As Weight Management and Obesity Care Shift, So Does the Pharmacist’s Role

Weight management is rapidly evolving as experts move beyond outdated, simplistic notions of treatment and management toward a deeper understanding of obesity as a complex neuroendocrine disease shaped by biological, environmental, and behavioral factors. In a Pharmacy Times Clinical Forum discussion moderated by Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, diabetes pharmacist and director of education and training in diabetes technology at Cleveland Clinic in Ohio, pharmacists highlighted what influences appetite regulation and weight.

Against this backdrop of expanding scientific insight, new treatment options—particularly glucagon-like peptide-1 (GLP-1) receptor agonists—are reshaping the therapeutic landscape, although questions remain about long-term use and optimal integration with lifestyle interventions. As therapies advance and evidence grows, pharmacists remain as crucial as ever when providing patients with safe, effective, and individualized treatment, serving as educators, collaborators, and key facilitators of patient-centered care.

How Has the Definition of Obesity Changed?

Obesity is recognized as a neuroendocrine disease, explained Isaacs. Historically, obesity was often simplistically defined as “just calories in, calories out,” as described by Isaacs, meaning that taking in too many calories would inevitably lead to weight gain. Although consuming excess calories leads to weight gain, current understanding acknowledges that underlying factors are more complex. Appetite regulation is challenging and is affected by several biological signals. For instance, hormones such as leptin signal satiety, and insulin, which regulates glucose levels, influence hunger. Aside from these hormones and the increase in dopamine levels people experience because of “reward-based eating,” sleep quality, environmental conditions, genetics, and certain medications that can increase hunger also influence weight gain.

Current Treatment Options: GLP-1 Receptor Agonists

Amid the expanding treatment landscape, GLP-1 receptor agonists are reaffirming their use in weight management. Semaglutide injections are approved by the FDA for weight management under the brand name Wegovy (Novo Nordisk), whereas Ozempic (Novo Nordisk) and the oral tablet formulation (Rybelsus; Novo Nordisk)—which are indicated for type 2 diabetes—are used off-label for weight management.^1-3 Another GLP-1 receptor agonist is tirzepatide, and it is approved by the FDA for chronic weight management under the brand name Zepbound (Eli Lilly and Company).⁴

Although GLP-1 medication use is surging, the panelists caution that these cannot be used alone and must be administered in combination with diet, exercise, and other lifestyle modifications. Additionally, Isaacs acknowledges that the long-term effects are unknown and that there is significant debate over whether it is safe to take these for extended periods. She and the other panelists emphasized that research specifically addressing these concerns must be conducted.

Regarding the prescription and use of GLP-1 medications, the panelists said that data from pivotal trials such as the STEP, SCALE, and SURMOUNT clinical trial series were critical for helping them use the treatments effectively in real-world settings. In particular, data from the randomized phase 3 STEP 4 clinical trial (NCT03548987)⁵ showed that, among adults with overweight or obesity who completed a 20-week run-in period with 2.4 mg of Wegovy once weekly, maintaining treatment with Wegovy, compared with switching to placebo, resulted in continued weight loss over 48 weeks.^5,6

Specifically, the mean body weight change from week 20 to week 68 was approximately −7.9% with Wegovy compared with +6.9% with the switch to placebo (difference, −14.8% [95% CI, −16.0 to −13.5]; P < .001). Additionally, waist circumference (−9.7 cm [95% CI, −10.9 to −8.5 cm]), systolic blood pressure (−3.9 mm Hg [95% CI, −5.8 to −2.0 mm Hg]), and SF-36 physical functioning score (2.5 [95% CI, 1.6-3.3]) also improved more with continued Wegovy treatment than with placebo (all, P < .001). Gastrointestinal events were reported in 41.9% of participants who continued on Wegovy, but similar percentages of patients discontinued treatment due to adverse events (AEs) with Wegovy (2.4%) and placebo (2.2%).^5,6

Of note, data from the trials, particularly the phase 3 SURMOUNT-4 (NCT04660643) trial,⁷ helped raise awareness of the effects of discontinuing GLP-1 medication, including relapse and weight gain.

What Is the Pharmacist’s Role in Weight Management?

The panelists unanimously agreed that the pharmacist’s most notable roles in weight management are as an educator, collaborator, and a bridge across care gaps.

Prioritizing Comorbidities, Broadening the Scope of Discussions, and Leveraging New Indications

Rather than focusing solely on body mass index, pharmacists can advocate for patient evaluation based on the Adiposity-Based Chronic Disease model. This measurement assesses how adiposity affects metabolism and other organ systems and considers other factors, such as genetics, food environment or availability, sedentary lifestyle, underlying medical conditions, medications, and other environmental or economic factors.⁸

During patient interactions, even if the visit is focused on diabetes or another condition, pharmacists can discuss how guideline-directed therapies benefit a patient’s overall health, including their cholesterol, heart, and kidney disease markers. From there, pharmacists can then leverage new indications when helping treat patients with overweight or obesity. It is crucial that pharmacists stay current on the rapidly evolving therapies, especially GLP-1 receptor agonists, which now have indications in chronic kidney disease, sleep apnea, and metabolic dysfunction-associated steatohepatitis. By tracking and communicating these indications to health care professionals and other specialists, pharmacists ensure that patients with these conditions receive appropriate treatment.

Pharmacists play a key role in maintaining treatment adherence, which is critical for managing overweight or obesity in patients. Regarding their medications, pharmacists can counsel patients early about potential AEs, such as nausea, diarrhea, or constipation, and provide guidance or additional medications as needed to help manage those issues. By consistently working with patients, pharmacists can build the core relationship necessary for open communication, allowing patients to share honestly about their struggles. From there, the entire multidisciplinary team can address these treatment layers.

Collaboration With Prescribers to Support Timely Care

Within the broader care team, pharmacists may help ensure a comprehensive approach, as focusing solely on lifestyle or solely on drugs will miss critical support elements. Further, pharmacists are uniquely positioned to lead efforts to ensure patients receive guideline-recommended medications by closing critical care gaps in medication access and chronic disease coordination. One of the biggest barriers to timely care is the perception among primary care providers that access issues exist, leading them to delay offering pharmacotherapy, the panelists agreed. Pharmacists can mitigate this by dedicating time and resources to navigate insurance hurdles, such as prior authorizations, and figure out exactly what medications are covered for the patient; advocating for guideline-aligned care to overcome “legacy thinking” or “provider inertia,” as described by Isaacs; and creating systematic, concise charts or documentation to summarize drug products and their specific indications to help providers efficiently choose the right drug for the right patient.

“The power of the pharmacist [is] to really spearhead getting guideline-recommended medications that help people with their obesity and with their comorbidities, educate, can help [patients] stay on [their treatments], we can figure out how to access it for them and what is covered [by insurance],” Issacs concluded. “So, I would love for more pharmacists who are in all kinds of settings to help.”

REFERENCES

1. Managing weight with Wegovy. Wegovy.com. Accessed December 4, 2025. https://www.wegovy.com/about-wegovy/managing-weight-with-wegovy.html

2. Ozempic – semaglutide injection. Ozempic.com. Accessed December 4, 2025. https://www.ozempic.com/

3. Rybelsus – semaglutide tablets. Rybelsus.com. Accessed December 4, 2025. https://www.rybelsus.com/

4. Zepbound – tirzepatide injection. Lilly.com. Accessed December 4, 2025. https://zepbound.lilly.com/

5. Research study investigating how well semaglutide works in people suffering from overweight or obesity (STEP 4). ClinicalTrials.gov. Updated January 19, 2022. Accessed December 4, 2025. https://www.clinicaltrials.gov/study/NCT03548987

6. Rubino D, Abrahamsson N, Davies M, et al; STEP 4 Investigators. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414–1425. doi:10.1001/jama.2021.3224

7. A study of tirzepatide (LY3298176) in participants with obesity or overweight for the maintenance of weight loss (SURMOUNT-4). ClinicalTrials.gov. Updated May 22, 2024. Accessed December 4, 2025. https://clinicaltrials.gov/study/NCT04660643

8. Nadolsky K. March 4th is World Obesity Day - but what is adiposity-based chronic disease (ABCD)? American Association of Clinical Endocrinology. March 4, 2021. Accessed December 4, 2025. https://www.aace.com/trending-topics/patient-news-global-health/march-4th-world-obesity-day-what-adiposity-based-chronic