The Two Biggest Hurdles for Better Obesity Care

The progress we have witnessed in 25 years of working on obesity care has been nothing short of remarkable. Especially in the last four years with the introduction of advanced new obesity medicines. But let’s step back from the minutia of research, clinical care, and policy, to look at the big challenges that remain. When we do, we see two major hurdles to progress toward better obesity care.

Almost every other challenge flows from these two things.

The Focus on Weight Loss

The dominant focus on weight loss in every conversation about coping with obesity dooms us to making the same mistakes over and over again.

Investors are making this mistake when they evaluate new obesity medicines based upon how much short-term weight loss they yield. They don’t get it that the future belongs to medicines and surgeries that can be transformative for a person’s health. So if the numbers for percent weight loss don’t dazzle them, they send stock prices tumbling.

Patients are stuck on this mindset too, most commonly thinking that if they lose plenty of weight with surgery or with one of these medicines, their problems will be over. They will eat right and keep the weight off. They shouldn’t have to keep taking that GLP-1, they think.

Payers tap into this thinking and look for ways to “wean patients off” obesity medicines to save money. Framing obesity as an acute problem that weight loss solves makes it possible to rationalize this harmful approach. They would never seek to “wean patients off” diabetes or blood pressure medicines to save money. It is obviously wrong.

News and social media reflect this bias, more often referring to drugs and surgery as being for “weight loss” than for obesity.

To clear this hurdle will require embracing chronic care for obesity instead of weight loss. It requires us to focus on health outcomes more than weight outcomes. The goal should be to gain health, not just lose weight.

Delivering Care at Scale

We are making progress on the excessive weight loss focus. But on the other major hurdle – delivering obesity care at scale – we have barely begun. Yes, the number of people receiving medical obesity care is rising. One study estimated that it had risen from 0.3% of persons with obesity in 2010 to 1.8% in 2020.

That six-fold increase is a tiny increment of what is necessary.

If we are honest about it, right now obesity care reaches only a thin layer of people with money and privilege that grants them access. More than nine out of ten who need it can’t get it. The costs and systems for delivering the care put it out of reach. Change is coming, but it’s coming too slowly. We need more skilled providers, better cost structures, and health insurance that facilitates rather than blocks care.

It can’t happen fast enough because the health of so many people suffers while we wait.

Click here for more on a health focus for obesity care, here and here for more on the challenge of delivering care at scale.

Hurdles, illustration created with Gemini image generation for ConscienHealth

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September 9, 2025