Introduction: In 2006, Tennessee Medicaid (TennCare) offered its recipients access to Weight Watchers for a nominal fee. The aim of this study was to determine the weight change among adult participants. Methods: This is a retrospective analysis of weight change among overweight and obese TennCare recipients who participated in the program. Weight change was calculated as the median difference from the first date of participation to the last. Weight change was also calculated as median percentage change from initial weight and categorized as weight loss or gain of 0 to 5, ≥5 to 10, and ≥10 %. Results: During the study period, 1,605 individuals started the program and 1192 had at least one follow-up weight measurement and thus met the inclusion criteria for the study. Women (n = 1149) had a BMI of 39.6 kg/m2 and men (n = 43) had a BMI of 43.0 kg/m2. The median weight loss for all participants was 1.9 kg, or 1.8 % of initial weight. Twenty percent of participants lost 5 % or more of their initial body weight while participating in the program. Over 13 % of participants only attended two meetings; on average, these participants lost 0.5 % of initial weight. Over 23 % of participants attended 13 or more meetings, and they lost an average of 6.4 % of initial weight. Discussion: Twenty percent of TennCare recipients who joined Weight Watchers lost a clinically significant amount of weight. Participants who attended more meetings lost more weight. Reimbursement for Weight Watchers has been maintained by all of the Medicaid managed care organizations in Tennessee. Partnerships that allow low-income populations to access weight loss programs may provide a valuable weight management tool. © 2012 Society of General Internal Medicine.