Obesity treatment access in the United States: a state-level scorecard.

Abstract

Background: Obesity affects more than 40% of U.S. adults and carries substantial morbidity and mortality, yet access to evidence-based treatment varies widely across jurisdictions.

Objectives: To evaluate and compare state-level access to evidence-based obesity treatment across the United States using a standardized composite framework.

Setting: 50 U.S. states and the District of Columbia (51 jurisdictions).

Methods: Ecological cross-sectional study using publicly available policy and administrative data aggregated in 2026; the unit of analysis was the jurisdiction and no individual patient-level data were used. The Obesity Treatment Access Scorecard was derived from 44 metrics across 6 weighted tiers, coverage, access barriers, workforce capacity, regulatory factors, patient context, and treatment utilization, yielding scores of 0-100 mapped to letter grades (A-F). Data were verified by expert review with multisource validation, and sensitivity analyses tested alternative tier-weighting schemes.

Results: Scores ranged from 25.5 to 77.7 (mean, 48.5; standard deviation [SD], 12.8). No state achieved an A grade (≥80). Fifteen jurisdictions (29.4%) scored below 40 and 10 (19.6%) scored 60 or higher. Massachusetts (77.7) and Minnesota (76.4) ranked the highest; Arkansas (25.5), Oklahoma (28.5), and West Virginia (28.9) ranked the lowest. Mean scores were highest in the Northeast (62.7 [SD, 10.2]) and lowest in the South (39.9 [SD, 10.5]). Variability was greatest in the patient context and workforce capacity tiers. Jurisdiction rankings were robust to alternative tier-weighting schemes (Spearman ρ ≥ .99).

Conclusions: Access to evidence-based obesity treatment is highly variable across the United States, with no state achieving top performance. These findings highlight significant geographic disparities and support the need for policy and system-level reforms. The Obesity Treatment Access Scorecard is presented as an exploratory benchmarking framework requiring further validation before use in policy evaluation.