By Rhonda M. Smith, Special to California Black Media Partners
California has always been seen as the land of vitality — sunshine, beaches, and wellness culture. But beneath that image is a growing public health crisis we cannot afford to ignore.
Roughly 11 million adults in California — about 27% of Californians — are living with obesity. If trends continue, that number could surpass 40% by 2030. This is not a cosmetic issue. It is a chronic disease crisis with profound health and economic consequences.
And like most health crises in this country, it does not impact all communities equally.
Nearly 38% of Black adults in California – including 41% of Black women in the state – are obese or overweight. Because obesity is a precursor to many other conditions, Black Californians experience disproportionately high rates of diabetes, hypertension, and cardiovascular disease.
Black women are also more likely to be uninsured or underinsured and rely on our state’s health safety net. In fact, roughly 35% of Black women in our state depend on Medi-Cal for health coverage, a sign of limited ability to absorb additional healthcare costs when coverage disappears.
For many Black households, access to preventive care, healthy food, safe environments for exercise, and consistent insurance coverage is already fragile. When evidence-based treatments become available, access to them should be expanded — not restricted.
That is why the state’s decision to eliminate Medi-Cal coverage for GLP-1 obesity medications is deeply concerning. This cut disproportionately impacts Black women and the families who depend on them and will widen health disparities for Black Californians even further.
Obesity is not a personal failure. It is a complex, chronic disease influenced by biology, environment, stress, trauma, and access to care. While healthy eating, physical activity, and lifestyle changes are essential, they are not always sufficient — especially for individuals who have struggled for years with metabolic conditions rooted in inequitable systems.
GLP-1 medications have proven to be effective tools in helping patients reduce weight, lower cardiovascular risk, and prevent disease progression. For many Medi-Cal patients, these medications represent stability, hope, and measurable health improvement.
Removing coverage does not eliminate the disease. It simply eliminates access.
From a fiscal standpoint, this decision is shortsighted. Obesity-related conditions account for a significant share of Medi-Cal spending. Investing in prevention and disease management is far more responsible than paying for emergency interventions, dialysis, amputations, heart attacks, and disability, especially in the era of HR1.
Preventing these complications is a far more responsible investment than absorbing the escalating costs of emergency care, advanced procedures, and long-term disability.
Public opinion reflects this reality. Voters across the political spectrum understand that disease prevention is more cost-effective and humane than treating preventable complications. Californians expect their leaders to invest in evidence-based solutions that promote long-term health. A 2025 poll revealed that a majority of voters believe government health programs should cover obesity treatment, with 72% agreeing that coverage of these medicines under Medicare and Medicaid should be on a par with access under the Federal Employee Health Benefits program. That same poll showed that 73% of Americans agree that providing coverage of obesity medications could improve productivity.
Gov. Gavin Newsom has positioned California as a national leader in health equity. Leadership requires consistency. It means ensuring that residents enrolled in Medi-Cal have access to the same standard of care available to those with employer-sponsored or federal employee coverage.
Reinstating Medi-Cal coverage for GLP-1 medications is not about aesthetics or trends. It is about chronic disease management, health equity, and fiscal responsibility.
For the communities we serve, access to these medications has nothing to do with vanity and everything to do with health: reducing the risk of stroke, preventing diabetes complications, keeping individuals healthy enough to work, protecting seniors from cascading health decline, and ensuring that Black Californians are not once again left behind when effective care becomes available.
California can — and should — lead on this issue. The health of our most vulnerable residents depends on it.
About the Author
Rhonda M. Smith is the Executive Director of the California Black Health Network.