I am a NP treating the disease of obesity both in the medically managed population and the surgical weight loss population. I use anti- obesity medications in both populations and it has been imperative to the treatment of this chronic recurrent disease that associated with numerous risk factors and over 200 medical diseases, including 13 types of cancer. The proposed changes are not in line with current literature or national recommendation  for treating the disease of obesity. 

The BMI mandate changes alone are not keeping with current medical Scientific base guidelines. Specifying mandating that this education must be done by a dietician is impractical. 

There are NOT enough dietitians in the state of Virginia to meet the demand and consultation are generally NOT covered for the diagnosis of obesity.

Having to have a patient fail medications that are unsafe for that patient to be on in the first place is unsafe and unethical.