Chicago Panel Weighs Barriers to Transplant Weight-Loss Access

Glucagon-like peptide-1 (GLP-1) receptor agonists have reshaped demand for obesity care, but health systems still have not settled who manages a patient once the prescription is written. Physicians, pharmacists, and a dietitian working across endocrinology, primary care, and solid organ transplant programs described overlapping referral pathways and persistent uncertainty over which clinician ultimately owns a patient's weight-management plan.

The clinicians gathered on August 6, 2026, in Chicago for a Population Health Roundtable event hosted by The American Journal of Managed Care^® focused on building multidisciplinary teams for obesity and type 2 diabetes care. The discussion was moderated by Robert F. Kushner, MD, professor emeritus at Northwestern University Feinberg School of Medicine, former director of the Center for Lifestyle Medicine at Northwestern Medicine, and founding chair of the American Board of Obesity Medicine. Nine panelists, including endocrinologists, pharmacists, a registered dietitian, and a health care consultant, represented Northwestern Medicine, Loyola Medicine, and the University of Chicago Medicine, two of whom run a transplant-specific weight-management clinic.

Care Ownership Splinters Across Transplant, Endocrinology, and Primary Care

Panelists described several starting points for obesity care rather than 1 consistent entry. Maria Fariduddin, MD, an endocrinologist at Loyola University Medical Center and Gottlieb Memorial Hospital, said referrals once came mainly from primary care physicians, but now a large share originates from transplant clinics screening candidates for weight-related disqualification.

"I think at least 30% of my patients come from the transplant clinics," she said, noting an electronic medical record alert flags any patient with a BMI above 30 for a bariatric referral.

A third entry point is the patient. Rod Marianne Arceo-Mendoza, MD, an endocrinologist and associate fellowship program director at Loyola Medicine, said patients now raise GLP-1s unprompted, often citing a neighbor's results, even at visits booked for thyroid disease or diabetes.

"These questions I never would have encountered 5 years, 6 years ago," she said.

Suja Mathew, MD, FACP, an independent health care consultant whose clients include the American Medical Association, spent 4 years as executive vice president and chief clinical officer at Atlantic Health System and 22 years in the Cook County Health System as system chair of medicine. She argued the entry point matters less than timing.

"Wherever it begins, it's too late," she said.

Carrie Yu, PharmD, a pharmacist at Northwestern Medicine, said confusion over who manages a GLP-1 prescription intensifies once a primary care physician begins adjusting a dose that was started in a specialty clinic.

"It's who owns the script," Mathew said.

Transplant Weight-Loss Clinics Emerge to Close Access Gaps

Two panelists from University of Chicago Medicine described building a program from scratch to serve patients disqualified from organ transplants because of their weight. Anesia Reticker, PharmD, BCTXP, a clinical pharmacy specialist in solid organ transplant, and Annie Guinane, MS, RD, CCTD, a transplant dietitian, cofounded the Access to Transplant through Novel Approaches to Weight Loss (ACTNOW) clinic after watching patients reach end-stage organ disease before anyone addressed their weight.

"We're seeing patients almost a little too late," Reticker said, adding that much of the clinic's referral base is patients with at-risk metabolic dysfunction-associated steatohepatitis (MASH) or chronic kidney disease, with hypertension and diabetes the leading drivers of kidney failure.

The program initially struggled for institutional support. Reticker said hospital administrators "shut us down for 8 months," declining to commit space or staffing, so the pair now handle their own scheduling and outcomes tracking. Guinane said wait lists at the health system's existing weight-management programs are "extremely long," running about 6 months for many patients and pushing them toward online prescribers or compounding pharmacies.

Rising BMI thresholds compound the problem, though for different reasons at each institution. Vishal Prakash, PharmD, a pharmacist at Northwestern Medicine, said his institution tightened its referral criteria from a BMI of 30 plus two obesity-related comorbidities to a BMI above 35 with certain gastrointestinal comorbidities. At Loyola, Fariduddin said the constraint is insurance rather than capacity: the BMI required for GLP-1 coverage has moved from 27 to 30 to 35, cutting off patients already taking the drugs.

Pharmacists Absorb Access Work Without Formal Recognition

Pharmacists described taking on prior authorizations, appeals, dose titration, and patient education under collaborative practice agreements, often without ever seeing the patient in person. Christine Pan, PharmD, BCACP, and Prakash said their team of pharmacy technicians processes prior authorizations for GLP-1s and other medications across the 2 clinics they support, but that work rarely translates into institutional credit.

"Pharmacists don't generate revenue," Prakash said, echoing Reticker. "We make money by saving money."

Sabrina Sanchez, PharmD, a liver transplant pharmacist at University of Chicago Medicine, said she increasingly sees prescriptions written through telehealth platforms and online weight-loss programs and questioned whether patients cycling through a different prescriber each month receive any continuity of care.

Reticker said 30 patients previously disqualified for transplant because of their weight have since received transplants, but that her team has never been asked to present grand rounds at its own institution.

Closing the session, Kushner noted the panel had built its programs largely on its own initiative and urged staff training in nonstigmatizing language, describing an incident in which a front-desk comment undermined a patient who had already lost 200 pounds after bariatric surgery. Kushner suggested embedding obesity medicine specialists directly within cardiology, nephrology, and other subspecialty clinics rather than requiring a separate referral.