SNAP, Obesity and Delaware’s Health

By C.D. Casscells, M.D.

Director, Center for Health PolicyCaesar Rodney Institute

While more than a dozen states have received or sought the U.S. Department of Agriculture (USDA) waivers to restrict certain Supplemental Nutrition Assistance Program (SNAP) purchases beginning in 2026, Delaware has chosen not to pursue such an option. Those waivers allow states, with federal approval, to limit which foods and beverages may be purchased with SNAP benefits, including soda and other sugar-sweetened beverages.

Medical research has long shown that overweight and obesity increase the risk of serious conditions such as Type 2 diabetes, high blood pressure, heart disease and stroke, according to clinical guidance from the National Institute of Diabetes and Digestive and Kidney Diseases. When public programs allow SNAP benefits to be used for products associated with weight gain, it is reasonable to ask whether nutrition assistance and health policy should be better aligned to address the health consequences that follow.

The Health Impact in Delaware

In 2022, nearly 38% of Delaware adults reported being obese, according to data from the Delaware Department of Health and Social Services (DHSS). The department also reports that 23.9% of adults who reported obesity also reported having diabetes, compared with 5.3% of adults at normal weight.

Additionally, weight-related risk begins at an early age. A 2021 survey conducted by DHSS found that about 15% of Delaware high school students reported being obese, and nearly one in three reported being overweight or obese. The survey also revealed widespread consumption of sugar-sweetened beverages, low intake of fruits and vegetables and low levels of physical activity among adolescents.

These patterns indicate that diet-related health risks are established well before adulthood and contribute to long-term chronic disease and rising health care costs.

Obesity Treatment and GLP-1 Medications

One medical tool increasingly used to treat obesity is a class of medications known as glucagon-like peptide-1, or GLP-1, receptor agonists, including semaglutide. These medications are prescribed for obesity and Type 2 diabetes and act on appetite regulation and glucose metabolism. Large randomized clinical trials published in The New England Journal of Medicine have shown that GLP-1 medications can produce sustained weight loss and improvements in metabolic health.

These medications are now widely used in clinical practice under physician supervision. In Delaware, utilization of GLP-1 medications has increased sharply in recent years, according to a 2025 report from the Delaware Department of Insurance. Delaware already allows Medicaid coverage of GLP-1 medications under defined clinical criteria. 

The state also noted that GLP‑1 drugs already account for more than 6% of total pharmacy spending in the fully insured market, underscoring the need to balance access with affordability.

Bringing Policy in Line With Practice

Many SNAP recipients are also enrolled in Medicaid. Yet the two programs operate independently. SNAP influences dietary behavior, while Medicaid bears much of the cost of treating obesity and related disease after it develops.

Nutrition assistance policy continues to permit SNAP benefits to be used for sugar-sweetened beverages, which state health surveys identify as widely consumed, particularly among youth. Those purchasing patterns matter because public benefits influence behavior and, indirectly, long-term health outcomes.

From a health and policy perspective, this separation represents a missed opportunity. Allowing greater coordination between nutrition assistance and medical care would not require new taxes, expanded eligibility or mandated treatment. It would give individuals the option to use existing public benefits in ways that better align food assistance with effective medical treatment.

A Path Forward for Delaware

No state has yet attempted to formally align SNAP and Medicaid in this way. That does not mean the idea lacks merit; it means the question has not been tested. Delaware’s size and integrated health care infrastructure make it well positioned to serve as a pilot or demonstration state to evaluate whether closer coordination between nutrition assistance and medically prescribed obesity treatment could improve health outcomes and reduce long-term costs.

As 2026 approaches and states consider changes to how SNAP is administered, Delaware’s decision not to restrict SNAP purchases, including sugar-sweetened beverages, makes it important to consider whether public benefits should better support both access to food and access to effective obesity treatment. 

Delaware should seize this moment to pilot a coordinated SNAP and Medicaid approach to obesity, carefully tracking health outcomes and costs to see whether closer alignment can make public assistance both healthier and more sustainable.