Advancing Multidisciplinary Strategies for Obesity Care

Am J Manag Care. 2026;32(Spec. No. 3):SP188-SP191. https://doi.org/10.37765/ajmc.2026.89911

The treatment of obesity, a chronic, multifactorial disease influenced by a complex interplay of genetic predisposition, behavioral patterns, environmental exposures, and social determinants of health, needs a multilevel approach to be effective. Addressing obesity, which is recognized as not merely a lifestyle issue but as a progressive condition requiring sustained, evidence-based intervention, needs to include individual behavior support, community-based programs, health care system reforms, and policy-level changes.

A recent Institute for Value-Based Medicine roundtable of experts convened in Boston, Massachusetts, by The American Journal of Managed Care^® explored multidisciplinary strategies for obesity care, focusing on identifying systemic and operational barriers, discussing comorbidity considerations, and exploring practical, scalable solutions to promote patient ownership and improved outcomes.

From Silos to Shared Care

A central theme of the roundtable was the shifting “ownership” of obesity care within health systems. Traditionally, obesity management was siloed into surgical or medical arms with little overlap.

“When I think about the history of the weight program at Brigham, obesity care was really siloed,” observed Ali Tavakkoli, MD, bariatric surgeon and codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital. “We had, essentially, surgery and we had this diet program…. Patients tried it, it wasn’t successful, or they didn’t like surgery, and that was the end of the weight management journey.”

However, the advent of glucagon-like peptide-1 (GLP-1) receptor agonists has fundamentally changed the volume and nature of referrals. Caroline Apovian, MD, codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, noted that her program became “inundated with referrals” to the point where a patient must wait a year before seeing a provider.

Many specialists are currently managing the “lion’s share” of these patients, said Fatima Cody Stanford, MD, MPH, MBA, an obesity medicine physician-scientist at Massachusetts General Hospital. When primary care doctors see how much work goes into prior authorizations (PAs) for GLP-1s, they get sent back to obesity medicine. There is a team at Mass General handling PA with an entire workflow, but they are overwhelmed, she said.

The panel agreed that a centralized model is not sustainable for a disease affecting such a large portion of the population. The GLP-1s have “changed the game,” Tavakkoli said, with far more patients being seen than in the past.

“The idea of obesity medicine managing all obesity is just not sustainable,” said Tavakkoli. He suggested a model similar to diabetes care, where “the complex [cases] come to the center” but the average cases are managed in the primary care provider (PCP) office, supported by nurse educators.

The BMC Model: Empowering the Front Lines

The discussion highlighted contrasting institutional models, specifically between Mass General Brigham (MGB) and Boston Medical Center (BMC). Whereas MGB specialists described feeling overwhelmed by referrals, BMC experts described a more integrated approach that empowers PCPs.

At BMC, obesity care is often delivered within primary care, thanks to an effort by specialists to educate the PCPs and teach them how to prescribe GLP-1s, explained Christine Pace, MD, vice president and chief of population health services at BMC.

Ivania Rizo, MD, director of obesity medicine at BMC, echoed this sentiment, stating that although BMC has a dedicated obesity center, care is “owned by multiple people.” Primary care owns obesity care because the obesity medicine clinic was created within general internal medicine (GIM) to create this clinic, and it partners with surgery. “Surgery owns it. Endocrine owns it. GIM owns it,” she said.

This multidisciplinary ownership extends to other specialties, including cardiology and renal care and even gastrointestinal care because GLP-1s are being used for metabolic dysfunction–associated steatohepatitis (MASH).

“At BMC, we’ve been somewhat fortunate with the partnership of the MDs, NPs [nurse practitioners], and clinical pharmacists,” Rizo said. “I think multiple people are owning obesity, which is what we have to do.… We can’t see everybody, and we need to be able to provide access [to care for patients].”

The PA Bottleneck

PA remains a significant hurdle to patient access because of the administrative burden it creates. To manage this, some systems have developed sophisticated internal workflows.

The roles of clinical pharmacists and pharmacy technicians emerged as critical components of a successful multidisciplinary team. Pace noted that BMC utilizes a “huge fleet of pharmacy technicians” whose primary job is facilitating PAs, with GLP-1s now accounting for roughly 80% of their workload.

“We have clinical pharmacy specialists who are pharmacy techs who are running the PAs,” added Karen Flanders, MSN, CBN, NP-C, a coordinator at the Mass General Weight Center. This specialized support allows clinicians to focus on patient care rather than administrative paperwork.

Shared Medical Appointments

As health systems struggle to meet the demand for obesity care, shared medical appointments (SMAs), or group appointments, were identified as a potential solution for improving access and delivering education to multiple patients simultaneously.

Rizo shared her experience learning from the SMA model at Atrius Health, which utilized a health coach and a medical assistant (MA) to facilitate group visits: “What I have found is that it does take a significant administrative commitment.”

Atrius is also starting to include behavioral health in the appointments, added John A. Zambrano, MD, MHS, chief of internal medicine at Atrius Health.

“It’s a win for primary care. It’s a win for patients,” he said. “And you talk about sleep, you talk about mental health, you talk about nutrition, you talk about cooking.”

Flanders shared a similar experience with telemedicine-based SMAs conducted during the COVID-19 pandemic with a teaching kitchen that involved dieticians. “People loved it,” she said, although she emphasized that such programs require robust institutional infrastructure to survive.

The SMA model also addresses a common gap in clinician training: lifestyle and nutritional counseling. “I don’t think we as doctors are trained super well around teaching and the lifestyle stuff,” Pace admitted. “Knowing how to educate the frontline PCP about the key nutritional goals for those patients on GLP-1s is really helpful.”

Clinical Considerations: Comorbidities and the Whole Patient

The roundtable underscored that obesity management cannot be isolated from the treatment of its many comorbidities and it is important to integrate obesity care with management of sleep apnea, MASH, and cardiovascular disease.

Osama Hamdy, MD, PhD, medical director of the Obesity Clinic Program and Inpatient Diabetes Program at Joslin Diabetes Center, noted that patients with specific conditions—such as sleep apnea, osteoarthritis, and prediabetes—derive the most direct health economic value from weight loss.

However, the rapid weight loss associated with newer medications and surgery has raised concerns about muscle mass loss, particularly in older or high-risk populations. This led to a spirited debate regarding the “quality” of weight loss.

“When you have, in just 1 year, a loss in muscle mass equivalent to around 8 to 10 years of age-related loss in muscle mass, you have to [put] a question mark,” argued Hamdy. He emphasized the need for a high-protein diet and resistance exercise to counteract sarcopenia.

Flanders countered by pointing to the functional improvements seen in clinical trials. “We have no data that losing mass equals losing function.… Every single day you see patients come and say, ‘Now I can go grocery shopping. Now I can go up the stairs.’”

The Economic Case for Treatment and the Cost of Inaction

A major barrier to broader coverage for obesity treatments—both pharmacotherapy and surgery—is the perceived high cost to payers and employers.

Samar Hafida, MD, an endocrinologist at BMC and vice president of the Obesity Association (a subdivision of the American Diabetes Association), said research into the health economics of treatment shows the cost of inaction if obesity is not treated with lifestyle interventions, bariatric surgery, or pharmacotherapy. Unpublished data have shown a “break-even” point as early as year 2.

Hamdy added that achieving even a 7% weight loss and maintaining it for 1 year can reduce total health care costs by 25% and diabetes-related costs by 44%. However, he cautioned that “health economics doesn’t work if the price of the medication is extremely expensive.” He predicted that in the future, insurers may mandate a step therapy approach, starting with oral medications before moving to more expensive injectables.

Equity and Access for Diverse Populations

The goal of promoting equitable access was a recurring theme, particularly when discussing patients living in poverty. Pace highlighted the unique risks for these populations.

“The majority of our patients at BMC are living in poverty,” she said. “And when they’re on a GLP-1 and have poor nutritional access at baseline, the micronutrient deficiencies...[are] actually pretty scary.”

Access also remains a challenge due to drug shortages and the “prohibitive” cost of treatment for those without comprehensive coverage. “The No. 1 reason why they stop [medication] is because they don’t have access to it—because the cost is prohibitive,” Stanford stated, debunking the myth that adverse events are the primary cause of discontinuation.

Tavakkoli shared data from his center showing that at 1 year, only 54% of patients prescribed semaglutide (Wegovy) were still taking it. Of the 46% who stopped, roughly 40% cited issues with access, expense, insurance, or drug shortages.

Future Outlook: The “Cancer Center” Model for Obesity

As the roundtable concluded, the experts looked toward a future in which obesity care is treated with the same multidisciplinary team care model and seriousness as oncology. Apovian envisioned a future with a multidisciplinary center for obesity treatment that removes the stigma from therapy. She compared this to a model for treating breast cancer: “If you have breast cancer, you walk into a cancer treatment center. You are offered not just 1 or 2 things. You’re offered [radiation], chemo[therapy], and surgery based on the degree [and] what kind of tumor you have.”

Creating such a model requires systemic change from the national level down to the individual provider. Stanford emphasized the need for a “comprehensive care model where we have multiple players at the table.”

By connecting the dots among primary care, specialized obesity medicine, surgery, pharmacy, and nutrition, health systems can move toward a sustainable, equitable framework for managing this chronic disease. As Apovian summarized, the path forward involves bringing the “BMC model” to broader systems, thus empowering PCPs and supporting them with a robust team of pharmacists and dietitians.

“The PCPs are empowered over there to treat obesity,” Apovian concluded.

Author Information: Ms Joszt is an employee of MJH Life Sciences, the parent company of the publisher of Population Health, Equity & Outcomes.