With GLP-1 medications, updated standards of care and growing awareness of weight bias, clinicians are navigating expanding treatment options — and rising expectations — in the fight against chronic disease.
Obesity care is undergoing a profound shift – from a narrow focus on weight loss to a more comprehensive, chronic-disease approach that spans prevention, treatment and long-term support. Across primary care clinics, specialty organizations and patient advocacy groups, clinicians are increasingly recognizing obesity as a complex medical condition that intersects with diabetes, cardiovascular disease and a host of other health risks. That evolution is reshaping everything from care delivery models to the products and therapies used to support patients.
Family physicians are often on the front lines of that change. Dr. Brent Smith, a family physician and member of the American Academy of Family Physicians’ Board of Directors, said the past five years have brought a stronger emphasis on addressing obesity as a root cause of many chronic conditions.
“Family physicians play a key role in helping patients get to a healthy weight and reduce risks for related health concerns,” he notes. Today, care teams are combining lifestyle counseling, behavioral health strategies, medications such as GLP-1s and, when appropriate, bariatric surgery – an approach echoed by experts from the American Diabetes Association and the Obesity Action Coalition, who stress that effective obesity care requires coordinated, patient-centered support across the continuum.
New options, greater expectations
As new therapies and care models reshape obesity treatment, family physicians are finding themselves at the center of a rapidly expanding set of options – and expectations. From counseling patients on nutrition and physical activity to prescribing advanced medications and coordinating referrals, primary care practices are navigating a broader, more complex treatment landscape than ever before.
Dr. Smith said that shift is both encouraging and challenging. For years, family physicians have treated the chronic conditions associated with obesity, such as Type 2 diabetes, hypertension and cardiovascular disease. Now, they are increasingly able to target obesity itself as a root cause. “We have always known that reducing a patient’s weight might prevent, lessen or eliminate these chronic conditions altogether,” he explained. “We are just now gaining the tools to more effectively act on the need to combat obesity.”
The emergence of GLP-1 medications and other anti-obesity drugs has been particularly transformative. While these therapies build on medications long used in diabetes care, they represent a new era in which pharmacotherapy can significantly affect weight. Family physicians weigh a range of factors when considering these treatments, including patients’ existing conditions, risk profiles and ability to manage potential side effects. At the same time, access remains uneven. Coverage for obesity medications and behavioral interventions varies widely across public and private payers, often lagging behind clinical evidence and patient demand. As a result, physicians frequently must help patients navigate benefit limitations, affordability concerns and the risks associated with unregulated or counterfeit weight-loss drugs.
In this evolving environment, team-based care has become essential. Dietitians, behavioral health specialists, pharmacists and, when appropriate, bariatric surgeons all play a role in helping patients achieve and maintain healthier weights. Yet Dr. Smith emphasized that the family physician remains the central coordinator. As the patient’s medical home, primary care brings together medical history, ongoing conditions and treatment goals to ensure that interventions – whether lifestyle changes, medications or surgery – are aligned and sustainable. That coordinated approach, he said, offers the best chance of improving long-term outcomes in a condition that is both chronic and deeply interconnected with overall health.
A patient’s point of view
For many patients living with obesity, the primary care office can be either a gateway to effective treatment or a place that reinforces long-standing stigma. Joe Nadglowski, president and CEO of the Obesity Action Coalition (OAC), said that historically, too many patients have experienced the latter. “For many years, patients didn’t see their PCP as a trusted source for information on obesity,” he said. Conversations about weight were often framed in ways that felt judgmental or dismissive, leaving patients feeling shamed rather than supported. Those early negative encounters can linger, making individuals less likely to seek follow-up care or engage in future discussions about their health.
Yet Nadglowski noted that the landscape is beginning to change. Greater clinical understanding of obesity as a chronic disease, along with the emergence of more effective treatments, has prompted a shift in how some primary care practices approach care. He pointed to his own recent experience with a new physician as an example: a visit marked by empathy, privacy and thoughtful accommodations such as appropriate seating and respectful weighing procedures. “Progress is possible,” he said, but it requires both intentional actions by clinicians and institutional changes that make healthcare environments more inclusive for people with larger bodies.
Weight bias, however, remains a persistent barrier. It can surface in subtle ways – language choices, assumptions about patient behavior or treatment decisions – as well as in the physical environment of a practice. Waiting rooms without sturdy, armless chairs; exam rooms without properly sized gowns or blood pressure cuffs; and weigh-ins conducted without privacy all send signals that patients with obesity are not fully considered. These experiences erode trust and can lead to delayed or avoided care. According to Nadglowski, patients who encounter stigma are less likely to pursue preventive services such as cancer screenings, vaccinations or mental health care, and more likely to cancel appointments or avoid new providers altogether.
Even when patients find a skilled and compassionate primary care physician, access to treatment can be complicated by insurance requirements. Coverage for anti-obesity medications, behavioral counseling and multidisciplinary support varies widely, often requiring extensive documentation, step-therapy protocols or referrals to specific programs. For patients who have already overcome fear or embarrassment to seek help, these hurdles can feel discouraging. Nadglowski said improving outcomes will require not only empathetic clinical care but also more consistent coverage policies and stronger support systems that make evidence-based obesity treatment accessible and sustainable.
Setting a standard
As obesity care evolves, new clinical standards are seeking to reshape both how patients are treated and what treatment looks like in practice.
Last May, the American Diabetes Association’s Obesity Association released the first installment of new Standards of Care in Overweight and Obesity, offering comprehensive, evidence-based guidance aimed at improving treatment and reducing weight stigma in healthcare settings. The recommendations call for clinician training on bias, more inclusive clinical environments, respectful, person-centered communication and shared decision-making that prioritizes outcomes beyond weight alone. Developed with input from multiple medical organizations, the standards are designed to help clinicians deliver compassionate, effective care and recognize obesity as a complex chronic disease. Leaders say the guidance represents a broader effort to improve access, quality and dignity for people living with overweight and obesity.
Kimberly Gudzune, MD, MPH, FTOS – co-chair of the Standards of Care in Overweight and Obesity “Pharmacologic Treatment of Obesity in Adults” section and chair of the American Diabetes Association’s Professional Practice Committee on obesity – said the recently published guidelines send a clear message: obesity is a chronic condition that deserves comprehensive, evidence-based care delivered with dignity.
The current standards include two chapters most relevant to the public: one focused on weight bias and stigma, and another on pharmacologic treatment. Together, they emphasize that patients with overweight or obesity should expect respectful care and clinical environments that accommodate people of all sizes. “People with obesity should expect to be treated with respect in healthcare settings and clinics should have equipment and furniture that accommodates all individuals,” Dr. Gudzune said.
The pharmacologic chapter highlights the growing role of medications in obesity management. Today’s treatments can lead to meaningful health benefits – such as improved blood sugar control, lower blood pressure and weight reduction – but are typically intended for long-term use. Patients should work with clinicians to determine the most appropriate therapy based on their medical history and undergo a comprehensive evaluation before a prescription is written. Medication, she added, should be paired with guidance on nutrition and physical activity, along with regular follow-up to monitor progress and address challenges.
Beyond individual treatment decisions, the standards aim to influence the broader healthcare ecosystem. By grounding expectations in scientific evidence, they provide a roadmap for clinicians and a reference point for insurers and policymakers considering coverage for obesity care. “Having standards may also help policymakers … when evaluating eligibility for and benefits coverage of obesity care services,” Dr. Gudzune noted.
Dr. Gudzune also pointed to persistent disparities in obesity prevalence across the United States. “Obesity still impacts a significant number of people across the U.S., although the prevalence is typically higher in the South and Midwest regions among both adults and children,” she said. “Obesity prevalence continues to be higher among low-income individuals.” These patterns underscore the role that social and economic conditions play in both the development of obesity and access to treatment.
Addressing those conditions will be essential to improving outcomes. “They are critically important when thinking about obesity, as these factors impact a person’s risk of developing obesity as well as their ability to access and engage in treatment,” Dr. Gudzune said, referring to determinants such as food access, housing and economic inequality. She highlighted insurance coverage as a particularly pressing barrier: “One of the most critical factors currently impacting treatment access is insurance coverage for obesity care. Many people’s insurance plans do not include coverage of nutritional counseling, obesity medications or metabolic-bariatric surgery – and other people who previously had coverage are discovering that their plans no longer cover the treatments that had been working for them. This is happening quite commonly with coverage of obesity medications.”
At the same time, the treatment landscape is evolving quickly. “In the last few years, we have had multiple new obesity medications come to market and there will likely be more medications approved in the next few years,” Dr. Gudzune said. “These represent important treatment advancements as having more medications that work in different ways will give clinicians more tools; we can find the medications that work best for each patient.” She also pointed to emerging opportunities in behavioral care: “It will be exciting to see how AI might influence behavioral interventions. There is already work demonstrating that an AI version of the Diabetes Prevention Program achieved just as well as the traditional human-led program that is typically based in the community.”
Primary care and preventive health systems will play a central role in putting the standards into practice, but only if clinicians and clinics are equipped to do so. Before beginning to treat obesity, Dr. Gudzune said primary care and preventive health systems should determine whether their clinicians have:
- Training in obesity care as appropriate knowledge and skills are needed,
- Have adequate time in their schedules dedicated to obesity care,
- Have resources in place to support obesity treatment such as access to experts that can address questions that may arise or staff available to assist with prior authorizations, and
- The clinic environment supports a non-stigmatizing care experience for people with obesity (e.g., furniture and equipment appropriate for all body sizes)
“For clinics without these resources, they can consider referring their patients to obesity medicine physicians or other clinical settings that have these requirements in place.”
A cultural shift
Even as treatment options expand, family physicians say one of the most important shifts in obesity care is cultural: recognizing obesity as a chronic disease while confronting the stigma that still surrounds it. Dr. Smith noted that family medicine has long approached obesity through a whole-person lens, even before it was formally classified as a chronic disease in 2013. Yet weight bias and fear of judgment continue to create barriers. Patients who feel shamed are less likely to trust providers or stick with care plans, making the exam room environment critical. Family physicians, he said, must create safe, supportive spaces where patients feel heard rather than judged.
Practical challenges remain. Time constraints during routine visits, uneven access to specialists and programs, and limited resources in rural or underserved communities can make comprehensive obesity care difficult to deliver. Conversations about weight can be sensitive, leading both patients and clinicians to avoid them altogether. Expanding access to dietitians, behavioral health support, medications and structured weight-management programs could help bridge those gaps.
The AAFP sees continued emphasis on holistic, team-based care as the path forward. Treating obesity as part of a broader fight against chronic cardiovascular disease – rather than as a personal failing – can improve outcomes and reduce stigma. As new therapies such as GLP-1s evolve, Dr. Smith said physicians will be watching long-term effects, coverage and affordability closely. “No matter how a patient chooses to move forward with their care plan,” he added, “we have their backs and want the best for them.”
From the patient perspective, the rapid expansion of obesity treatment options is bringing something that has long been in short supply: hope. Nadglowski said that for years many people felt they had to manage obesity on their own, cycling through do-it-yourself approaches with limited support from the healthcare system. Newer medications, more informed primary care providers and the growth of telehealth services are beginning to change that dynamic. “The new treatment options … have given many with obesity new hope that they might find an option that works for them,” he said. For some who had previously given up on seeking care, the availability of effective therapies and more compassionate clinical conversations is prompting a return to the healthcare system.
Importantly, patients are redefining what success looks like. While weight loss may be an initial goal, Nadglowski emphasizes that long-term engagement is often driven by improvements in health, mobility and quality of life. Many patients celebrate what advocates call “non-scale victories” – better blood sugar or blood pressure control, increased energy, the ability to play with children or grandchildren, or simply greater comfort in everyday activities like traveling. These outcomes, he noted, are powerful motivators that reinforce sustained treatment and healthier behaviors.
Looking ahead, Nadglowski believes two changes could dramatically improve the patient experience in primary care. First, consistent insurance coverage for evidence-based obesity treatment – including medications, counseling and multidisciplinary support – would remove one of the biggest barriers to care. “We need to stop making people earn obesity care and treat obesity just like every other chronic disease,” he said. Second, continued education and training for primary care and other healthcare professionals can further reduce stigma and improve clinical confidence. Together, those shifts could help ensure that more patients not only seek care, but stay engaged in it for the long term.