention that helps patients manage and improve chronic conditions—including obesity—by teaching sustainable, personalized strategies for eating well. Despite overwhelming evidence showing its effectiveness, MNT remains underutilized and under covered in Medicare and across our healthcare system.
A systematic review published by the Academy of Nutrition and Dietetics found that MNT interventions led to significantly greater weight loss, reductions in BMI and waist circumference, improvements in fasting blood sugar and blood pressure, and likely increased quality of life. One to three contacts per month with a dietitian yielded the greatest improvements.
The power of MNT becomes even clearer when it is paired with other interventions. A 2017 systematic review on bariatric surgery showed that patients who received post-operative MNT from a registered dietitian nutritionist had significantly greater outcomes—including excess weight loss ranging from 60% to 80% and BMI reductions between 5% and 31%--compared to those who did not receive MNT. In other words, nutrition therapy magnifies the impact of high-cost, high-intensity interventions.
The same principle should apply to the newly approved GLP-1 medications for obesity. These drugs offer real promise, and the Academy celebrates their potential to change lives. But if the goal is sustained weight loss, improved health outcomes, and long-term cost savings, they must be paired with MNT.
The economic case is equally strong. A new Avalere Health analysis estimates that expanding Medicare coverage of MNT to include obesity would save the federal government $27.3 million over ten years. This is a rare opportunity to align better health outcomes with budgetary savings.
By contrast, the Congressional Budget Office recently estimated that expanding Medicare coverage of glucagon-like peptide-1 receptor agonists, commonly known as GLP-1-based anti-obesity medications, would cost $35 billion over the same period. CBO’s modeling does not currently factor in the cost-offsetting potential of MNT—something that lawmakers should urge them to re-evaluate. Incorporating MNT into these models could reveal ways to lower the net cost of expanding access to obesity medications.
As of May 2024, according to a KFF Health Tracking Poll, approximately 6% of adults in the United States reported using GLP-1 medications primarily prescribed for type 2 diabetes and weight management. Given the increasing popularity of these medications, it's plausible that the number of individuals using them has risen even higher. These medications are effective for weight management with up to 25% body weight loss, however the side effects can be serious. The most common side effects range from gastrointestinal issues such as nausea, vomiting, diarrhea, and constipation to headache, fatigue, and loss of muscle mass. These side effects impact how long and whether individuals continue the medications. In a recently published cohort study of over 125,000 individuals starting GLP-1’s, 46.5 % of patients with and 64.8% without type 2 diabetes discontinued taking the medications within the first year.
MNT is a therapeutic, individualized intervention shown to significantly improve outcomes and reduce costs when paired with other obesity treatments. To fully realize the potential of GLP-1s and other anti-obesity tools, Congress must add MNT to the list of covered services. MNT is the foundation that will make these new treatments more effective and potentially reduce the federal cost burden associated with their coverage. The Academy of Nutrition and Dietetics supports the Treat and Reduce Obesity Act (TROA)—bipartisan legislation that expands Medicare coverage for both anti-obesity medications and Intensive Behavioral Therapy (IBT), a valuable service that complements nutrition counseling. However, TROA does not currently authorize Medicare to cover Medical Nutrition Therapy (MNT) for obesity—a crucial gap.
The future of obesity care is not either/or—it’s both/and. Medication plus MNT. Innovation plus education. The Treat and Reduce Obesity Act is the path forward.
We urge Congress to seize this moment, and pair any coverage expansion for anti-obesity medications with expanded access to Medical Nutrition Therapy.
Dr. Wylecia Wiggs Harris is CEO of the Academy of Nutrition and Dietetics.
