ByJerel EzellGuest contributor
Aug. 4, 20263:02 AM PT
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A few years ago, I interviewed a Black teen as part of a study on the health of Gen Z. What this ninth-grader from an inner-city community was most passionate about surprised me
“In eighth grade, lunch used to be something tasty; I could eat it,” she told me. “Here we go now: 65% reduced fat. Barely any seasoning. I’m like, ‘What is this crap?’”
She was talking about the healthy meals program being rolled out in California K-12 schools like hers as part of the Obama administration’s effort to tame the nation’s childhood obesity epidemic
I suggested to her that the government’s lunch initiative — which to be fair was also deeply disliked by a number of adults, namely Republicans in Congress — might help teens she knew lose weight or stave off diabetes. She wasn’t having it. “When they get home,” she said of her peers, “they’re going to eat a thousand bags of hot Cheetos.”
Roughly 30% of Los Angeles Unified School District students are overweight or obese, uncannily mirroring the rate among Los Angeles County adults. Black and Latino individuals are disproportionately represented in each group, making the city ground zero for this persistent, racialized epidemic. And by 2030, a staggering 41.5% of California adults, a good portion of whom will be Black and Latino members of Gen Z, are expected to be obese
In America, obesity rates are consistently higher among racial minorities relative to white populations. The same pattern exists for type 2 diabetes, with nonwhite individuals having a higher burden of the complex disease. Disproportionately lower levels of access to healthy, affordable foods and limited access to infrastructure and amenities that promote physical activity serve as the primary culprits. The downstream effects, a lower quality of life and a higher likelihood of premature death, are grave.
GLP-1s, the seemingly magic drugs capable of dramatically reducing diabetes and obesity-related issues, seem to be an obvious — or at least the most efficient — solution to this preventable public health crisis. But studies consistently show that, despite their elevated need, racial minorities receive significantly fewer prescriptions for GLP-1s. And it’s not necessarily from a lack of trying on the part of Big Pharma, an industry eager to expand its customer base. In fact, in the last few years, Big Pharma and its allies have worked hard to bring minority customers into the GLP-1 fold.
In 2021, Novo Nordisk, the maker of Ozempic and Wegovy, sponsored a panel on obesity at a conference held by the powerful Congressional Black Caucus. Last year, the mammoth pharmaceutical company organized a similar panel for the influential National Assn. of Hispanic Nurses
Oprah Winfrey, whose battles with weight loss are well-documented, hosted a highly publicized ABC special on GLP-1s in 2024. The billionaire media personality formerly served as a board member and spokesperson for Weight Watchers, which now offers a subscription-based program providing customers with access to various GLP-1s. Winfrey later discussed in an interview the profound ways the drugs helped her quiet the “food noise” around her. And in 2025, telehealth company Ro, which has its own GLP-1 distribution service, unveiled a partnership with tennis megastar Serena Williams, who used GLP-1s to manage her postpartum weight gain.
A host of well-known Black and Latino social media influencers have also served as boosters for GLP-1s (and, by extension, Big Pharma’s outreach efforts)
The lower adoption of GLP-1s by racial minorities has been, ironically, largely of Big Pharma’s making. Racial minoritiesfrequently aren’t included in the formative clinical trial testing phase in which drugs are optimized to prospective patients’ biological and cultural nuances. The dearth of participation is both a function of researchers’ historically soft interest in including minorities in studies and minorities’ own distrust and fears about participating
Despite awareness of these participation gaps, which go back decades, there have been only marginal improvements in minorities’ representation in clinical studies, including those for GLP-1s. A review of clinical trials conducted with GLP-1s found that Black and Latino people were significantly underrepresented relative to white people
There’s also the stingy issue of price. Totaling an average of nearly $7,000 annually, the costs of GLP-1s are simply untenable for the many racial minorities who lack the income or premium insurance needed to cover the expenses. Indeed, a number of private and public insurers are still only marginally covering the costs of GLP-1s, if at all
Medicaid coverage for GLP-1s is currently optional for states. Only 13 currently cover GLP-1s for obesity treatment , and that largely doesn’t include states with large racial minority populations dealing with obesity like Florida and Texas. Despite outcry, Medi-Cal severed coverage of GLP-1s for weight loss earlier this year as part of a broader budget-trimming effort in California. GLP-1 coverage through Medicare, which historically has been hostile to covering weight loss drugs, is even more limited. However, the Centers for Medicare & Medicaid Services, which administers Medicare, began a pilot program in July to provide coverage to some Medicare beneficiaries. This program may provide a path for lowering GLP-1s’ steep financial burden for low-income minorities, but even if it’s successful, other barriers exist to racially equitable uptake.
For one, despite their mainstreaming, GLP-1s still haven’t entirely shed their image as an amenity for white elites and at odds with the body positivity movement. Years of social conditioning around the white female beauty standard — one exalting thinness — may push some racial minorities to outright reject GLP-1s and the bodily gentrification the drugs seem to facilitate. Relatedly, some believe GLP-1s are a shameful shortcut, misaligned with the grit we traditionally associate with “real” fitness. Incidentally, though, a 2024 Pew poll found that 70% of Black people and 68% of white people feel that willpower alone is usually not enough to lose weight and keep it off.
I asked that Black teen a few years ago what a potential answer to the obesity epidemic could be, and she was clear: “If you’re going to have somebody eat healthy, pair it with exercising. Or it ain’t doing nothing.”
GLP-1s’ success largely upends such conventional wisdom. That these drugs can be an all-in-one solution is becoming increasingly obvious, even to naysayers. Whether we should allow them to be is a very different — and very racialized — question
Jerel Ezell is a sociologist and assistant professor at the University of Chicago Medical Center
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Ideas expressed in the piece
The article argues that California’s efforts to curb childhood obesity, such as healthier school lunches, have done little to counter a deep, racialized epidemic in which Black and Latino students are disproportionately overweight or obese, mirroring adult patterns in Los Angeles County and across the United States.[5][13]
Building on this, the piece contends that structural factors — including limited access to affordable healthy foods and to safe places to exercise — drive higher rates of obesity and type 2 diabetes among Black and Latino Californians, resulting in lower quality of life and higher risks of premature death.[5][6][13]
The article presents GLP-1 drugs as an apparently efficient medical solution to obesity and diabetes, but emphasizes that Black and Latino patients receive significantly fewer prescriptions than white patients despite having greater need, citing research that finds lower odds of GLP-1 use among nonwhite groups even after adjusting for clinical and socioeconomic factors.[2][8][9][10]
The piece suggests that this inequitable uptake is partly “of Big Pharma’s making,” noting that racial minorities have been underrepresented for decades in clinical trials of GLP-1 medicines, which can erode trust and limit the tailoring of treatments to diverse biological and cultural contexts.[7]
At the same time, the article describes how pharmaceutical companies and allied industry players have aggressively courted Black and Latino consumers — sponsoring panels with the Congressional Black Caucus and Hispanic nursing groups, and partnering with high-profile figures such as Oprah Winfrey and Serena Williams — yet argues that these marketing efforts have not overcome deeper access barriers or representation gaps.[5][6][11]
The article further maintains that price and insurance coverage are central obstacles, pointing out that GLP-1s can cost roughly $7,000 a year and that many private and public plans offer minimal or no coverage, while state Medicaid programs are not required to cover the drugs for obesity treatment, leaving many low-income Black and Latino patients unable to afford them.[1][3][6][13]
Focusing on California, the piece criticizes Medi-Cal’s recent decision to sever coverage of GLP-1s for weight loss as a budget-cutting move that disproportionately harms low-income, disproportionately Black and Latino residents who already face high rates of obesity and live in “food deserts” and “medical deserts.”[6]
The article also explores cultural and social dimensions, noting that GLP-1s are often perceived as an amenity for white elites and as clashing with body positivity movements and nonwhite beauty norms; it highlights lingering beliefs that using such medications is a “shortcut” inconsistent with the expected grit and willpower associated with “real” fitness, even as polling shows many people doubt willpower alone can sustain weight loss.[5]
Finally, the piece suggests that GLP-1s increasingly function as an all-in-one answer to obesity and related diseases, but argues that whether society should allow these drugs to serve as the primary solution — given racially unequal access, cultural tensions, and policy choices like Medi-Cal cuts — is a profoundly racialized question that remains unresolved.[1][3][5][6][13]
Different views on the topic
In contrast to the article’s emphasis on tailoring GLP-1s to racial and cultural nuances, clinical trial evidence synthesized in recent meta-analyses finds that GLP-1 drugs produce similar weight loss across racial and ethnic subgroups, with no significant differences in treatment effect by race or ethnicity; some researchers therefore suggest that biology does not justify race-specific optimization and that the focus should be on broad, equitable access rather than racialized pharmacology.[4]
While the article frames policy decisions such as Medi-Cal’s cuts as shortsighted and stigmatizing, health policy analyses note that GLP-1 coverage poses large and uncertain budget impacts for public programs, especially at current prices; these reports indicate that legislators must weigh spending on GLP-1s against other essential services, and some policymakers argue that limiting coverage reflects fiscal constraints rather than targeted disregard for minority communities.[1][3][13]
The piece portrays GLP-1s as an increasingly obvious “all-in-one” solution, yet some obesity specialists and ethicists caution against over-medicalizing weight management and argue that lasting progress requires comprehensive strategies: healthier food environments, urban design that supports physical activity, and sustained behavioral support. These commentators warn that heavy reliance on GLP-1s could divert attention and resources from structural reforms that benefit all communities, including Black and Latino neighborhoods.[5][13]
Whereas the article foregrounds racial inequity around GLP-1s as a distinct problem, several studies stress that the observed disparities are part of broader socioeconomic and insurance gaps affecting many high-cost therapies. Researchers in large cohort analyses conclude that lower GLP-1 use among Asian, Black, and Hispanic patients is closely tied to lower income, lack of insurance, and weaker ties to routine care, and argue that solutions should prioritize expanding coverage, strengthening primary care access, and addressing social determinants rather than focusing narrowly on GLP-1 marketing or trial representation.[8][9][10][12]
The article highlights distrust of clinical research and underrepresentation in GLP-1 trials as major barriers, but other experts note that, despite these gaps, minority patients in existing studies achieve comparable benefits from the drugs. These commentators contend that emphasizing underrepresentation without acknowledging similar efficacy may inadvertently fuel skepticism among patients who could benefit from treatment, and they advocate for messaging that underscores both trial limitations and the robust effectiveness data now available.[4][7]
Additionally, some clinicians and patient advocates raise concerns about side effects, the possibility of long-term dependence, and unknown outcomes of decades-long use, particularly among younger adults. They question whether rapid, wide-scale adoption of GLP-1s — even if access became racially equitable — is the optimal public health strategy, and urge caution in framing the drugs as the default solution to obesity given these unresolved safety and sustainability issues.[5][13]
