I would like to take this time to stress the concerns that I have about the proposed changes to criteria for weight management for medicaid recipients in the state of Virginia.  I have been prescribing the class of medication including Wegovy for few years now.  It not only helps people to lose weight but allows people to lower their blood pressures, lower cholesterol levels, improve insulin levels/glucose levels and most importantly offering a reduction in cardiovascular events with the latest data showing heart failure protection.  In my opinion the benefit is far beyond that of weight loss.  This class of medication has been life changing for many people of Southwest Virginia.  I have been working in Southwest Virginia for the past 9 years, in my hometown.  Lee County is significantly underserved for multiple medal reasons including lack of medical services beyond primary care and emergency room care, we have a lack of specialists that can provide the essential care patients of Lee County need without a significant drive which is difficult for many citizens of the county. Obesity is a growing concern for the county and there is high population of individuals with significantly elevated BMIs, including that of children.  With the proposed changes for the medication, patients will be far advanced in illness levels before being offered the medication that could potentially cost the state of Virginia millions of dollars in healthcare costs related to treatments of cardiovascular disease and/or heart failure, if this medication is still allowed at current criteria it could save the state millions of dollars over time.  This will be a major setback for the patients of Lee County as on the proposed recommendations is an evaluation by dietician which there is only 1 in Lee, Scott and Wise counties to the best of my knowledge, which would make obtaining consults practically impossible.  If there is any way possible this class of medication could be held at same criteria for approval that is currently in place would be ideal, making changes to the new criteria would be detrimental to the people of Lee County and many would be disqualified mainly for the inability to not have consults with dieticians.  Thank you for your time and thank you for taking interest in the people of Southwest Virginia.