By Dr. Arnold Saperstein, CMO


The astonishing amount of media attention, word of mouth, and direct marketing surrounding the efficacy of GLP-1s for obesity and chronic weight management has exploded in demand. So have recent studies suggesting these GLP-1s have cardiovascular benefits for patients with prior events such as myocardial infarction or stroke. (Further research, as I’ve written previously, is needed for those without such history.) However, this surge has outpaced drug availability, masking a larger concern. From observation in our national practice, we see that significant variability of care has been introduced, challenging standards of care for the treatment of obesity and obesity-related diseases and raising concerns around the adequacy of patient support. 


Challenges to quality care 

Managing patients on GLP-1 medications presents unique challenges in today’s healthcare landscape. Ensuring high-quality care for obesity and chronic weight management requires careful patient evaluation and adherence to clinical guidelines, and prescribing GLP-1 medications only when clinically appropriate. Even when appropriate, initiation for patients is not trouble-free. Complications, particularly gastrointestinal issues, can lead to hospitalization, non-adherence, and poor outcomes. These can be alleviated by closely monitoring patients while educating them on potential side effects, the importance of adherence, and gradual titration to achieve optimal outcomes.  


Providers, reasonably, only want to prescribe GLP-1s for patients that meet clinical criteria. However, we observe that demand has led to alternative access points and shortcuts for these drugs, such as clinical spas or online services whereby patients may be able to obtain prescriptions without a complete evaluation. This combination of mass marketing, insufficient studies, and cross-specialty clinical impact raises concerns about clinical protocols and patient safety. Concerns around bypassing clinical appropriateness and delivering insufficient support (e.g., not providing adequate nutrition counseling or lifestyle interventions) can lead to devastating impacts on not only the efficacy of treatment but overall patient health and well-being. 


Balancing GLP-1 access with patient safety 

To deliver a high level of quality care and maximize the effectiveness of treatment, patients need to be educated on GLP-1 medications once prescribed, and when they are appropriate for use. This empowers patients to make more informed decisions as they navigate the noise of marketing from the many point solutions that are offering direct-to-consumer options. Focusing solely on weight management may not address crucial, interrelated cardiometabolic needs (such as managing cardiovascular health) or manage complications (as described above regarding GI issues). Embracing comprehensive, well-coordinated, and integrated care has a much greater potential of achieving positive clinical outcomes and reduced morbidity. 


Promoting patient safety in an evolving landscape 

By our count, at least fourteen drugs in development may reach the market in the coming months and years.  Looking ahead, how can we set the foundation for safety? 

  • Provider organizations need to stay vigilant and constantly monitor not only the literature but also re-examine their own protocols given the ever-evolving data. Simply waiting for insights from clinical decision support tools isn’t enough in the face of this extraordinary patient demand.  
  • Payers play a unique role in promoting the importance of cohesive, well-coordinated obesity and chronic weight management programs while educating patients on any prior authorization requirements and outcome expectations. 
  • Other healthcare stakeholders have a responsibility to ensure patient safety, even if their primary goal (à la clinical spa) is to expand access. Making sure published information is accurate, updated frequently, and within health literacy standards can go a long way in educating patients about the benefits of GLP-1s—and helping to decide if treatment is right for them.  


About the Author

Dr. Saperstein began his managed care career in 1992 and continues to dedicate his expertise to developing programs that ensure the highest quality of care. He joined Cecelia Health in 2019 as Chief Medical Officer, where he built the first national virtual Endocrinology telemedicine practice. Dr. Saperstein has expanded the company’s chronic disease management approach beyond Diabetes to include Cardiovascular risk reduction, Congestive Heart Failure, Obesity, Chronic Kidney Disease, Asthma, and COPD programs.

Dr. Saperstein leads Cecelia Health’s national network of expert clinicians and specialty providers, achieving excellent clinical results for patient populations across the country. Prior, Dr. Saperstein held leadership positions at MetroPlus Health Plan, joining in 1995 as Chief Medical Officer, next serving as President and CEO from 2006 until 2019. Under his leadership, MetroPlus ranked as one of the highest scoring plans for quality of care (measured by the New York State Department of Health Medicaid Incentive Program and by the Medicaid Consumer Guide for New York City) and rose to the forefront of Value Based Purchasing. During his tenure, Dr. Saperstein developed a groundbreaking quality incentive pay for performance program across the entire network of an estimated 32,000 providers and grew the member population 1100% to serve more than 500,000 people.