H.R. 4231: Treat and Reduce Obesity Act of 2025

Medicare currently covers a narrow version of obesity counseling — only from your primary care doctor, in a clinical setting. That leaves out the dietitians, psychologists, and nurse practitioners who specialize in long-term weight management.

H.R. 4231 expands that list. Under the bill, HHS could approve coverage for obesity therapy provided by physician assistants, nurse practitioners, clinical psychologists, and registered dietitians. It also opens the door to community-based weight management programs — think structured group counseling that meets federal privacy standards.

The bigger change is on the drug side. Right now, Medicare Part D specifically excludes drugs used for weight loss — including GLP-1 medications like Ozempic and Wegovy that have transformed obesity treatment. The bill lifts that exclusion for obesity treatment and for overweight people with related conditions like diabetes or heart disease. That change kicks in two years after enactment.

The bill's findings lay out why Congress thinks the math works: $50 billion in Medicare spending tied to obesity in 2014, roughly $2,018 in extra annual costs per beneficiary with obesity, and a trajectory that puts nearly half of Medicare beneficiaries over 65 in the obesity category by 2030 if nothing changes.