Evolving Obesity Treatment Guidelines and Best Practices to Break Barriers in Modern Care
For years, physicians treating patients with obesity had a limited toolkit for weight management. The results were often disappointing, while the stigma for overweight and obese patients could be overwhelming. But in recent years, we’ve seen revolutionary new medicines and evidence-based obesity treatment guidelines transform how physicians approach this complex medical condition.
"When I think about how the treatment of obesity, or the approach to treating obesity, has evolved over the last few decades, I actually just really think about the last five years," says Dr. Gaby Berger, FACP, a general internal medicine and primary care physician who is also a clinical associate professor of medicine at the University of Washington.
The rise of GLP-1 agonists, as well as medications that combine GLP-1 and gastric inhibitory polypeptide (GIP), has fundamentally changed how physicians treat obesity. The contrast with previous options approved by the Food and Drug Administration—medications like phentermine or bupropion plus naltrexone—is striking.
“These medications have revolutionized our approach to obesity, and I use them regularly in my practice,” says Dr. Berger, noting their remarkable efficacy and safety. For many patients, these medications have changed their lives.
“These aren't just clinical outcomes—they're transformations in how patients experience their health and interact with the healthcare system,” she adds.
Though this new class of medications has become the gold standard for treating obesity, physicians and patients continue to face challenges, including inequitable access and deep-seated biases. The promise of modern obesity care comes with complexities that every physician needs to navigate.
Here's what Dr. Berger and others have learned about providing obesity treatment guidelines that prioritize equity and compassion.
Reframing Obesity From Personal Failure to Brain Disease
The revolution in obesity treatment encompasses not only new medications but also a fundamental shift in understanding the condition. As Dr. Fatima Cody Stanford, MPH, MPA, emphasizes in her CMEssentials conversation with Dr. Berger, obesity is a chronic relapsing-remitting disease rooted in brain biology, not a personal weakness.
"The brain is always pulling us back to where it wants to be," explains Dr. Stanford, an obesity medicine expert at Harvard Medical School.
Neural pathways regulate body weight through set points that resist change. This understanding transforms how physicians approach treatment conversations and set guidelines for obesity management in adults.
Rather than focusing on weight targets, Dr. Stanford advocates for health goals: "I never give them a weight target,” she says, “I think weight goals are really arbitrary. I do, however, have health goals."
She says she encourages patients to instead target metrics like cholesterol, blood pressure, fasting glucose, or waist circumference.
This brain-based model explains why sustained weight loss proves so challenging without medical intervention. The hypothalamus regulates weight through two key pathways—one telling the body to eat less and store less, the other driving increased consumption and storage. Modern obesity medications work primarily by modulating these neural circuits, not just suppressing appetite.
Confronting the Equity Crisis in Obesity Care
Perhaps the most pressing challenge in modern obesity treatment isn't medical but economic.
"The biggest challenges in treating obesity are absolutely the cost of the medications that we want to prescribe," Dr. Berger explains. With cutting-edge obesity medications often exceeding $1,000 per month amid varying levels of insurance coverage, healthcare inequity has become impossible to ignore.
"This is really an equity issue," Dr. Berger says. "Folks who may be on Medicaid in their state or are what we call underinsured, meaning they do have insurance, but their co-pays are extremely high … are really at a disadvantage."
The result? A two-tiered system where breakthrough treatments remain out of reach for many who need them most. Dr. Berger calls on the pharmaceutical industry to do more, "Make these really effective medications more widely available,” she says, “and address the inequities that exist in current prescribing practices."
Breaking Down Stigma in Obesity Treatment
Beyond cost barriers, Dr. Berger identifies another critical challenge—pervasive stigmas affecting every aspect of obesity care for patients and providers.
Drawing on insights from conversations with Dr. Stanford, Dr. Berger emphasizes how bias—particularly for Black and brown patients—creates additional barriers to effective treatment and increases health risks.
In their CMEssentials conversation, Dr. Stanford explained how stress and trauma contribute to higher obesity rates in minority communities: "As stress levels go up, accumulation of adiposity goes up." This biological response to generational trauma and ongoing discrimination adds another layer of complexity to obesity treatment.
For many years, “obesity has been deeply stigmatized, and that's true for providers, as well," Dr. Berger notes. "We need to confront our own bias and understanding of this disease process and make sure that we create spaces where patients feel welcomed and comfortable."
This means recognizing obesity as a complex medical condition rather than a personal failing and creating judgment-free clinical environments. When setting obesity treatment guidelines, tailor them to individual patient needs and cultural contexts.
"I would say that's an ongoing challenge for many of us in healthcare and in medicine," Dr. Berger admits, "and something that I personally have tried to work on quite a bit over the last number of years."
Viewing CGMs and Digital Health Tech as Game-Changers
Today's innovations extend across multiple medication classes. Much of the focus has been on advanced pharmacological options, such as GLP-1s, with unprecedented abilities to help patients lose weight. But other advances include technology-enabled monitoring and feedback systems for better weight management, integrated behavioral health approaches, and personalized treatment strategies based on individual patient needs and health conditions.
Modern obesity treatment increasingly relies on technology to empower patients and personalize care. Continuous glucose monitors (CGMs), originally developed for diabetes management, have emerged as powerful tools for obesity treatment.
"These CGMs really help folks understand their glucose trends in real time," Dr. Berger explains. "It gives patients a sense of ownership over what they're eating. It empowers them to change their diet with real-time feedback."
This real-time data helps patients understand how specific foods affect their metabolism. CGMs can reduce medication needs by informing dietary choices. They can also create a sense of control and engagement in treatment while providing objective feedback that supports behavior change to a healthy weight.
The rise of digital health platforms—from telemedicine consultations to app-based monitoring—has expanded access to obesity care. That said, Dr. Berger acknowledges controversy over the emergence of online pharmacies offering compounded medications. These highlight both the demand and desperation in the current healthcare system.
Rethinking Treatment Duration and Challenging Assumptions
One of the most common misconceptions Dr. Berger encounters is the belief that all obesity medications require lifetime use. This is an oversimplification for an evolving field.
"’‘We don't know’ is the real answer to the question of whether or not folks need to stay on these medications for life," she says. Likewise, patients can regain weight after they stop taking medication, but that is not an absolute, either.
"The space of treating obesity and drug development is changing so rapidly," Dr. Berger explains. "I fully believe that we will have other ways to treat obesity or understand more about how to use these medications in the future, such that people may not need to be on them for life."
This uncertainty underscores the importance of honest communication about current knowledge limitations. Physicians setting obesity treatment guidelines should prioritize individualized treatment planning, regularly reassess treatment goals and strategies, and maintain flexibility as new evidence emerges.
Continuing the Role of Metabolic Surgery
Alongside these pharmaceutical advances, bariatric surgery retains an important place in comprehensive obesity care, particularly as systematic reviews demonstrate its long-term effectiveness for sustained weight loss and potential for reducing the risk of cardiovascular disease.
"When it comes to metabolic surgery, I think that it really can still play a large role in modern obesity treatment," Dr. Berger says. Bariatric procedures remain particularly relevant for patients who can’t afford newer medications, prefer to avoid long-term medication use to maintain weight loss, or may benefit from more intensive intervention.
Dr. Berger reminds physicians that treatment decisions must consider the whole person, not just numerical markers, especially because "BMI itself is not a perfect indicator of obesity status."
As Dr. Stanford notes in their CMEssentials discussion, BMI's origins can be traced back to the 19th century for use in compiling military statistics, then later in actuarial tables. BMI was never designed as a medical diagnostic tool or to influence obesity treatment decisions.
Looking on the Horizon for Obesity Treatment
Obesity treatment guidelines continue to evolve at breakneck speed. For example, emerging research on medications targeting dopamine feedback pathways could potentially address what some patients describe as "food voices" influencing their eating habits. Dr. Berger predicts that such medications could “fundamentally change how we treat obesity in the future."
But perhaps the most important evolution isn't in medications or procedures—it's in how healthcare approaches obesity as a medical condition deserving of evidence-based treatment. Best practices for obesity treatment require a judgment-free approach, equitable access regardless of socioeconomic status, integrated care addressing physical and psychological aspects, and ongoing innovation in treatment and delivery methods.
Providing Modern Obesity Care as a Physician
Based on Dr. Berger's experience and current obesity treatment best practices, successful obesity treatment in primary care today requires a multifaceted approach. Prescribing medications is part of the mix but insufficient on its own. Here are elements for physicians to consider.
Address Bias Head-On
Physicians must create welcoming clinical spaces that are free from judgment. This requires examining their assumptions about obesity, an ongoing task that healthcare providers should continue to reassess throughout their careers.
Fight for Equity
Care providers and healthcare systems should advocate for expanded insurance coverage of new and potentially life-changing treatments. This work can include connecting patients with assistance programs and considering all treatment options based on individual circumstances. The goal is to provide breakthrough treatments to everyone who needs them, not just those who can readily afford them.
Embrace Technology Thoughtfully
Physicians should integrate CGMs and digital tools when appropriate, including leveraging telemedicine to expand access in primary care settings. Effective obesity treatment requires staying informed about digital health innovations that can enhance patient engagement and outcomes. Any use of technology should empower patients to achieve and maintain a healthy weight, not create additional barriers.
Maintain Flexibility
Today's certainties could be tomorrow's outdated practices. Avoid absolute statements about treatment duration, and regularly reassess treatment plans to stay current with GLP-1 prescribing guidelines, evidence-based recommendations, and evolving clinical trials. “The space is changing so rapidly," Dr. Berger notes, physicians must adapt while providing nuanced care.
Provide Comprehensive Care
Physicians should address not just the physical and diagnostic aspects of care, but also the mental health aspects of obesity and weight gain. This means considering all treatment modalities, including bariatric surgery, when appropriate, per clinical practice guidelines. Obesity treatment should focus on overall health, not just weight loss, to ensure successful and sustainable outcomes. Success isn't to be measured on the scale, but in reduced cardiovascular disease risk and improved quality of life.
Moving Forward Together
The revolution in obesity treatment offers unprecedented hope, but realizing its promise requires more than new medications. It demands a fundamental shift in how healthcare systems, providers, and society approach this complex condition.
As Dr. Berger's insights reveal, successful care requires creating equitable, compassionate obesity treatment guidelines that view each patient as individuals who deserve respect and evidence-based treatment options.
The tools have never been better. The challenge now is ensuring everyone can access them.
Ready to stay current on obesity treatment innovations and other primary care advances? Explore Oakstone's CME offerings designed to keep you at the forefront of compassionate, evidence-based practice.