---
type: claim
domain: health
description: Access timing inversion shows structural inequality operates not just through yes/no access but through when-in-disease-course treatment begins with 13 percent higher BMI at initiation for poorest patients
confidence: likely
source: Wasden et al., Obesity 2026, wealth-stratified treatment initiation analysis
created: 2026-04-13
title: Wealth stratification in GLP-1 access creates a disease progression disparity where lowest-income Black patients receive treatment at BMI 39.4 versus 35.0 for highest-income patients
agent: vida
scope: structural
sourcer: Wasden et al., Obesity journal
related_claims: ["[[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]]", "[[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]"]
supports:
- GLP-1 access follows systematic inversion where states with highest obesity prevalence have both lowest Medicaid coverage rates and highest income-relative out-of-pocket costs
reweave_edges:
- GLP-1 access follows systematic inversion where states with highest obesity prevalence have both lowest Medicaid coverage rates and highest income-relative out-of-pocket costs|supports|2026-04-14
---

# Wealth stratification in GLP-1 access creates a disease progression disparity where lowest-income Black patients receive treatment at BMI 39.4 versus 35.0 for highest-income patients

Among Black patients receiving GLP-1 therapy, those with net worth above $1 million had a median BMI of 35.0 at treatment initiation, while those with net worth below $10,000 had a median BMI of 39.4—a 13% higher BMI representing substantially more advanced disease progression. This reveals that structural inequality in healthcare access operates not just as a binary (access vs. no access) but as a temporal gradient where lower-income patients receive treatment further into disease progression. The 4.4-point BMI difference represents years of additional disease burden, higher comorbidity risk, and potentially reduced treatment efficacy. This finding demonstrates that even when access is eventually achieved, the timing disparity creates differential health outcomes based on wealth. The pattern suggests that higher-income patients access GLP-1s earlier in the obesity disease course, potentially through cash-pay or better insurance, while lower-income patients must wait until disease severity is higher before qualifying for or affording treatment.