By Latisa Carson
San Diego Union-Tribune
Obesity is a chronic disease that requires attentive, specialized and compassionate care. As a board-certified physician in obesity medicine and obstetrics/gynecology, I see firsthand how women’s bodies undergo profound metabolic shifts. Regardless of a woman’s willpower or lifestyle, hormonal transitions trigger rapid weight gain that is both distressing and medically concerning.
And these hormonal shifts are not minor. Estrogen decline alters how the body stores fat, increases appetite signaling and reduces resting energy expenditure. These changes make weight gain almost inevitable, even for women who maintain healthy habits.
To not only improve women’s health, but also better treat obesity while helping prevent co-occurring chronic conditions like type 2 diabetes and fatty liver disease, my patients need a holistic, multi-pronged approach that helps them regain metabolic stability. For many, this approach is incomplete without GLP-1s.
Unfortunately, last year, California decided to reverse decades of obesity treatment coverage by discontinuing Medi-Cal coverage of GLP-1s when used solely for weight management. This decision contradicts scientific evidence and ignores the reality that women — particularly Black women — bear a disproportionate burden of obesity and its complications.
Obesity is not reflective of a lack of “willpower” as some believe — it is a public health epidemic, with nearly 1 in 3 Californians considered obese. That’s approximately 11 million people whose disease management likely involves direct medical expenses associated with hospitalizations, medications, regular monitoring and worsening comorbidities, as well as indirect costs like lost productivity and long-term disability care.
Those indirect costs contribute to the fact that obesity costs California $89.5 billion annually, straining public health resources and driving up insurance premiums. California is mistakenly putting the brunt of saving money on its sickest, most vulnerable patients, but the most ethically and fiscally sound option is prevention.
Preventive care specifically is an aspect of transformative healing that I sought to bring back to my community in southeastern San Diego once I started practicing medicine. This community faces health disparities and higher rates of obesity compared to other parts of the county, and it is home to the highest concentration of Black residents.
I care for many Black women who enter menopause earlier and experience more severe metabolic changes than their white counterparts — these changes dramatically increase the risk of weight gain, insulin resistance and cardiovascular disease. Denying access to GLP‑1s during this critical window leaves women without the tools they need to protect their long‑term health.
I did not receive my medical degree to perpetuate the harmful myth that diet and exercise alone cure obesity. Frankly, one does not need a credential at all to offer unhelpful and shortsighted advice. Instead, my medical training prepared me to synchronize advanced pharmaceutical breakthroughs with holistic disease management techniques. Of course, patients must do their “homework” to adhere to their treatment plan, but that means medical providers must be afforded the resources to help these patients in the first place.
We love nothing more than to help our patients achieve their goals and improve their health, but it becomes harder to do so when state policy undermines medical advice and ignores scientific evidence. Everyone deserves access to effective weight management tools before they experience obesity-related complications.
Reinstating coverage is not only the most ethical and fiscally sound option, but it’s also the right investment in women’s health. Supporting women through the metabolic challenges of postpartum, perimenopause and menopause strengthens families, communities and the entire health system.
Carson, M.D. is a double board-certified OB-GYN and obesity medicine physician in Chula Vista.