Clinicians Grapple With Barriers to Multidisciplinary Obesity Treatment

Am J Manag Care. 2026;32(Spec. No. 6):SP276-SP278. https://doi.org/10.37765/ajmc.2026.89968

As obesity rates continue to climb in the US, clinicians across specialties are confronting the reality that although therapeutic options have expanded rapidly, the systems designed to deliver care have not kept pace.¹

During a recent population health roundtable hosted by The American Journal of Managed Care in Phoenix, Arizona, local physicians, pharmacists, and health system leaders discussed how obesity care is evolving and where it continues to fall short. Their conversation revealed a shared sense of urgency fueled by frustration over fragmented care delivery, administrative burdens, and persistent gaps in insurance coverage.

“We’re here to really talk about how we all together [can] come up with approaches that can make health care sustainable, more affordable for everyone, and support good outcomes,” said Ed Clarke, MD, chief medical officer at Banner Health Plans and Networks, who moderated the discussion.

Who Owns Obesity Care?

One of the first issues raised was also one of the most fundamental: Who is responsible for managing obesity? Unlike many chronic diseases that fall squarely within a single specialty, obesity intersects with nearly every aspect of medicine—from endocrinology and cardiology to mental health and primary care. As a result, responsibility is often diffuse.

“I think ownership is a difficult word,” said Nancy Koch, MD, an internist at Mayo Clinic Arizona. She explained that primary care doctors may worry about making patients feel judged when discussing obesity, noting, “I think everybody needs to take ownership to fight this battle.”

In consultative settings, patients often arrive with established diagnoses and multiple comorbidities, making it unclear who should take the lead. In primary care, however, clinicians tend to be the default coordinators.

“I am often the one to take ownership of prescribing, of facilitating conversations around holistic weight loss therapy,” said Nathan Delafield, MD, an outpatient internist at Mayo Clinic Arizona. However, many of his patients are now taking the initiative to ask about antiobesity medications such as glucagon-like peptide-1 (GLP-1) agents, showing “they already have recognized that there are available treatment options that may benefit them.”

Doug Maready, MD, who practices internal and obesity medicine as chief medical officer at Forte, argued that earlier intervention in primary care could prevent downstream complications. “I think that primary care should be the place where it originates,” he said, emphasizing the importance of addressing obesity before comorbid conditions develop.

For some clinicians, reframing obesity as part of a broader cardiometabolic condition may help unify care. By using the cardio-renal-metabolic framework, “we try to teach our patients the relationships between all the specialties,” said Rajkumar Sugumaran, MD, an interventional cardiologist with Heart One Associates, describing an approach that integrates obesity with related risks such as diabetes, kidney disease, and cardiovascular disease.

Pharmacists Step Into Expanded Clinical Roles

As care models evolve, pharmacists are playing an increasingly prominent role in obesity management, often bridging gaps between diagnosis, treatment selection, and long-term follow-up. “I get to do the exciting part, and that’s going over all the medication options,” said Angela Coulter, PharmD, BCPS, BCACP, a clinical pharmacist embedded in a Mayo Clinic Arizona primary care setting.

With longer appointment times and specialized training, pharmacists are uniquely positioned to counsel patients on medication mechanisms, adverse effects, and lifestyle considerations. In many cases, they also manage titration and ongoing monitoring under collaborative practice agreements. However, their role extends beyond clinical decision-making. In complex insurance environments, pharmacists often serve as navigators of formulary restrictions and prior authorization requirements.

“A decent amount of what the pharmacist does is ensure that we’re picking an appropriate product that we can get covered,” said Casey Hilde, PharmD, who oversees pharmacy teams across multiple clinics as Optum’s director of clinical pharmacy in Arizona and New Mexico.

To support clinicians at the point of care, some pharmacy teams have developed tools to streamline decision-making.

“Our clinical pharmacist actually made us a formulary sheet.… It’s incredibly useful,” said Grishma Sheth, MD, an endocrinologist at Banner University Medical Center in Phoenix, noting that such resources help avoid recommending therapies that are unlikely to be covered.

Despite these contributions, participants agreed that opportunities remain for pharmacists to become more integrated into the workflow of treating obesity.

“We definitely need more pharmacist collaborative pathways; that’s so underutilized today,” Sugumaran said.

Building Systems That Support Obesity Care

Although individual clinicians make meaningful contributions, participants emphasized that sustainable progress will require system-level changes. One strategy discussed was the development of structured care pathways within electronic health records (EHRs), allowing clinicians to identify and manage obesity more consistently.

“The pathways can be set up. The EHR can be programmed,” Maready said, pointing to emerging models that embed screening and treatment workflows into primary care. Sugumaran highlighted the importance of leadership within organizations, suggesting that designated experts, or super users, can help drive adoption.

Such models could align with broader value-based care initiatives, which increasingly focus on preventing costly complications. However, participants noted that current incentive structures do not adequately prioritize obesity care.

“How do you make it incentivizing to the provider…to do this line of work and to do it well?” Sugumaran asked.

Fragmentation Remains a Major Challenge

Even as multidisciplinary care expands, coordination remains a persistent challenge. Patients often move between providers and settings without a clear central point of responsibility.

“Patients need a quarterback,” Delafield said. “Whether that is a clinical pharmacist, a primary care physician, a cardiologist [who is] deeply invested, or an obesity specialist, they need someone they can trust to say, ‘I’m going to run the show. I’m going to own this in partnership with you. I’ll prescribe the medicine. I’ll titrate the medicine. I’ll decide when we need to come off the medicine or de-escalate the medicine in partnership with you.’”

Without that leadership, care can become disjointed. “Most medical care is fragmented today, unfortunately,” Koch said, noting that this issue extends beyond obesity to many chronic conditions.

Coverage Barriers, Administrative Burden, and Workarounds

If fragmentation is one obstacle, cost and coverage represent 2 additional—and perhaps more immediate—barriers. Despite the clinical promise of newer medications,² access remains limited. Craig Primack, MD, an obesity medicine specialist at Scottsdale Weight Loss Center, estimated that only a fraction of patients can access these agents through their insurance. “Only 1 out of 10 people get coverage for GLP-1s,” Primack said.

For those who pursue treatment through their insurance, the prior authorization process can be lengthy and unpredictable, Sheth said, as “people wait weeks and weeks for a prior auth to go through.”

The lack of transparency around coverage further complicates decision-making for both clinicians and patients. “I think that would be a huge improvement if they know, ‘I’m able to afford this medicine. Tell me about it. Educate me about it,’ ” Sheth added. “And then we can make a shared decision together if we know it’s a drug that they can actually afford.”

Preparing small practices to prescribe GLP-1s requires building the institutional knowledge and staff readiness to handle coverage requirements, according to Jennifer Meyfeldt, MD, an outpatient internist at Banner University Medical Center. “It’s easy to teach physicians the basics of obesity medicine—that can be done in medical school,” she said, “but to really have physicians feel comfortable to treat obesity and practice obesity medicine, it needs a lot more than that from a systems level and more support.”

In response to these barriers, clinicians have developed a range of strategies to navigate the system. Some adopt a trial-and-error approach to prescribing, with Primack describing “writing 2 or 3 prescriptions [to] see [whether] it’s covered.”

Others rely on emerging technologies to streamline administrative tasks. Hilde described integrated tools that automate parts of the process: “We can submit a prior auth in 45 seconds now.”

Clear communication with patients is also essential. “We give them a heads-up of how it’s going to go down,” Sugumaran said, noting that setting expectations can help maintain engagement during delays.

Still, these workarounds can create ethical dilemmas. Some clinicians acknowledged screening and rescreening for certain diagnoses to ensure that indications, such as sleep apnea, remain on a patient’s chart.

Others emphasized the importance of reframing how insurers view treatment success, such as when a patient’s body mass index decreases after treatment. “That doesn’t mean they don’t have the disease anymore. They just have it well-treated,” Maready said, arguing that coverage should continue even after clinical improvement.

Screening Gaps, Misaligned Incentives, and Reframing the Chronic Disease

Participants also highlighted inconsistencies in screening and diagnosis, particularly for type 2 diabetes, a common comorbidity of obesity. The inability to use obesity as a primary reimbursable diagnosis further complicates care. This can lead to counterintuitive incentives and emotions.

“It’s the first time in my life that I’ve actually, in partnership with a patient, been a little excited that they have diabetes, because now they can get their drugs,” Sugumaran said, highlighting the disconnect between disease prevention and treatment access.

Underlying many of these challenges is a broader issue: the need to fully recognize obesity as a chronic, treatable disease.³ Primack expressed that clinicians have a responsibility to address the condition: “If you’re not treating obesity, it’s medical malpractice.”

At the same time, participants emphasized shifting the focus from weight loss alone to overall health outcomes. “Don’t get caught up in the weight loss. Get caught up on the risk reduction,” Sugumaran advised.

Although the challenges are significant, participants expressed cautious optimism about the future of obesity care. Advances in pharmacotherapy, growing patient awareness, and emerging care models all point toward progress. However, meaningful change will require alignment across stakeholders, from clinicians and health systems to payers and policy makers. At the center of these efforts, participants agreed, must be the patient experience.

For Clarke, the path forward is clear, even if the work ahead is complex. “It’s hard work, and it’s a team sport,” he concluded.

REFERENCES

1. DeCleene NK, Kahn E, Yuan CW, et al. US state-level prevalence of adult obesity by race and ethnicity from 1990 to 2022 and forecasted to 2035. JAMA. 2026;335(11):975-985. doi:10.1001/jama.2025.26817

2. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al; SELECT Trial Investigators. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563

3. Recognition of obesity as a disease H-440.842. American Medical Association. Updated 2023. Accessed May 12, 2026. https://policysearch.ama-assn.org/policyfinder/detail/obesity?uri=%2FAMADoc%2FHOD.xml-0-3858.xml