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¹ This list is the rapporteur’s summary of points made by the individual speakers identified, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They are not intended to reflect a consensus among workshop participants.

The second session also included a presentation and discussion on nutrition considerations and interventions for patients on AOM and panelist presentations and a panel discussion on integrating physical activity and AOM therapy into obesity treatment. Jeanne Blankenship, Academy of Nutrition of Dietetics, moderated the session.

OBESITY TREATMENT: NUTRITION WITH ANTI-OBESITY MEDICATIONS

Colleen Dawkins, Big Sky Medical Wellness, discussed how nutrition interventions can support patients receiving AOMs. Nutrition is not only a component of survival but a necessary part of treating and preventing chronic diseases. Ideally, treatment for obesity draws upon a range of tools to create layers of ongoing support—that may include nutrition approaches and AOMs—within a comprehensive treatment plan, said Dawkins. Because obesity is a chronic disease, the level of support that a patient needs will vary over time, but those who receive more support are more likely to achieve good outcomes. It has been estimated that around 95 percent of people with obesity are not receiving obesity care, reported Dawkins (Look, 2024). Although the advent of more effective treatment options may lead more people to seek care, she emphasized that AOMs alone do not constitute a comprehensive treatment plan.

Dawkins emphasized that weight is merely the outcome of obesity—which is a complex, multifactorial neuroendocrine disorder—and that addressing the underlying metabolic health dysfunction should be the primary focus of treatment. Working with a dietitian can help patients improve their quality of life, restore gut health, and provide support for long-term lifestyle changes. She cited a systematic review of RCTs that found that working with a dietitian reduced systolic blood pressure, waist circumference, and BMI while increasing the percentage of body weight lost (Morgan-Bathke et al., 2023). The study also found that quality of life improved after dietitian interventions. Dawkins also highlighted a 2023 meta-analysis that found that weight management treatment with a dietitian reduces the risk of disordered eating (Raynor et al., 2024).

MNT with AOM Treatment

Dawkins explained that MNT is a nuanced, patient-centered approach that involves assessing nutrition status, supporting gut health, identifying symptoms related to certain foods and allergies, and providing guidance on food selection, preparation, and planning. Noting the general agreement among clinicians that AOMs are not intended to be stand-alone treatments, she described MNT as a component of a comprehensive treatment plan that can optimize outcomes for patients taking AOMs by improving tolerance and supporting health. Nutrition interventions can facilitate reducing adipose tissue—particularly visceral adipose tissue—and preserve lean mass, she explained. MNT can also help to prevent health issues related to nutrient deficiencies that can arise during AOM treatment. She noted that appetite changes on AOMs may lead a patient to forget to eat regularly or adopt unhealthy eating patterns.

Like any aspect of obesity treatment, MNT should be customized for each patient’s unique needs, said Dawkins. Thus, providers should be intentional in meeting patients where they are and creative in helping people set personal health goals—which may not always include weight changes. She emphasized the importance of listening to patients and reflecting on what they have said back to them to ensure understanding of their goals. Moreover, for both pediatric and adult care, MNT should involve the entire family in nutrition and lifestyle approaches. It also involves anticipating and planning for challenges (e.g., weight-loss plateaus, weight regain, metabolic adaptation) as the patient moves through phases of treatment, she added.

Dawkins described how MNT providers can support patients by assessing nutrition status, hydration, access to a safe environment for physical activity, and access to food intake, including transportation to procure food. MNT can include support for the gut microbiome and gastrointestinal

function to reduce symptoms such as reflux, constipation, gas, bloating, and diarrhea. An MNT provider works to identify foods that may be causing symptoms, such as dairy or highly spiced foods. Dawkins noted that food additives or preparation can affect tolerance, and some patients find that trying a different brand or switching from raw produce to frozen or cooked versions reduces their symptoms.

To improve adherence to nutritional changes, MNT providers discuss healthier convenience options and strategies to simplify meal planning and preparation. Reserving time in one’s schedule for meal planning and preparation can foster healthy eating habits. Guidance can extend to identifying the healthiest options from restaurant or fast food chain menus. A patient and MNT provider can look at menus together to determine the options that best fit their dietary plans, create grocery shopping lists, and discuss food bank use, if appropriate. Technology can be used to schedule reminders for hydration and mealtimes, given that people on AOMs sometimes forget to eat meals and have insufficient nutritional intake. Additionally, MNT involves planning for potential challenges in adherence. For example, one of Dawkins’s patients expressed anxiety about visiting her grandmother, who always serves large helpings of food and expresses hurt feelings if the entire amount is not eaten. Providers should offer anticipatory guidance to help patients return to treatment plans when life stressors interrupt adherence, she added.

Insurance Coverage for MNT

MNT is underused, and broader provision would benefit patients, said Dawkins, but its coverage and reimbursement by Medicare, Medicaid, and private insurance are limited and variable. For example, Medicare only reimburses MNT for patients with diabetes, chronic kidney disease, or a kidney transplant within the previous 36 months. Medicaid sometimes covers MNT as part of preventive counseling, but this varies from state to state. Commercial insurance coverage ranges from no coverage to two MNT visits per month to more frequent visits. Nutrition counseling is covered as a requirement before bariatric surgery, but Dawkins noted that coverage before and after surgery has limitations and variations. Although coverage gaps are common, some obesity medicine clinics have begun incorporating MNT for patients preparing for AOM treatment to foster patient understanding of what to expect once taking the medication and during the process of weight loss, she added.

Dawkins highlighted two pieces of legislation intended to address gaps in coverage and expand access to obesity care. The Treat and Reduce Obesity Act (TROA), reintroduced into Congress in July 2023, seeks to expand

Medicare to include obesity screening, intensive behavioral counseling, and medication approved by FDA for chronic weight management. The Medical Nutrition Therapy Act, reintroduced in the Senate in November 2023, would expand Medicare to include MNT for obesity and numerous other conditions and increase the number of providers able to make MNT referrals.

Guidelines for Obesity Treatment

Professional organizations, such as the Academy of Nutrition and Dietetics, Obesity Medicine Association, and American Association of Clinical Endocrinology, offer guidelines for obesity treatment, Dawkins stated. Commonalities among these guidelines include (1) treatment of obesity as a chronic disease, (2) an understanding that weight is one of many components of concern, (3) awareness that failure to treat obesity leads to adiposity-based chronic diseases, and (4) acknowledgment that FDA-prescribing guidelines involve the BMI marker. She highlighted that not all obesity care providers agree with using BMI to determine prescribing guidelines. Dawkins emphasized the value of trauma-informed care in obesity treatment, noting that trauma influences physiology within the body and can affect one’s relationship with food. For example, some patients use food to soothe, escape, or protect themselves. This behavior may be related to adverse childhood events or experiences during adulthood.

Pediatric Considerations for Obesity Treatment

Pediatric considerations for obesity treatment include involving the entire family in the plan and avoiding attributing blame to patients or their guardians, said Dawkins. The goal is often to prevent further weight gain. Supports should be put in place to help patients establish healthy habits, improve nutrition quality, and nurture a healthy relationship with food. She noted that medication may be a component of treatment, as appropriate. Orlistat, phentermine/topiramate, liraglutide, and semaglutide are approved for adolescents aged 12 and older. Noting that medications can cause side effects, she underscored the role of nutrition in managing these. She added that genetic components are sometimes at play in obesity: for instance, Down syndrome, Bardet-Biedl syndrome, and Prader-Willi syndrome can all drive weight gain in childhood. Setmelanotide is a medication for specific rare genetic conditions—including Bardet-Biedl syndrome, proopiomelanocortin deficiency, and leptin receptor deficiency—that can be used in children as young as 6.

the variety and nutritional content of a patient’s diet. Dawkins cautioned against automatically recommending multivitamins and supplements to AOM patients—as is done with bariatric surgery patients—given that needs will vary depending on the drug. For off-label metformin treatment, she noted that B12 supplementation is recommended. Providers should also consider whether a patient is awaiting a kidney or liver transplant, the reasons why the patient has not had bariatric surgery performed, and any other issues that could inform whether supplementation is appropriate.

In response to a question about whether nutrient deficiencies in patients on AOM treatment result from inadequate dietary intake or some mechanism of action of the drug, Dawkins stated that this is not yet known. Many patients experienced strong appetite and high levels of food noise; upon taking the drug, thoughts of food become infrequent, and some patients forget to eat all day, leading to inadequate intake. Remarking on the difficulty in meeting nutritional needs in one daily meal, she stated that MNT providers emphasize the importance of food in fueling the body and the value of regular, nutritious meals. Dawkins added that proton-pump inhibitors used for reflux management block intrinsic factor—which plays a role in processing and absorbing vitamin B12—and that additional research is needed to determine whether mechanisms of action that affect nutrient absorption are at play with other AOMs. Metformin also blocks the absorption of B12.

PANEL: SHIFTING THE PARADIGM TO A FOCUS ON HEALTH BEHAVIORS

A panel featured presentations on integrating physical activity into AOM treatment and the knowledge gaps and access barriers affecting obesity treatment.

Physical Activity Considerations

John Jakicic, University of Kansas Medical Center, outlined physical activity considerations in the context of AOM treatment. Despite the many potential benefits of GLP-1s and other contemporary AOMs—such as weight loss, better control of type 2 diabetes, and reductions in cardiometabolic risk and adiposity—they are also associated with reduced lean body mass. He reported that literature suggests that these reductions are 25–40 percent. In comparison, typical lifestyle intervention programs demonstrate 15–20 percent losses. Jakicic highlighted that specific losses in muscle mass are unknown because the measurement techniques do not differentiate it from other types of lean mass. Moreover, he stated that limited data indicate that when exercise is added to obesity treatment for people taking AOMs, it is associated with improved parameters of fitness

(e.g., cardiorespiratory fitness, strength, mobility, function). Jakicic noted that patients only saw improvements in cardiorespiratory fitness after adding exercise; those who did not do so experienced weight loss but not improved fitness. According to Jakicic, this indicates that physical activity should be incorporated into obesity treatment plans to improve parameters that weight loss alone will not change.

Emphasizing the importance of differentiating lean mass from muscle mass, Jakicic explained that lean mass includes organ tissue, connective tissue, bone, and muscle. Shifting the focus from weight loss to body composition incorporates this distinction and considers the quality of both lean and muscle mass. Many patients with obesity have large amounts of muscle mass, but it constitutes a small proportion of total weight in comparison to people without obesity. Maintaining all muscle mass during weight loss will not enable patients with obesity to become stronger and more physically fit, but improving the quality of muscle mass to make it stronger and more efficient will. Jakicic stated that blunting the loss of lean tissue or muscle is insufficient; instead, stimulation of tissue through exercise is needed to improve physical fitness. He noted that after some patients lose weight via bariatric surgery or low-calorie energy diets and engage in exercise, muscle strength and function increase despite loss of lean mass. In addition, exercise increases cardiorespiratory fitness, enhances glucose regulation, and reduces insulin resistance even in the presence of loss of lean mass. Jakicic emphasized that providers should discuss the specific benefits of exercise with patients being treated with AOMs.

More research is needed to determine the optimal dose, volume, intensity, and mode of exercise to complement contemporary AOMs, said Jakicic. However, providers understand that some activity is better for health than none. Given that many patients with obesity face limitations in the level of physical activity they can fully participate in, providers should consider titrating physical activity for patients on AOMs, he said. He added that feedback from patients with obesity indicates that being told to exercise is unnecessary. Rather, patients need guidance and problem solving in addressing mobility limitations and barriers to exercise. Research by Jakicic and colleagues has demonstrated that physical activity improves muscle quality and function, reduces sarcopenia-related chronic conditions, and reduces non-weight-related chronic conditions in patients on AOMs (Jakicic et al., 2024).

Emphasizing the goal of holistic patient health and well-being, Jakicic said that providers should consider health benefits beyond weight loss. Given that physical exercise enhances the quality of body tissues and offers health benefits that weight loss alone does not, obesity treatment should shift to a holistic approach that extends beyond weight loss and uses proxy measures to assess the quality of body tissues, stated Jakicic. He suggested

that holistic obesity treatment should (1) focus on body composition rather than weight loss; (2) use measures that remain valid and reliable as body composition changes; (3) develop measures of muscle mass to deepen understanding of body composition; (4) include measures of bone health, particularly for older adults; and (5) consider tissue quality. For instance, a patient who has lost lean mass and is becoming weaker warrants more concern than one who has lost lean mass but demonstrates increased strength on functional tests, such as the grip strength test, Jakicic explained. Certified clinical exercise physiologists can be helpful in the process and are valuable additions to holistic obesity treatment teams, he added.

Integrating Lifestyle and Medications into Obesity Treatment

Daniel Bessesen, University of Colorado Anschutz Health and Wellness Center, outlined barriers to comprehensive obesity treatment and focused on implications related to the forthcoming generation of what he calls “highly effective AOMs” (HEAOMs). He began by exploring how the state of obesity treatment deviates from best practice, which includes patient access to a care provider able to knowledgeably discuss lifestyle, diet, physical activity, medications, and surgery. Furthermore, patient-centered decision making should tailor treatment to the patient’s unique characteristics, available local resources, and insurance coverage. He maintained that the goal should be optimizing overall health, with weight loss as one of several components. In contrast, many care providers are constrained in discussing obesity by limited time, lack of reimbursement, insufficient training, and persistent stigma and bias. Bessesen noted that evidence-based treatments are not covered by insurance to a degree comparable with that of other metabolic disorders; consequently, treatment is often limited to patients who can afford it rather than those who might benefit most. Moreover, he added that obesity treatment too often focuses on weight and BMI rather than health. Insurance companies, FDA, and clinicians often silo obesity from weight-related diseases, such as cardiovascular disease, hypertension, and diabetes. Despite these related diseases, the structures for medication and billing for obesity treatment services are based on BMI rather than health-related metrics, he added.

Speculating on the future state of obesity treatment, Bessesen predicted that HEAOMs will eventually become widely prescribed and result in weight loss comparable to bariatric surgery but with a range of advantages, such as dose flexibility. Surgery is a one-time procedure that a patient decides to pursue or reject. In contrast, HEAOMs will be available in a range of doses, allowing for variable amounts of weight loss via adjustable dosing, and the patient has an ongoing choice. HEAOMs employ a variety of pharmacological mechanisms, enabling a patient to switch mechanisms

if a medication is not effective or has excessive side effects. Furthermore, some combinations of drugs with different mechanisms could increase effectiveness while reducing side effects. Bessesen emphasized that HEAOMs offer potential health benefits in multiple areas. However, their cost and the need to continue them indefinitely generate high monthly and lifetime expenses. Insurance coverage will need to evolve to offer greater access to HEAOMs, he noted, although the specific steps needed to drive this change are uncertain.

To prepare for the emergence of HEAOMs, Bessesen suggested providing insurance companies, FDA, and clinicians with actionable steps to conceptualize obesity treatment in the context of health rather than exclusively weight. Models are in place for treating cardiovascular disease, hypertension, and diabetes but not obesity. Likewise, FDA criteria focus on BMI, with no model for approving HEAOMs in the context of health benefits. Insurance companies do not have a method of covering treatment for multiple diseases in tandem, such as cardiovascular disease and obesity or diabetes and obesity, he stated. Siloing health conditions hampers integration of treatments. Knowledge gaps, such as whether hypertension is more effectively treated with a blood pressure medication or an HEAOM, also persist.

Bessesen also recommended reframing the goal of obesity treatment to extend beyond weight loss to other parameters (e.g., body composition, lean/fat mass, muscle quality, regional adiposity, lower A1C, functional mobility, quality of life). He noted that circumstances for initiating treatment with HEAOMs have been established, but clarity on the goal is lacking. Bessesen attributed the current nonspecific “more weight loss is better” goal of obesity treatment to the limited efficacy of older AOMs. Defining goals that are actionable for insurance companies, FDA, and clinicians could drive progress toward wider access to treatment, he suggested, adding that cost–benefit analysis using data from real-world settings could determine the circumstances in which HEAOMs are cost beneficial.

Bessesen highlighted a set of additional knowledge gaps pertaining to HEAOMs that will need to be addressed, such as how to integrate older, less expensive, and less effective AOMs with HEAOMs in clinical care—for example, whether to use a low dose of an HEAOM versus an older AOM if less weight loss is needed. Treatment considerations regarding the circumstances in which HEAOMs should be prescribed have yet to be determined, such as whether a person with a BMI of 30 and mild hypertension should be treated with an HEAOM or if this could result in too much weight loss. Additional considerations related to HEAOMs include (1) exploring the role of combining with lifestyle approaches, (2) determining whether to initiate therapy preventively or wait until health complications develop, (3) establishing appropriate weight-loss quantity and tempo, and (4) developing

guidance about how to prepare patients for substantial weight loss, akin to that which is provided before bariatric surgery.

The advent of HEAOMs will require a conceptual shift in how obesity is treated, reiterated Bessesen. Systematic collection of input from regulators, insurers, employers, clinicians, and researchers could elucidate key questions. Researchers could prioritize these questions and determine the best approaches to answering them in a manner that satisfies various constituencies and establishes common understanding. Methods for disseminating learnings will then be needed to enable clinicians to adopt the updates in best practices. Bessesen was optimistic that HEAOMs, and their opportunity for highly effective care, will change health care worldwide. However, much work remains before this future is realized.

Panel Discussion

A panel discussion addressed metrics for assessing obesity treatment, monitoring weight loss for patients on HEAOMs, the potential influence of hormones on obesity treatment variability, resistance training considerations for patients with obesity, addressing obesity as a chronic disease in communications with patients, considerations for AOM discontinuation, and evidence gaps regarding obesity treatment.

Obesity Treatment Assessment and Weight Loss Monitoring

In response to a question about the goals of HEAOM therapy and whether too much weight loss is possible, Bessesen stated that weight is an important parameter, as BMI serves as a surrogate for adiposity. However, other health conditions must be considered, and obesity-related diseases that generate high costs should be factored into cost–benefit analysis of HEAOMs, he said. In determining the goal of treatment, the resolution of comorbid illnesses, functional status, and diet quality are important to consider but difficult to measure and institutionalize. Adverse effects could be another consideration in determining the end point of treatment, said Bessesen. He suggested that researchers should focus on comorbid conditions and their relationships with weight, approaching studies with an integrated view that some diseases affect one another. Jakicic echoed that improvement in function is difficult to measure, but when strength decreases, function also decreases. Therefore, measurements of declining strength would indicate that function is declining, which could indicate that the patient has lost too much weight. Jakicic added that this scenario is of particular concern with older adults.

Dawkins said that numerous factors related to well-being contribute to determining whether a patient has lost too much weight. For instance,

patient reports of how well they feel, whether they are engaging in activities they enjoy, how well they are sleeping, and whether they have been able to discontinue targeted medications inform the provider about their health. When a patient appears to have lost sufficient or too much weight, the provider must decide whether to reduce the dosage, wean the patient off the AOM, or discontinue it. Dawkins stated that she individualizes these decisions to each patient. She explained that close monitoring enables her to determine the rate at which each patient is losing weight and adjust medication before reaching the point at which a patient has lost too much weight or needs to regain. When patients are losing weight very rapidly, Dawkins adjusts medication to avoid unintended issues.

Hormone Considerations in Treatment Variability

An audience member asked about conditions that influence the effectiveness of AOMs and whether special considerations regarding AOMs, nutrition, or physical activity are needed for people with polycystic ovary syndrome (PCOS). Jakicic replied that PCOS or other factors may cause variability in response to AOMs. However, variability is also found in response to lifestyle modifications. He said that guidance is available for approaching physical activity for patients with PCOS, and this guidance could be applied to AOM treatment. Bessesen commented that people with diabetes tend to lose less weight with any obesity therapy, whether medication or surgery, than other patients. Even though PCOS is associated with insulin resistance, it poses a smaller barrier to effective AOM treatment than does type 2 diabetes. Noting tremendous variability in the response to obesity treatments, Bessesen explains to patients that hundreds of different biologic mechanisms and genes likely play a role in weight gain; therefore, expecting one therapy to have similar efficacy in all patients is probably unrealistic. Accurate genetic testing to categorize obesity is lacking, so treatment is a process of trial and error. Dawkins echoed that variability exists in response to both AOMs and nutrition. In general, nutrition guidance recommends lowering intake of added sugars and increasing fiber with the goal of improving insulin resistance and reducing inflammation. Patient responses to interventions vary, and thus a combination of medication, nutrition, physical activity, and other lifestyle modifications (e.g., sleep quality, stress management) appears to be beneficial for most patients, including those with PCOS, perimenopause, or menopause, said Dawkins.

Resistance Training Considerations for People with Obesity

Given that some patients with larger bodies may not be used to an active lifestyle, Blankenship asked about considerations for exercise, including resistance training, for patients with obesity. Jakicic replied that resistance

training is a component of a holistic approach to improved fitness for all people, but the scientific literature indicates that the amount required to blunt the loss of or build lean tissue is far greater than what most people new to it are able to perform. A patient new to exercise who attempted that level would likely be too sore and stiff the following day to be physically active. Therefore, when providers recommend exercise to any patient—regardless of obesity—they should consider the level of strength and function and titrate physical activity upward. Additionally, many patients find gyms intimidating and feel uncomfortable visiting them. Exercise bands and other resistance tools can be used at home, but most patients do not know how to do so properly. Jakicic said that telling patients to exercise is not likely to be effective and highlighted the lack of infrastructure within and outside of the clinical space to support those with obesity in undertaking an exercise regimen. Acknowledging these potential barriers, he stated that resistance training is important for strength and function, and level of activity should be titrated. Jakicic added that no evidence has been generated on the effects of combined resistance training and AOM treatment on lean body mass. Bessesen commented that just as the components of a healthy diet are clear and include consuming a variety of foods, including adequate protein, adequate fluid, vegetables, fiber, and healthy fats, different types of exercise—resistance, aerobic, flexibility, and balance—are known to have benefits that contribute toward good health. He underscored that AOMs offer patients the opportunity to be more physically active.

Helping Patients View Obesity as a Chronic Disease

Noting that many patients view obesity as “the need to lose a few pounds,” Blankenship asked about approaches to helping patients understand that it is a chronic disease. She also asked whether markers other than weight loss could be helpful in monitoring and managing obesity. Bessesen replied that obesity is a biologic condition; he wants patients to understand that it is not their fault, particularly given how much stigma and bias they face. He approaches obesity treatment by asking patients about their goals and then determining how the health care system can help them reach these. Goals may include achieving a target weight, being more physically active, eating healthier foods, or reducing food noise. Bessesen said that his job is to ask patients questions, help them feel able to answer honestly, and address goals collaboratively with them. Dawkins explains to patients that numerous contributing factors are at play with obesity, and if addressing obesity were simply a matter of losing a few pounds, the patient would not have been referred to her. She, too, asks patients about their goals and determines how to help patients attain them. Dawkins said that she rarely uses weight as a marker of success; rather, she works to develop plans with patients that they will be able to maintain over the long term.

Jakicic noted that many patients with obesity participate in lifestyle modifications, experience some degree of effectiveness, and then regress for multiple and complex reasons. A focus on weight loss may not address this. However, shifting to a focus on weight loss and maintenance incorporates the understanding of obesity as a chronic condition. Jakicic said that a component of obesity treatment is preparing patients for the difficulty of maintaining lifestyle modifications and planning for steps to take if regressions occur. He also explains to patients that in addition to weight loss, AOMs offer potential benefits for cardiometabolic and musculoskeletal health. Jakicic commented that effective obesity treatment can delay or avoid joint replacements, and such musculoskeletal benefits should be considered in holistic treatment.

Considerations for Medication Discontinuation

Given that some patients will want to change their AOM treatment after meeting weight-loss goals or experiencing problematic side effects, Blankenship asked how providers should address this and approach concerns about weight regain that could accompany reducing or ending the AOM treatment. Bessesen replied that all chronic metabolic conditions require chronic treatment—obesity is no different. Because many patients come to the clinic believing that AOMs are a short-term proposition for losing weight, providers need to clarify from the very beginning that they only work as long as they are taken, so if treatment is successful, they will be needed long term for most patients, he added. For side effects or other concerns, Bessesen lowers the dosage or prescribes a different AOM. Additionally, AOM treatment enables patients to learn lifestyle skills and become accustomed to being more physically active and eating smaller portions. Nonetheless, biologic forces are strong, said Bessesen. Jakicic emphasized the importance of creating a strong lifestyle foundation that benefits patients who need to discontinue treatment for a variety of reasons. Lifestyle modifications and medication bolster one another and combine to support patient health goals, he added.

Dawkins replied that when she has patients who want to discontinue AOM treatment because they have attained a weight that feels good, she recommends slowly lowering the dosage over time. This approach enables adjustment should weight regain occur. In some cases, patients continue taking a lower dose of AOM or a low dose of phentermine on an as-needed basis, such as some patients who are able to maintain healthy habits most of the time but find that holidays or family events that involve lots of food and/or stress can disrupt habits. Dawkins said that when providers assist patients in planning ahead for these types of scenarios, some patients are able to successfully navigate them without medication.

then semaglutide, retatrutide, tirzepatide, and now cagrilintide/semaglutide which is currently in clinical development—his excitement grew in having effective treatments to offer patients. Highlighting that 70 AOMs are in the development pipeline, he described this moment as an exciting time in which pharmaceutical companies are highly motivated to develop effective treatments for obesity. He emphasized that obesity carries a social stigma that cholesterol and blood pressure issues do not, and patients have strong emotions about it. Bessesen said that having effective treatments to offer people has made him hopeful; it is this hope of continued progress that inspires him to spotlight the research needs regarding treatment.

Jakicic commented that the benefits of physical exercise cannot be attained through a medication. Providers should understand not only that a combination of medication and exercise is best for patients but also the barriers that patients may encounter in pursuing physical activity. For example, patients may find gyms to be intimidating, the equipment may not fit their bodies, trainers may not be sensitive to how AOMs work, and AOM side effects can influence activity level. Such considerations should be incorporated into work to offer broader care that addresses the complexities patients face, he emphasized. Jakicic underscored the need for equitable access to medications and the components that support health to provide the best treatment for patient.