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Costs Costs are another important factor

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Several metabolic adaptations make it challenging to sustain weight loss long-term, including hormonal changes, increased food noise, and the energy gap. Shifts in Hunger Hormones Hunger and satiety are partially driven by hormones released from the gut to the hypothalamus (a region of the forebrain)

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This factor also reflects expected impacts of the reduced state premium subsidies for 2027 and the continued impacts of the subsidy cliff returning for consumers above 400% FPL beginning in 2026. Optimum Choice UnitedHealthcare (Maryland) Appendix The Peterson Center on Healthcare and KFF are partnering to monitor how well the U.S