I am an internal medicine physician who has practiced obesity medicine for the past 10 years. During this time, the single biggest advance in the treatment of obesity has been FDA approval of GLP1 agonists. I have been able to help so many more people become successful and regain their lives. None of the other anti-obesity medicines work nearly as well. I have seen patients who have failed weight loss surgery become successful again. GLP1 agonists have helped people get their lifesaving transplant surgeries and life altering joint replacements. I have also had patients no longer need their joint replacements.

I work at an urban academic medical center and treat a large number of Medicaid patients. The ability to use GLP1 agonists has been transformative. I understand these medications are expensive, but so is treating the downstream cost of obesity not only for the patient but for society as a whole.

The proposed changes are not in line with society guidelines for treating obesity nor the FDA indications for use of these medications. I think it is reasonable to try another medication for 6 months if there are no contraindications, but use of anti-obesity medications is indicated in patients with a BMI of 30 or more or 27 or more with 1 weight related comorbidity.  Additionally, in my 30 years of medical practice, I have never had a single patient see a dietitian and lose weight. We do all of our own nutritional counseling and have been very successful.

I am asking that you please reconsider the barriers the are being proposed because they will leave some of our most vulnerable patients without access to this very effective treatment.