Clinical Forum Events Highlight the Evolving Landscape of Obesity Management

Obesity is no longer viewed as a simple failure of willpower or a lifestyle choice; it is recognized by leading medical organizations as a complex, chronic, and relapsing disease. As the prevalence of obesity continues to rise, the role of the pharmacist has transitioned from a traditional dispenser to a critical clinical navigator in chronic weight management.

To explore the latest evidence and real-world challenges, 2 clinical forums were recently held: one in Edina, Minnesota, moderated by Natalie Hagy, PharmD, MS, DPLA, a clinical ambulatory pharmacist and an assistant professor of pharmacy at Mayo Clinic College of Medicine and Science in Rochester, Minnesota; and one in Boston, Massachusetts, moderated by Jennifer Goldman, PharmD, CDCES, BC‑ADM, FCCP, professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences and a clinical pharmacist at Well Life in Massachusetts.

Supported by Wegovy (semaglutide; Novo Nordisk), both discussions brought together clinical pharmacists from leading health systems to share best practices and insights.

Beyond "Eat Less, Move More"

Both forums opened with a consensus that obesity management must move beyond reductive explanations. Panelists highlighted the roles of genetics, the brain-gut axis, socioeconomic factors such as food deserts, weight-contributing medications, and cultural considerations around diet. In Boston, Goldman drew attention to the significant stigmatization patients face even within health care, noting that providers sometimes dismiss complex presentations with a simple directive to lose weight, without further investigation.

Both groups agreed that virtually every patient presenting for obesity care has already attempted lifestyle modification. As one Minnesota pharmacist noted, "The patients…have already gone through a lot of that lifestyle intervention before they reach me." The conversation then shifted to how to maximize lifestyle alongside medication, rather than as a prerequisite for it. The pharmacist also flagged ongoing debate around body mass index (BMI) as a diagnostic tool, noting the American Medical Association's call to move beyond it and the inadequacy of current thresholds for diverse patient populations.

The Clinical Evidence

Hagy provided an overview of the major glucagon-like peptide-1 (GLP-1) trial programs. The STEP clinical trials for subcutaneous semaglutide demonstrated a mean weight loss of approximately 15% to 18.7%. The OASIS trials for oral semaglutide showed 13.6% to 15.1% weight reduction at the 50-mg dose. The SURMOUNT trials for tirzepatide (Zepbound; Eli Lilly and Company) demonstrated approximately 15% to 20.9% weight loss by dose, with head-to-head SURMOUNT-5 data showing tirzepatide's superiority over semaglutide (20.2% vs 13.7%, respectively).¹ The ATTAIN trials for orforglipron (Foundayo; Eli Lilly and Company) showed approximately 11.2% weight loss over 72 weeks.²

The STEP UP trial (NCT05646706)³, which tested semaglutide at 7.2 mg vs 2.4 mg, generated significant discussion. Jacqueline Burke, PharmD, senior clinical pharmacist at Atrius Health in Watertown, Massachusetts, noted that it offers a meaningful option for patients who have plateaued on the standard dose. "I think we've gotten a lot of patients [who] have reached the max dose of semaglutide [2.4 mg], and they're now looking for something else. So, this allows us another option before switching to a different medication."

Cardiovascular outcome data were cited as a major driver of treatment selection. The SELECT trial (NCT03574597)⁴ demonstrated a 20% reduction in major adverse cardiovascular events with semaglutide in patients with established cardiovascular disease and obesity. The FLOW trial (NCT03819153)⁵ established semaglutide as the only incretin class agent with an FDA indication for chronic kidney disease progression in type 2 diabetes. On the hepatic side, semaglutide holds FDA approval for metabolic dysfunction–associated steatohepatitis (MASH) based on trial data showing a 62.9% reduction in disease activity and an approximate 36.8% decrease in liver fibrosis staging.

Vicki Saengkheune, PharmD, a clinical pharmacist at an ambulatory care pharmacy in Danvers, Massachusetts, concisely contextualized the weight-outcome relationship. "We know that at least a 5% weight reduction allows for glycemic control, 10% enables cardiometabolic benefit, and over 15%—you're getting disease modification."

The Access Problem

Despite robust evidence, insurance coverage emerged as the single largest barrier in both clinical forums. Minnesota pharmacists described what one participant called "the game we are getting good at playing," which involves strategically documenting comorbidities (eg, obstructive sleep apnea, MASH) to secure prior authorization, timing diagnostic tests to strengthen insurance cases, and navigating step therapy criteria that may require patients to fail liraglutide (Saxenda; Novo Nordisk) before accessing tirzepatide, even after already failing semaglutide.

One panelist described a patient who deliberately allowed their hemoglobin A_1C to rise so they could qualify for GLP-1 overage under a diabetes indication rather than obesity. "That might have been the right choice for them financially," another pharmacist remarked.

Insurers mandating titration even when patients are stable on lower doses added another layer of frustration. "We try to keep the patient where they're comfortable, but that's happened where insurance companies are mandating patients against that maintenance dose," one Minnesota pharmacist explained. Burke named the equity dimension plainly. "It's not just coverage, because now you can pay cash. But that's not an option—this is a huge inequality in care,” she said.

Both forums discussed the forthcoming Medicare Bridge Program, effective July 1, 2026, which will offer GLP-1 coverage for weight loss to Medicare patients. The program will require a $50 co-pay, which will not count toward the annual deductible or out-of-pocket maximum of about $600. Panelists noted that prior authorization is still required and that specific BMI and comorbidity eligibility criteria will exclude some patients with genuine clinical need.

Formulation Selection and Patient-Centered Care

Choosing between oral and injectable formulations involves balancing efficacy, lifestyle factors, and patient preferences. Many patients, upon hearing the administration requirements for oral semaglutide, find the weekly injection more convenient. A Boston pharmacist highlighted oral agents as a gateway formulation for patients averse to needles, helping them build confidence before transitioning to injectables. Frequent travelers also gravitated toward oral options to avoid injectable storage challenges.

Minnesota pharmacists raised patient-reported concerns about autoinjector pain, with several patients preferring traditional vials and syringes for greater control. Beyond gastrointestinal adverse effects (AEs), the Boston group discussed "Wegovy skin," an abnormal tingling skin sensation reported at higher doses; however, it rarely leads to treatment discontinuation.

Managing expectations was a consistent theme. Boston pharmacists raised concerns about patients undereating on therapy, with Samantha Schermerhorn, PharmD, a PGY2 ambulatory care resident at Tufts Medical Center in Boston, noting patients who reported losing only 1 or 2 lb but revealed they were barely eating. Burke connected this to broader disordered eating patterns she sees in the obesity population. "[There’s] a lot of brain cycling, a lot of disordered eating. They're fine just eating the cracker and the apple at lunch, but that's not a sustainable, healthy path," Burke said.

Minnesota pharmacists noted that patients are sometimes so desperate to remain on therapy that they conceal significant AEs, including vomiting severe enough to result in hospitalization.

The Pharmacist's Role

Both forums highlighted pharmacists as uniquely positioned to manage this patient population through extended visit times, collaborative practice agreements, proactive insurance navigation, and consistent follow-up that primary care cannot sustain. In Boston, Saengkheune described building Beth Israel Deaconess Medical Center’s pharmacist-led program from a solo effort 3 years ago to a team of 10, with a technician liaison conducting benefits investigations before every initial consult. Michael Baker, PharmD, RPh, MBA/HCM, pharmacist at Mayo Clinic in Minneapolis, Minnesota, described a nurse-led titration protocol that uses automated portal messaging to manage routine patients and reserves pharmacist involvement for clinical exceptions—with program enrollment also serving as prior authorization.

As Goldman closed the Boston session, she noted, "We are the only profession that has to keep proving ourselves out in the literature to the rest of the country—that everyone should have their own pharmacist, that we can take the burden off of primary care."

Hagy captured the resource gap that remains despite growing pharmacotherapy options. "There's still such a desert when it comes to resources and supporting these patients. There needs to be a starter kit addressing nutritional deficits, managing [AEs], setting realistic expectations," she said.

Both forums underscored that obesity must be treated as the lifelong, chronic condition it is—and that pharmacists are essential to making that vision a reality.^1,2

REFERENCES

1. A Study of tirzepatide (LY3298176) in participants with obesity or overweight with weight related comorbidities (SURMOUNT-5). ClinicalTrials.gov identifier: NCT05822830. Updated November 26, 2025. Accessed June 15, 2026. https://clinicaltrials.gov/study/NCT05822830

2. Wharton S, Aronne LJ, Stefanski A, et al. Orforglipron, an oral small-molecule GLP-1 receptor agonist for obesity treatment. N Engl J Med. 2025;393:1796-1806. doi:10.1056/NEJMoa2511774

3. A research study to see how semaglutide helps people with excess weight, lose weight (STEP UP) (STEP UP). ClinicalTrials.gov identifier: NCT05646706. Updated April 23, 2026. Accessed June 15, 2026. https://clinicaltrials.gov/study/NCT05646706

4. Semaglutide effects on heart disease and stroke in patients with overweight or obesity (SELECT). ClinicalTrials.gov identifier: NCT03574597. Updated August 30, 2024. https://clinicaltrials.gov/study/NCT03574597

5. A research study to see how semaglutide works compared to placebo in people with type 2 diabetes and chronic kidney disease (FLOW). ClinicalTrials.gov identifier: NCT03819153. Updated March 20, 2025. Accessed June 15, 2026. https://clinicaltrials.gov/study/NCT03819153