New York Experts Push for Coordinated Obesity Care Teams

Even with increasingly effective medications for obesity, building a care team that can identify, treat, and follow patients through years of chronic disease management remains an unsolved challenge, according to physicians, a dietitian, and health system leaders who gathered July 14, 2026, in New York City for a Population Health Roundtable event on constructing high-impact care teams for patients living with obesity and type 2 diabetes from The American Journal of Managed Care^®. The discussion was moderated by Judith Korner, MD, an obesity medicine physician at Columbia University and immediate past chair of the American Board of Obesity Medicine.

Care Origination Varies Across NYC Health Systems

Panelists described different starting points for obesity care. Stanislaw Klek, MD, division chief of endocrinology at NYU Langone Long Island, said his institution is building "Pathways for Obesity," a central hotline that routes patients to any of roughly a dozen interested clinicians across bariatric surgery, endocrinology, and primary care rather than requiring an endocrinology referral. Sriram Machineni, MD, director of Fleischer Institute Medical Weight Center at Montefiore Medical Center/Einstein College of Medicine, described a primary care–based model he helped launch at the University of North Carolina at Chapel Hill that has grown to 17 clinics without relying heavily on glucagon-like peptide-1 (GLP-1) receptor agonists.

"Primary care can do it," he said, "it just needs a different approach."

Nichola Davis, MD, vice president and chief population health officer at NYC Health + Hospitals, said her weight-management visits are embedded within primary care clinics but noted physicians often start patients on GLP-1s "isolated," without lifestyle counseling or adverse-effect support. Preeti Kishore, MD, who directs endocrinology for 2 NYC Health + Hospitals sites, said her Jacobi Medical Center program relies on health coaches, dietitians, and a psychologist for "multiple points of contact."

Pharmacists and Technology Fill Staffing Gaps

With too few obesity specialists to meet demand, several panelists pointed to pharmacists and automation. Shivani Agarwal, MD, senior director of community healthcare improvement and strategy at Montefiore, described clinician-designed electronic prompts that flag GLP-1 candidates and route prescriptions through an artificial intelligence (AI)–assisted prior authorization workflow, followed by an agentic AI call 2 weeks after the fill to check on adverse effects before escalating to human staff.

Rekha Kumar, MD, associate professor of clinical medicine and attending endocrinologist of Weill Cornell Medicine, said institutional specialty pharmacies, funded partly through the 340B program, now manage titration and adverse-effect checks after prescriptions are written, though she called the arrangement lucrative enough to raise questions.

Zachary Bloomgarden, MD, clinical professor of medicine at the Icahn School of Medicine at Mount Sinai, argued that reimbursable, nonclinician staff following structured protocols could extend care further than adding nurse practitioners, whose positions are harder to fund. Katherine Saunders, MD, executive vice president and cofounder of FlyteHealth, said scaling access will depend on similar technology-supported models but stressed there is "no replacement" for the clinician-patient relationship.

Insurance Rules, Not Clinical Judgment, Often Drive Prescribing

Coverage rules shaped much of the discussion. Korner said she routinely tells patients "the decision is going to be made by your insurance," working down a list of alternatives when GLP-1s aren't covered. Rachel Salzman, RD, diabetes care & education specialist at Weill Cornell Medicine, noted Medicare covers nutrition counseling only for patients with diabetes or chronic kidney disease, leaving prevention largely unfunded. Davis said she still prescribes phentermine and topiramate for Medicaid patients despite believing GLP-1s would work better, because those older drugs are what insurance will pay for. Machineni described patients whose coverage denials left them without options despite clear medical need, calling some situations "unethical."

Several panelists had begun using the Medicare GLP-1 Bridge Program, which Machineni said required about 10 days of troubleshooting pharmacy billing codes before approvals came through. Korner welcomed expanded eligibility, including a BMI threshold of 27 with prediabetes, but panelists questioned what happens once the program's window closes.

"There may be a long delay before we get to the point of affordable GLP-1s," Bloomgarden said.

Panelists Call for Coordination and Policy Engagement

Closing the session, Manish Parikh, MD, a general and bariatric surgeon at NYU Langone General Surgery Associates and director of bariatric surgery at Bellevue Hospital Center, said he remains "amazed at how fragmented our care still is" despite effective treatments now on the market. Salzman pointed to recurring touch points among a multidisciplinary team as key to catching problems early, and Kumar questioned whether employer-sponsored insurance can sustain treatments whose payoff plays out over decades.

"It makes you wonder if employer-based health care is the right system anymore in this country because employers aren't incentivized to look 20 years out because people don't keep their jobs anymore for 20 years," Kumar said.

Kishore urged colleagues toward policy advocacy, noting, "We have something that's really effective, but we just can't get it to all the people that need it." Klek closed with a simple summary: technology, he said, "needs to play a bigger role in this whole problem."