JAAPA Podcast: World Obesity Day Special

How PAs Can Shape the Future of Obesity Care: Science, Access, and Comprehensive Treatment

Date: March 27, 2026
Host: Martin (JAAPA)
Guests: Joseph Zukey, Angela Thatcher, Carly Burridge

Episode Overview

This World Obesity Day special explores the evolving landscape of obesity care in the United States, focusing on the unique and crucial role Physician Associates (PAs) play in comprehensive treatment. Drawing from both clinical experience and advocacy, guests discuss science-based interventions, systemic stigma, patient access, multidisciplinary care models, and the policy barriers that persist in 2026. The episode highlights the complexity of obesity, the need for holistic care, the challenges and promises of recent pharmacotherapy advances, and practical strategies for reducing stigma and improving patient outcomes.

Key Discussion Points & Insights

1. Introducing the Guests & Their Path to Obesity Medicine

• Joseph Zukey: Clinical supervisor at Transition Medical Weight Loss (Salem, NH), with a fitness and nutrition background. Developed a comprehensive program with dietitians, social workers, in-office healthy food store, support groups, and labs.

  "We just hit 50,000 pounds of weight loss as a practice." (02:05)

• Angela Thatcher: PA, obesity medicine specialist in NC; formerly a social worker and family medicine PA. Established her own practice focused on comprehensive, evidence-based care.

  "Those visits [obesity care] became my favorite part of the day. ...It was incredibly rewarding to see how patients' health and lives were transformed." (03:01)

• Carly Burridge: PA, Master Fellow of the Obesity Medicine Association (OMA); background in psychology, physiology, and exercise science. Started in primary care and bariatric surgery, now develops obesity programs and serves in multiple leadership roles.

  "I kind of eat, breathe, and sleep obesity medicine." (04:29)

2. Reframing Obesity: Moving from Personal Choice to Chronic Disease

• Framing obesity as a chronic disease removes blame and shame, opening the pathway to structured, comprehensive management.

  "By treating it as a disease, recognizing it as a disease, it changes the way that we approach it... We really want to look at all those different factors when we're treating somebody." – Carly Burridge (05:48)

• Comprehensive care involves thorough assessment, labs, addressing medications, comorbidities, mental health, and socioeconomic factors, not just focusing on weight loss.
• Education is lacking among clinicians; understanding pathophysiology is essential to reduce bias and provide effective treatment.

3. The Impact of Terminology, Media Portrayal, and Stigma

• Media and marketing frequently reinforce harmful stereotypes, showing people with obesity in unflattering or dehumanizing ways.

  "Not showing a whole person is really very dehumanizing... it's easy to not have as much empathy or to see someone as a person when you start to see them as a body part." – Angela Thatcher (11:44)

• Before-and-after images reinforce the false narrative of quick fixes rather than lifelong health.

  "Before and after pictures really reinforce the misconception... that it's only about appearance or a number on the scale." – Angela Thatcher (14:07)

• Patients often internalize societal biases, leading to shame, reluctance to seek care, and even self-blame during medical consultations.

  "They've started to treat coming to a medical office more like a confessional than a consultation." – Angela Thatcher (16:22)

4. Reducing Stigma and Improving Clinical Engagement

• Use person-first language (“person with obesity” instead of “obese patient”).

  "A patient with obesity is a more understanding term." – Joseph Zukey (19:29)

• Move beyond "eat less, move more" advice.
• Ask permission to discuss weight, respecting patient autonomy and opening a collaborative dialogue.

  "Just asking the patient, hey, you know, I'm concerned about your weight and how it might be affecting your health. Is it okay if we talk about this today?" – Carly Burridge (21:49)

• Clinician education is pivotal; recommended resources include AAPA’s Obesity Toolkit, OMA's certificate programs, and referral networking.

5. Online Prescribing Platforms: Pitfalls and Patient Education

• The surge of online GLP-1 platforms has created both opportunities and risks—some are reputable, many are not, offering little oversight, non-FDA compounds, and no support or monitoring.

  "It's become the wild west, unfortunately... patients are getting a compound prescription sent to them at their door. No one's monitoring them, no one's giving them any guidance." – Joseph Zukey (24:19)

• Insurance coverage gaps drive patients toward less regulated, direct-to-consumer options.

  "Obesity is not covered by many insurances and that's why these patients are now looking for better affordability options." – Joseph Zukey (27:13)

• Clinicians need to validate patients' proactive efforts, clarify medication and safety differences, and advocate for comprehensive support.

6. Barriers to Access, Disparities, and Early Intervention

• High-prevalence groups (by race, income, geography) have the lowest access to advanced treatments.

  "The groups with the highest prevalence of obesity also unfortunately have the lowest utilization when it comes to advanced treatment." – Angela Thatcher (29:17)

• Barriers: lack of insurance coverage, rural healthcare shortages, food deserts, unsafe environments for physical activity, systemic racism and sexism, chronic stress.
• Early intervention can prevent comorbidities and escalation, and need not rely only on the most expensive new medications.

7. Pharmacotherapy Advances: Current Landscape and Excitement Ahead

• Brief rundown:
  • Legacy meds: phentermine (1959), phentermine/topiramate, naltrexone/bupropion.
  • Modern: GLP-1 and GLP-1/GIP injectables, setmelanotide for rare genetic obesity.
  • Pipeline: amylin analogs, new formulations (monthly, quarterly injections), new targets (muscle, glucagon, etc.), oral GLP-1s.

  "It's certainly a very exciting time because I think the more tools that we have in our toolbox, the better, because not every patient is going to respond... the same way." – Carly Burridge (33:30)

• Medications offer benefits beyond weight loss: reversal of comorbidities (diabetes, sleep apnea, cardiovascular disease, MASH, possibly even cancer risk reduction).

  "It's not just a vanity drug, it's not just an obesity drug, it's a cardiometabolic drug." – Joseph Zukey (36:57)

8. Comprehensive & Multidisciplinary Care: Beyond the Prescription

• True success comes from structured, ongoing, holistic programs:
  • Weekly visits and accountability
  • Multidisciplinary team: dietitians, mental health, personal trainers
  • Support groups and education
  • Practical tools: meal supplies, body composition analysis, physical activity plans
• Multidisciplinary care is essential for health—not just weight—outcomes, helping prevent muscle loss, nutritional deficiencies, and supporting sustainable behavior change.

  "Comprehensive care is so important... all the pillars of obesity care are being addressed." – Carly Burridge (42:10)

• Even small clinics can network and refer; telehealth expands access to specialists.

9. Why This Work Is Personally Rewarding

• Providers describe working in obesity medicine as one of the most fulfilling areas of healthcare for both patient transformation and provider joy.

  "There's nothing more life changing than to be able to do this." – Joseph Zukey (43:56) "It is the most fun thing that you can do to help patients with this." – Carly Burridge (44:59)

Notable Quotes & Memorable Moments

• On the reality of obesity as a disease:

  "Obesity is not a failure of willpower — that's very important. That's one of the biggest takeaways tonight." – Martin (Host) (51:06)

• On stigma and clinical language:

  "Thank you for seeing me for who I am and not just for my weight." – Joseph Zukey (20:32, recounting a patient encounter)

• On patients’ perseverance:

  "Our patients with obesity are the hardest working. They have more willpower than I would ever have... they often have tried every diet under the sun." – Carly Burridge (12:56)

• Clinical pearls for providers:

  "Ask permission... If it's not a good time... at least you have opened up that door." – Carly Burridge (21:49)

• On medication misconceptions:

  "GLP-1s are not a crutch... This is a tool. If anything, it enables the lifestyle to become easier." – Joseph Zukey (46:56)
  "Medications are not a kickstart...Obesity treatment needs to be maintained long term for most people to continue to see the health benefits." – Carly Burridge (47:40)

Timestamps for Important Segments

• [02:05] — Guests introduce their backgrounds and clinics
• [05:48] — Framing obesity as a chronic disease: what changes in care
• [11:44] — Media portrayals, stereotypes, and stigma’s impact
• [15:07] — Internalized stigma: stories from the clinic
• [19:29] — How PAs can reduce stigma in their daily work
• [21:49] — The 5A's model and practical patient engagement
• [24:19] — The “wild west” of online platforms and compound medications
• [29:17] — Access disparities, barriers to care and early intervention
• [33:30] — Current and future obesity pharmacotherapy
• [38:46] — Why a prescription alone isn’t enough: The centrality of comprehensive care
• [43:56] — Why obesity medicine is so rewarding for providers
• [46:10] — Rapid round: Biggest misconceptions and needed policy changes
• [49:49] — Sources of hope for the future of obesity care

Rapid-Round Takeaways

(Most misunderstood fact, biggest medication myth, key policy wish, and a source of hope)

• Obesity is not about willpower but biology and complex disease mechanisms. (46:22)
• BMI is not the only diagnostic; weight alone isn't the health indicator. (46:10)
• GLP-1s are one tool among many, not a “crutch,” “kickstart,” or universal solution. (46:56)
• Policy priorities: Remove Medicare exclusions, pass the Treat and Reduce Obesity Act, implement comprehensive coverage. (48:57)
• Greatest hope: Unprecedented scientific advancement, rising clinician understanding, patient empowerment, and the potential to genuinely prevent chronic disease. (49:49)

Final Message

Evidence-based, holistic obesity care is centered on science, patient dignity, and accessible treatment—not on blame or quick fixes. PAs are uniquely positioned to lead this change. The future is bright: as access, science, and policy evolve, care can become truly transformative for patients and providers alike.