Across the US, Obesity Care Still Lacks an Owner

Obesity is diagnosed during hundreds of thousands, if not millions, of clinical encounters in the US every year, but is reliably managed in almost none of them, according to panelists across 5 American Journal of Managed Care Population Health Roundtables held June through August 2026. Clinicians in Philadelphia, Pennsylvania; Boston, Massachusetts; New York, New York; Atlanta, Georgia; and Chicago, Illinois, arrived at the same conclusion: Obesity treatment has never been more effective—or more difficult to coordinate.^1-5 The discussions described a common pattern: Once glucagon-like peptide-1 (GLP-1) receptor agonists moved obesity from an undertreated condition to one with high treatment demand, prescribing capacity outpaced the infrastructure meant to support it. Nearly
40 participating physicians, pharmacists, dietitians, and health system leaders reached the same 3 conclusions: No single clinician or department consistently owns the obesity care plan; prior authorization consumes a disproportionate amount of clinical time; and coverage rules, more than clinical judgment, often determine which patients get treated.

No City Has Solved Who Owns
Obesity Care

Every roundtable named a different default owner, and none described the arrangement as settled. In Philadelphia, participants noted that Temple University Health System and Penn Medicine split responsibility along specialty lines, with Penn’s downtown sites separating obesity medicine from bariatric surgery; its Lancaster practice colocates both.¹ Underlying that split, Daniel Rubin, MD, MSc, FACE, a professor of medicine at Temple’s Lewis Katz School of Medicine, pointed to a structural incentive problem: Payers rarely retain members long enough to capture the downstream cardiovascular and metabolic savings of obesity treatment, noting that“insurance providers are incentivized not to pay for it.”¹

Boston showed a similar spread. Samar Hafida, MD, an endocrinologist and obesity medicine specialist at Boston Medical Center, said referrals arrive from internal medicine, family medicine, and pediatrics rather than a central obesity clinic, even as the session’s moderator, Fatima Cody Stanford, MD, an endocrinologist and weight management specialist at Mass General Brigham and Harvard Medical School, has heard colleagues describe rising referral thresholds as forcing more triage into primary care.² New York panelists described a comparable range of models: NYU Langone Long Island built a central hotline routing patients to a dozen participating clinicians; Montefiore Medical Center/Einstein College of Medicine and NYC
Health + Hospitals have embedded weight management directly inside primary care visits.³

Atlanta clinicians gave the fragmentation its sharpest framing, describing primary care as the default owner even though a single visit cannot absorb obesity counseling alongside a patient’s other priorities.⁴ Jyoti Manekar, MD, an obesity medicine specialist at Northside Hospital, distilled the stakes for patients navigating the system: “Getting help is not failure. Not getting help is
a failure.”⁴

Chicago’s panel, moderated by Robert F. Kushner, MD, founding chair of the American Board of Obesity Medicine and professor emeritus at Northwestern University Feinberg School of Medicine, traced the same problem to prescription management rather than referral. Suja Mathew, MD, a senior physician adviser to the American Medical Association, argued that where care begins matters less than when it begins.⁵

Manish Parikh, MD, a bariatric surgeon at NYU Langone General Surgery Associates and Bellevue Hospital Center in New York, offered a thread for all
5 sessions. He said he remains “amazed at how
fragmented our care still is” despite effective treatments now on the market.³

The lag between diagnosis and specialty treatment showed up most starkly in Atlanta, where Kenneth Copperwheat, DO, FASMBS, DABOM, a metabolic and bariatric surgeon at Piedmont Physicians Surgical Specialists and Bariatrics Columbus in Georgia, said the average patient referred to his practice has a body mass index (BMI) of 47 after living with a BMI above 40 for decades.⁴ Elizabeth Hechenbleikner, MD, a surgeon and director of the Emory Bariatric Center at Emory University Hospital Midtown, called that delay
structural rather than clinical, arguing that existing brick-and-mortar staffing models cannot keep pace with demand at scale.⁴

Prior Authorization Drains
Time Everywhere

Panelists at every roundtable identified prior authorization as the most burdensome operational barrier, independent of health system size or region. In Philadelphia, Nina Thoguluva, PharmD, RPh, lead clinical pharmacy specialist in ambulatory care at Temple University Hospital, described routing denials through CoverMyMeds and coaching physicians on documentation language likely to satisfy payers.¹ In Boston, Ivania Rizo, MD, director of obesity medicine at Boston Medical Center, called the process a “colossal waste of our education and time,” and panelists from several institutions reported contracting with outside teams solely to manage submissions.²

Yolanda Whitty, PharmD, who manages an ambulatory pharmacotherapy clinic at Wellstar Health System in Marietta, Georgia, framed the issue as one of bandwidth rather than disagreement. No physician objects to connecting patients with appropriate medication, she said, but few have time to complete the paperwork required to secure it.⁴ In Chicago, Vishal Prakash, PharmD, a clinical pharmacist, and Christine Pan, PharmD, BCACP, a GLP-1 clinical pharmacist, both at Northwestern Medicine, described a technician team processing authorizations across 2 clinics, work that Prakash said generates no institutional revenue credit despite its clinical necessity.⁵

Pharmacists Fill the
Coordination Gap

As physician panels described capacity constraints, they noted that pharmacists in all 5 cities are the clinicians actually managing GLP-1 access day to day, titrating doses, monitoring adverse effects, and appealing denials. Panelists in Boston said pharmacists add a layer of clinical care that extends beyond dispensing.² New York panelists pointed to institutional specialty pharmacies, funded partly through the 340B program, that now manage titration after a prescription is written.³ Anesia Reticker, PharmD, BCTXP, a clinical pharmacy specialist in solid organ transplant at UChicago Medicine, cofounded a transplant weight-loss clinic after watching patients reach end-stage organ disease before their weight was addressed. She said her program has helped 30 previously disqualified patients receive transplants.⁵

The structural gap is compensation, not clinical value. Philadelphia’s Thoguluva flagged regional disparities in how pharmacist positions are funded, noting that clinical pharmacists on the West Coast and in the Midwest routinely bill for visits and have larger patient panels than their East Coast counterparts.¹

Technology Offers a Partial Fix

Only New York’s panel described automation as a formal strategy, but the workaround illustrates how far systems are reaching. Shivani Agarwal, MD, MPH, senior director of community health care improvement and strategy at Montefiore Medical Center/Einstein College of Medicine, described clinician-designed electronic prompts that flag GLP-1 candidates and route prescriptions through a prior authorization workflow assisted by artificial intelligence (AI), followed by an automated call 2 weeks after the fill to check for adverse effects before escalating to human staff.³ Katherine Saunders, MD, executive vice president and cofounder of FlyteHealth, argued that similar technology-supported models will be necessary to scale access, but stressed that no software can substitute for the clinician-patient relationship.³ Chicago’s reliance on a dedicated pharmacy technician team to process authorizations reflects the same instinct toward task-shifting, even without formal AI tools in place.⁵

GLP-1 Bridge Program Divides Opinion

The Medicare GLP-1 Bridge Program, an 18-month Part D pilot that launched July 1, 2026, for beneficiaries meeting BMI and comorbidity criteria, was addressed in 4 of the 5 sessions and drew a consistent mix of cautious optimism and skepticism. Philadelphia panelists noted Humana’s administration of the program and a projected $50 co-pay, with Anastassia Amaro, MD, medical director of Penn Metabolic Medicine, urging colleagues to move quickly given the program’s fixed window.¹

In Boston, Alexa Triot, MD, a primary care physician and obesity medicine specialist at Beth Israel Deaconess Medical Center, predicted turmoil at launch, and Harvard health economist Joseph Newhouse, PhD, cautioned that Medicaid coverage losses posed a bigger threat to access than anything happening in Medicare.²

In New York, Sriram Machineni, MD, director of the Fleischer Institute Medical Weight Center at Montefiore Medical Center/Einstein College of Medicine, said that using the program required approximately 10 days of pharmacy billing troubleshooting before approvals were granted. Moderator Judith Korner, MD, an endocrinologist and director of the Weight Control Center at Columbia University, welcomed the program’s expanded eligibility for patients with prediabetes.³ In Atlanta, Reema Dbouk, MD, FACP, assistant professor of medicine at Emory University School of Medicine, called the program historic—it is Medicare’s first medication coverage for obesity. She then flagged an inequity: Patients with more serious comorbidities can end up paying more than those with milder disease under the fixed co-pay structure.⁴ Chicago’s panel did not address the Bridge Program directly, instead describing insurance-driven BMI thresholds that have tightened on their own timelines, with Maria Fariduddin, MD, an endocrinologist at
Loyola University Medical Center and Gottlieb
Memorial Hospital, noting that the BMI required for
GLP-1 coverage at her institution has moved from 27 to 30 to 35 over time.⁵

Obesity Medicine Leaders Call
for Redesign

Both Stanford and Caroline Apovian, MD, also of Mass General Brigham and Harvard Medical School, and among the most cited voices in US obesity medicine, anchored the Boston discussion. Apovian, who codirects the Center for Weight Management and Wellness at Brigham and Women’s Hospital, tied the field’s persistent stigma directly to skepticism toward bariatric surgery, its most effective intervention.²

Kushner closed the Chicago session by urging obesity medicine specialists to embed directly within cardiology and nephrology clinics rather than wait for referrals.5 The New York panel closed with Preeti Kishore, MD, professor of medicine and chief of endocrinology at Jacobi Medical Center and an associate clinical professor at Albert Einstein College of Medicine, urging colleagues toward continued policy advocacy for equitable access.³

The sessions describe a treatment landscape that has outpaced the systems built to deliver it. Panelists also identified coding gaps in Philadelphia, staffing shortfalls in Boston, technology-dependent workarounds in New York, ownership gaps in Atlanta, and transplant-specific access barriers in Chicago, each of which reflects the same underlying problem from a different angle: Health systems built obesity care around episodic, specialty-driven visits, and GLP-1 therapy now requires the kind of longitudinal, team-based management that chronic disease programs for diabetes and hypertension were designed to provide decades ago. Whether that redesign happens through pharmacist-led models, embedded specialists, or new payment structures, panelists across all 5 cities agreed it needs to happen faster than the Bridge Program’s 18-month window allows. /

References

1. Grossi G. Coding, coverage gaps hamper multidisciplinary obesity care. AJMC. June 25, 2026. Accessed August 30, 2026. https://www.ajmc.com/view/coding-coverage-gaps-hamper-multidisciplinary-obesity-care
2. Grossi G. Boston panel confronts access and coordination gaps in obesity care. AJMC. August 3, 2026. Accessed August 30, 2026. https://www.ajmc.com/view/boston-panel-confronts-access-and-coordination-gaps-in-obesity-care
3. Grossi G. New York experts push for coordinated obesity care teams. AJMC. August 25, 2026. Accessed August 30, 2026. https://www.ajmc.com/view/new-york-experts-push-for-coordinated-obesity-
   care-teams
4. Grossi G. Obesity is diagnosed everywhere and owned nowhere, Atlanta clinicians say. AJMC. August 27, 2026. Accessed August 30, 2026. https://www.ajmc.com/view/obesity-is-diagnosed-everywhere-and-owned-nowhere-atlanta-clinicians-say
5. Grossi G. Chicago panel weighs barriers to transplant weight-loss access. AJMC. August 28, 2026. Accessed August 30, 2026. https://www.ajmc.com/view/chicago-panel-weighs-barriers-to-transplant-weight-loss-access