In my clinics, I see patients struggling with obesity, who have already tried everything to manage their weight.
They have counted calories, joined gyms and hired trainers. Some have done all of it for years without long-term results. Obesity is a frustrating, chronic disease, and for a long time, our health care system has failed to treat it like the disease that it is.
I have spent more than two decades working in obesity medicine. For much of that time, obesity was treated as a simple equation: fewer calories in, more calories out and the excess weight should decrease and health improve. That perspective is wrong. We now understand that excess weight is regulated by genetics, hormones and other factors and can be influenced by certain medications
and the environments in which people live.
Diet and exercise are not enough
Nutrition and physical activity are built into every treatment plan I write, but for a disease this complex, that alone is often not enough, no more than it would be for hypertension or type 2 diabetes. We would never tell a patient with high blood pressure to simply cut back on salt and return to the clinic once it resolves on its own. We pair lifestyle changes with medication because we know biology needs more than willpower to shift.
Today, after building obesity clinics across multiple health systems, I see that we have more and better treatment options than ever before.
As a result, there is less stigma and bias when it comes to weight treatment. GLP-1 medications, used as part of a comprehensive plan, help regulate appetite and improve the metabolic conditions driving obesity. They do not replace the hard work my patients are already doing, but they support and contribute to my patients’ successes.
Better treatments are changing obesity care
Fortunately, Tennessee is one of the states that is changing how it responds to obesity by treating it like the chronic disease that it is. TennCare reversed its long-standing exclusion of obesity medications in August 2025. This year, Tennessee became one of a handful of states to make that coverage permanent, with select GLP-1 medications listed as preferred drugs for eligible patients.
In covering GLP-1s for obesity in TennCare, the state has confronted the challenge that covering these medications does come with initial costs; Tennessee's Medicaid budget is not unlimited. But state leaders also know that untreated obesity is not free either. It drives type 2 diabetes, hypertension, sleep apnea and cardiovascular disease, conditions that are more expensive, disabling and harder to reverse than the disease that caused them.
Tennessee is leading on obesity treatment
As Tennessee's official expert on the Chronic Weight Management Task Force, I have spent the past several years working alongside colleagues and policymakers to get to this point, bringing the same clinical and policy research I have published on obesity practice management, health economics and public policy to the table.
I am proud of what we have accomplished. Our state leaders understood that the question they had to answer when deciding whether to cover these medicines in TennCare was not if Tennessee could afford to treat obesity; it is whether we could afford the cost of inaction.
Gitanjali Srivastava, MD, FACP, FAAP, is a world authority in adult and pediatric obesity medicine and a former professor of medicine, pediatrics and surgery at Vanderbilt Health, where she founded the obesity medicine enterprise, including the Nutrition and Metabolic Disease Fellowship. She is a diplomate of the American Board of Obesity Medicine, the American Board of Internal Medicine and the American Board of Pediatrics; vice chair of the Obesity Medicine Fellowship Council; and Tennessee's official expert on the Chronic Weight Management Task Force. She is the lead author of published standards of care in adolescent obesity pharmacotherapy and has authored numerous publications on obesity outcomes research, health economics and public policy.
This article originally appeared on Nashville Tennessean: Tenn. makes progress treating obesity as a chronic disease | Opinion
