When I reached the age of 50, my weight was 265 pounds. Throughout the subsequent 12 years, by engaging in walking, yoga, and strength training, I managed to shed 60 pounds and maintained that loss. However, despite my dedication, I continued to suffer from inflammation, pain, and sleep apnea.

Then last year, my physician recommended tirzepatide (Zepbound), not only for weight reduction but also to address my sleep apnea. This alternate diagnosis opened the door to insurance coverage and resulted in a transformative outcome. In just 12 months, I lost an additional 60 pounds, decreased visceral fat, alleviated inflammation, enhanced muscle mass, and ultimately achieved a state of being pain-free.

This wasn’t merely a shortcut; it served as a catalyst. The GLP‑1 quieted my cravings and provided the mental acuity necessary to maintain daily movement and nutrition routines that had previously stagnated.

Tales like mine, along with those of individuals such as a woman in perimenopause dealing with glucose fluctuations, underscore the fact that GLP‑1 drugs function as metabolic instruments, not just cosmetic solutions. Nonetheless, far too many insurance providers continue to deny coverage based on outdated BMI guidelines or limited weight-loss criteria.

These medications provide more than just leaner physiques:

– Stabilized A1C and daily blood sugar management
– Diminished inflammation and enhanced sleep quality
– Enhanced functionality across different age demographics

Many healthcare professionals are achieving success in securing coverage for GLP‑1s by utilizing diagnoses such as insulin resistance (E88.81), sleep apnea (G47.33), metabolic syndrome, or PCOS (E28.2), particularly when these are documented alongside prediabetes, hypertension, or cardiovascular risk factors. These conditions are genuine and treatable, responding well to GLP‑1 therapy, even if the patient’s BMI does not meet the criteria of outdated obesity standards. A wider acceptance of these diagnoses for coverage could help bridge the access divide and provide essential metabolic care to those otherwise underserved.

As the board chair of a nonprofit health plan, a former partner at Deloitte, and a yoga instructor, I have witnessed how antiquated coding practices and BMI-centric policies exclude many capable individuals from receiving effective care.

A shift is necessary. GLP‑1 medications should be positioned as instruments for equity in metabolic health, prescribed based on insulin resistance, prediabetes, sleep apnea, or age-related visceral fat, rather than solely on weight.

GLP‑1s are not miracle solutions. Yet, when combined with purpose, physical activity, and protein-rich nutrition, they rank among the most powerful tools for achieving health, particularly when access is fair and equitable.

*Rodney Lenfant is a patient advocate.*