obesity

Yes, Oprah Winfrey has discussed her weight loss and weight gain and weight in general before — many, many times before. The difference this time around, she says, is how little food noise there is in her daily life, and how little shame. It’s so quiet, in fact, that she can eat a whole croissant and simply acknowledge she had breakfast.

“Food noise,” for those who don’t experience it, is a virtually nonstop mental conversation about food that, according to Tufts Medicine, rarely shuts up and instead drives a person “to eat when they’re not hungry, obsess over meals and feel shame or guilt about their eating habits.”

“This type of obsessive food-related thinking can override hunger cues and lead to patterns of overeating, undereating or emotional eating — especially for people who are overweight,” Tufts said.

Winfrey told People in an exclusive interview published Tuesday that in the past she would have been thinking, “‘How many calories in that croissant? How long is it going to take me to work it off? If I have the croissant, I won’t be able to have dinner.’ I’d still be thinking about that damn croissant!”

What has changed is her acceptance 2½ years ago that she has a disease, obesity, and that this time around there was something not called “willpower” to help her manage it.

The talk show host has been using Mounjaro, one of the GLP-1 drugs, since 2023. The weight-loss version of Mounjaro is Zepbound, like Wegovy is the weight-loss version of Ozempic. Trulicity and Victroza are also GLP-1s, and a pill version of Wegovy was just approved by the FDA.

When she started using the injectable, Winfrey told People she welcomed the arrival of a tool to help her get away from the yo-yo path she’d been on for decades. After understanding the science behind it, she said, she was “absolutely done with the shaming from other people and particularly myself” after so many years of weathering public criticism about her weight.

“I have been blamed and shamed,” she said elsewhere in that 2023 interview, “and I blamed and shamed myself.”

Now, on the eve of 2026, Winfrey says her mental shift is complete. “I came to understand that overeating doesn’t cause obesity. Obesity causes overeating,” she told the outlet. “And that’s the most mind-blowing, freeing thing I’ve experienced as an adult.”

She isn’t even sharing her current weight with the public.

Winfrey did take a break from the medication early in 2024, she said, and started to regain weight despite continuing to work out and eat healthy foods. So for Winfrey the obesity prescription will be renewed for a lifetime. C’est la vie seems to be her attitude.

“I’m not constantly punishing myself,” she said. “I hardly recognize the woman I’ve become. But she’s a happy woman.”

Winfrey has to take a carefully managed magnesium supplement and make sure she drinks enough water, she said. The shots are done weekly, except when she feels like she can go 10 or 12 days. But packing clothes for the Australian leg of her “Enough” book tour was an off-the-rack delight, not a trip down a shame spiral. She’s even totally into regular exercise.

Plus along with the “quiet strength” she has found in the absence of food noise, Winfrey has experienced another cool side effect: She pretty much couldn’t care less about drinking alcohol.

“I was a big fan of tequila. I literally had 17 shots one night,” she told People. “I haven’t had a drink in years. The fact that I no longer even have a desire for it is pretty amazing.”

So back to that croissant. How did she feel after she scarfed it down?

“I felt nothing,” she said. “The only thing I thought was, ‘I need to clean up these crumbs.’”

SACRAMENTO — Many low-income Californians prescribed wildly popular weight-loss drugs will lose their coverage for the medications in the new year.

Health officials are recommending diet and exercise as alternatives to heavily advertised weight-loss drugs like Wegovy and Zepbound, advice that experts say is unrealistic.

“Of course he tried eating well and everything, but now with the medications, it’s better — a 100% change,” said Wilmer Cardenas of Santa Clara, who said his husband lost about 100 pounds over two years using GLP-1s covered by Medi-Cal, California’s version of Medicaid.

California is joining several other states in restricting an option they say is no longer affordable as they confront soaring pharmaceutical costs and steep Medicaid cuts under the Trump administration, among other financial pressures. Despite negotiated price reductions announced in November that the White House said would “dramatically lower cost to taxpayers” for the drugs and enable Medicaid to cover them, states are going ahead with the cuts, which providers say may undermine patient health.

“It will be quite negative for our patients” because data show people typically regain weight after stopping the drugs, said Diana Thiara, medical director of the UC San Francisco Weight Management Program.

Although California and New Hampshire will not cover GLP-1 prescriptions for obesity beginning Jan. 1, they will continue to cover the drugs for other health issues, such as type 2 diabetes, cardiovascular disease and chronic kidney disease.

Michigan, Pennsylvania, Rhode Island, South Carolina and Wisconsin are planning or considering restrictions, according to the Kaiser Family Foundation’s most recent survey of state Medicaid programs.

That reverses a trend that saw 16 states covering the medications for obesity as of Oct. 1. Interest in providing the coverage “appears to be waning,” the survey found, probably because of the drugs’ cost and other state budget pressures. North Carolina pulled back GLP-1 coverage in October, but Gov. Josh Stein reinstated it in December, bowing to court orders despite a lingering budget shortfall.

Catherine Ferguson, vice president of federal advocacy for the American Diabetes Assn. and its affiliated Obesity Assn., said it’s unclear how states will adjust to the White House plan to lower the cost of several of the most popular GLP-1s through TrumpRx, an online portal for discounted prescription drugs. The price of Wegovy, for example, will be $350 per month for consumers, versus the current list price of nearly $1,350, and Medicare and Medicaid programs will pay $245, according to the plan.

“Many states are facing budgetary challenges, such as deficits, and are working to address the impacts of the changes to Medicaid and SNAP,” Ferguson wrote, referring to the Supplemental Nutrition Assistance Program. “As more details become available for the Administration’s agreements, we will see how state Medicaid responds.”

The Department of Health and Human Services referred questions to the White House, which did not respond to requests for comment on states’ termination of Medicaid coverage for the weight-loss drugs.

California projected its costs to cover GLP-1s for weight loss would have more than quadrupled over four years to nearly $800 million annually if it didn’t end Medi-Cal coverage for that use. Medi-Cal has covered weight-loss drugs since 2006, but use of GLP-1s soared only in recent years. By 2024, more than 645,000 prescriptions were covered by Medi-Cal across all uses of the medications. The California Department of Health Care Services could not readily provide a breakdown of whether the drugs were for weight loss or other conditions.

When asked whether the state would reconsider its plans in light of the announced price cuts, Department of Finance spokesperson H.D. Palmer said it had no plans to do so. California’s cut is written into the state’s budget law.

California officials would not say how much it could save under the TrumpRx plan, citing federal and state restrictions on disclosing rebate information.

Healthcare providers don’t expect the Trump administration’s negotiated price cuts to make much difference to consumers, because pharmaceutical companies already offer discounts.

“The out-of-pocket costs will still be very cost-prohibitive for most, especially individuals with Medicaid insurance,” Thiara said.

New Hampshire will also end its coverage Jan. 1. Officials with the New Hampshire Department of Health and Human Services did not respond to requests for comment.

About 1 in 8 adults are taking a GLP-1 drug for obesity, disease or both, up 6 percentage points from May 2024, according to KFF poll results released in November. More than half of users said their GLP-1s were difficult to afford, and many who had stopped the treatment cited the cost.

Public and private payers have been trying to wean patients off of the drugs to save costs. California health officials said Medi-Cal members and their healthcare providers should consider “other treatment options that can support weight loss, such as diet changes, increased activity or exercise, and counseling.” That echoes advice from the New Hampshire Medicaid program.

California Department of Health Care Services spokesperson Tessa Outhyse said in an email that the official advice to try those other approaches now “is not meant to dismiss any past efforts, but to encourage Medi-Cal members to take a renewed, proactive, and medically supported approach with their healthcare provider that may appropriately include these additional options.”

But that may be unrealistic, said Kurt Hong, founding director of the Center for Clinical Nutrition at Keck School of Medicine of USC.

“We definitely want patients to do their part with the diet and exercise, but unfortunately, and from a practical standpoint, that itself frequently is not enough,” Hong said, adding that usually by the time patients see doctors, they have failed at achieving results through those means.

Hong understands why Medicaid programs, as well as private providers, want to cut back on covering the drugs, which can cost thousands of dollars per patient per year. However, they can produce twice the weight loss as the medications typically used previously, he said.

A school of medical thought supports people gradually ending their use, but Hong said obesity is generally considered a chronic condition that requires indefinite treatment.

“Once they reach their target weight, a lot of people will try to see whether or not they can wean off,” Hong said. “We do see a lot of patients — when they try to get off, unfortunately, then the weight comes back.”

Medi-Cal members younger than 21 will remain covered for purposes including weight loss, California officials said, citing a federal requirement.

Medi-Cal members will be able to keep their GLP-1 coverage if they can demonstrate it is medically necessary for purposes other than weight loss, the Department of Health Care Services said. Members who are denied coverage can seek a hearing, the department said in a letter to members.

Members will still be able to pay for the prescriptions out of pocket and may be able to use various discounts to lower costs. Another option is new pills to treat obesity, which will be cheaper than their injectable counterparts. The Food and Drug Administration approved a pill version of Wegovy on Dec. 22, which probably will cost $149 a month for the lowest dosage, and similar weight-loss pills are expected to be available in the first half of the year.

Although Cardenas said his husband, Jeffer Jimenez, 37, uses GLP-1s primarily for weight loss, Jimenez’s prescription is for diabetes, so the couple hoped to continue receiving coverage through Medi-Cal.

“He tried a thousand medications, pills, natural teas, exercise program, but it doesn’t work like the injections,” Cardenas said. “You need both.”

Thompson writes for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.