Obesity Is Diagnosed Everywhere and Owned Nowhere, Atlanta Clinicians Say

Body mass index (BMI) is recorded at nearly every clinical encounter, yet patients with obesity routinely reach specialty care only after years of untreated disease. Clinicians who treat them described a system in which the diagnosis is captured reliably, the treatment plan belongs to no one, and patients cycle between offices without a handoff.

Eight clinicians examined that gap on July 31, 2026, at a Population Health Roundtable hosted by The American Journal of Managed Care^® in Atlanta, Georgia. Moderated by Scott D. Isaacs, MD, FACP, FACE, medical director of Atlanta Endocrine Associates and adjunct associate professor of medicine at Emory University School of Medicine, the session brought together obesity medicine and primary care physicians, 2 bariatric surgeons, a cardiologist, and a pharmacist from Emory Healthcare, Piedmont, Northside Hospital, Wellstar Health System, and Morehouse School of Medicine.

Ownership Falls to Primary Care by Default

Reema Dbouk, MD, FACP, assistant professor of medicine at Emory University School of Medicine, said screening begins in primary care at Emory, and Jyoti Manekar, MD, obesity medicine specialist, Bariatric Innovations of Atlanta, at Northside Hospital, called primary care the quarterback for everything downstream. That assignment collided with what a single visit can absorb, and Dbouk questioned how an automated referral prompt would fare against a patient’s agenda.

“If you're sitting in front of a patient who has a laundry list of 10 things they want to talk about and a thing pops up to you on Epic saying, ‘refer this patient to bariatric surgery,’ how are you supposed to sort of navigate switching over, talking about what your priority is when the patient wants to go through their own things?” Dbouk asked.

The consequence shows up in how late patients arrive, said Kenneth Copperwheat, DO, FASMBS, DABOM, a metabolic and bariatric surgeon at Piedmont in Columbus, Georgia.

“The average referral to my practice is a BMI 47,” Copperwheat said. “How do they get there? These patients are 50, 45, 55 years old. They've been having a BMI of 40 for decades.”

Elizabeth Hechenbleikner, MD, director of the Bariatric Center at Emory University Hospital Midtown, called the shortfall structural, not clinical.

“We can’t do it with brick and mortar, with appointments, with the resources that we have,” Hechenbleikner said. “It has to be thought of completely differently because it’s at such a large scale that we just can’t keep pace.”

The Medicare Bridge Program Opens a Door and an Inequity

Panelists were broadly familiar with the Medicare Bridge program, effective July 1, 2026, which set a fixed $50 co-pay for a 30-day supply of semaglutide, tirzepatide, or orforglipron for eligible beneficiaries with obesity. Dbouk called it the first time Medicare has covered medication for obesity and a step toward recognizing the disease as one that warrants treatment, then called it uneven in practice.

“There’s definitely an inequity here with this program in that somebody who maybe has a more serious comorbidity is now paying more for their medication than someone else,” Dbouk said.

Copperwheat said the criteria diverge from FDA indications and commercial plan rules, and Manekar described a patient who deferred a prescription for months awaiting the $50 co-pay, then learned her Medicare Advantage plan did not participate.

Coverage Rules, Not Evidence, Drive Treatment Selection

Prior authorization (PA) dominated the discussion of operational barriers. Yolanda Whitty, PharmD, who manages an ambulatory pharmacotherapy clinic at Wellstar Health System, said the work is not contested, only who has the room to do it.

“Who has the time to do the PA?” Whitty asked. “I can't think of any doctor that wouldn't want the patient to be connected to the right medication for their condition. But who has the bandwidth to complete the PAs?”

Whitty said she calls payers directly after a denial, then logs the insurance type, denial reason, and diagnosis code to find patterns. Panelists described hunting for secondary diagnoses, such as obstructive sleep apnea, to secure coverage that obesity alone does not obtain, and they split on whether step therapy protects patients or delays them. Manekar said the rules have narrowed prescribing criteria to 2 considerations.

“I think I could just go by 2 criteria,” she said. “One is contraindication, second is coverage, unfortunately. It shouldn’t be that way, but it is that way.”

Primary Care Implementation Challenges

Elizabeth O. Ofili, MD, MPH, FACC, professor of medicine at Morehouse School of Medicine and chief medical officer of the Morehouse Choice Accountable Care Organization and Education System, said any new workflow asked of primary care needs evidence behind it, and she put implementation at 18 months. Hechenbleikner named clinical pharmacy partnership as her immediate opportunity, and Manekar pointed to physician education across Northside.

The group closed on the isolation of the work. Copperwheat said expertise remains trapped among specialists who already agree with one another, and Dbouk said the evening’s value was learning that every institution was solving the same problem separately. Manekar addressed readers beyond the room.

“Getting help is not failure. Not getting help is a failure,” Manekar said.