Scaling Obesity Care With Equity in Mind: Jaime Almandoz, MD, MBA

In this second half of a recent interview on trends in tirzepatide use, Jaime Almandoz, MD, MBA, calls for scalable, team-based care models to support the growing use of obesity medications like tirzepatide. Integrating pharmacotherapy with nutrition, behavioral health, and surgery is essential—but so is equitable, sustained access. Almandoz stresses the need for better training in access navigation. He also highlights how Insurance coverage remains uneven, with some plans adding hurdles and others ignoring obesity, and highlights priorities for future research: real-world outcomes, long-term adherence, cost-effectiveness, and equity across diverse populations.

The rise of tirzepatide, he says, marks a turning point in how obesity and related conditions are treated. To truly shift the landscape, care models and policies must move beyond weight loss and glucose metrics to focus on quality of life and total health outcomes. For insights on early adoption trends, see part 1 of this interview, published in April.

Almandoz is associate professor of medicine in the division of endocrinology and medical director of the weight wellness program at UT Southwestern in Dallas.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

How should clinical infrastructure and care models adapt to support new obesity medications effectively?

These data strongly support the need for scalable multidisciplinary models of care that integrate pharmacotherapy with nutrition, behavioral health support, and, where appropriate, bariatric surgery. With the rapid uptake of advanced obesity medications, there's growing demand for clinical infrastructure that can support safe, effective, and equitable delivery of care. From a policy perspective, this reinforces the importance of insurance coverage for FDA-approved obesity care. Incretin-based therapies have the potential to decrease downstream health care costs by preventing complications of obesity and type 2 diabetes. But this can only be realized if access is equitable and sustained.

What role do insurance coverage decisions play in integrated obesity care and realizing economic benefits?

Some are increasing and others are kind of rolling back or are encouraging or requiring people to be part of additional programs. It may be that you can still have access to tirzepatide or semaglutide for obesity, but we would like you to also enroll in a behavioral health program. It's yes and no, and that's the issue. The irony, when you look at indications such as obstructive sleep apnea [and] cardiovascular risk reduction, we see coverage by Medicare for these additional indications, but not for obesity, but in commercially insured patients, we don't see coverage for those indications, but we will see obesity care coverage.

The challenge is, there's such a need for a different kind of literacy, I would call it, when it comes to navigating access issues for our patients that many clinicians aren't trained in, that I think we would do well to create programs for education within medical school, residency, and fellowship that help clinicians to understand how to navigate these systems so that they can advocate for their patients. But I wish we had better-informed policies and access for patients where clinicians didn't have to spend time doing that and could spend time applying evidence-based care to improve health.

What are logical next steps to further elucidate tirzepatide’s impact, particularly in real-world or diverse patient populations?

More real-world evidence to understand the impact of tirzepatide beyond the early-adoption phase. Some of these key steps could include evaluating long-term, real-world clinical outcomes, such as change in [hemoglobin] A_1c, body weight, cardiovascular risk factors, mortality, and other outcomes; investigating adherence patterns, medication discontinuation, and reasons for gaps in treatment could also be helpful; assessing cost-effectiveness and long-term health care utilization associated with tirzepatide use; and finally, exploring uptake and outcomes across racial, ethnic, and socioeconomic groups to identify and address equity gaps.

Are there deeper implications for the trends observed in the recent tirzepatide utilization study for how we understand and treat obesity as a chronic disease?

I feel that this study captures a critical inflection point in how we treat obesity and type 2 diabetes. The increasing uptake of tirzepatide is part of a larger shift in how we manage obesity and related conditions. Obesity is a chronic and complex disease that underlies much of the cardiometabolic burden we see in clinical practice. This includes type 2 diabetes, hypertension, and things like sleep apnea. As these diseases continue to rise in prevalence, we need to ensure that evidence-based obesity care is accessible, equitable, and outcomes focused. This means moving beyond narrow end points, like glucose and weight reduction, and focusing on broad health outcomes, including quality of life, long-term health care utilization, and total cost of care. Real-world adoption is happening now. Our systems and policies need to keep pace to support patients who need these therapies most.