There is no one-size-fits-all approach to weight management, but recent advancements in GLP-1 based medications offer a new treatment opportunity for patients with obesity and related conditions. UI Weight Management clinicians and members of the Division of Endocrinology and Metabolism Leon Jons, MD, and Amanda Pitts, ARNP, DNP, are helping to lead a new effort to expand safe, sustainable access to these medications for University of Iowa employees.
Jons and Pitts serve as providers for a pilot program developed jointly by University of Iowa Human Resources, UI health plans, and UI Health Care. The program aims to design a high-quality and financially sustainable plan for covering GLP-1 medications in weight management. At its six-month mark, the pilot reported a 97% patient-visit satisfaction rating, according to survey results from participants receiving care through the UI Weight Management Clinic.
While FDA-approved for the treatment of Type-2 diabetes and obesity, many GLP-1 medications are not covered by insurance companies or remain costly even with coverage. Consequently, many consumers turn to cheaper compounded versions purchased online—products that are not FDA-approved or evaluated for safety, quality, or efficacy. The UI pilot program seeks to determine whether adding FDA-approved GLP-1 medications to their formulary can reduce these risks and improve access for employees, and eventually, additional patient groups.
Announced in Nov. 2024, the program invited benefits-eligible UI employees to apply for enrollment by entering a lottery. A randomized number generator then selected 500 participants to kickstart the program in January 2025. There are 417 employees currently enrolled in the two-year pilot. Of those, 320 participants completed the six-month survey, yielding a 77% response rate, says Joni Troester, UI Senior Assistant Vice President of Human Resources. Additional survey data will be collected at the one-year mark and again at the program’s conclusion in two years.
Participants on a UIChoice or UISelect plan qualified for the pilot if they had a BMI of 40 or higher, or a BMI of 35 or higher with at least two co-morbidities, such as high blood pressure, osteoarthritis, or nonalcoholic fatty liver disease.
The pilot experience
Jons notes that many patients appreciate the ability to use GLP-1 medications at a reasonable cost while receiving coordinated care through the UI Weight Management team.
GLP-1 agonists promote weight loss by mimicking the body’s naturally occurring GLP-1 hormone. Produced in the small intestine, this hormone stimulates insulin release, prevents rapid elevation in blood glucose, slows digestion, and increases feelings of fullness after eating. By activating GLP-1 receptors, these medications help reduce appetite and hunger, contributing to weight loss.
Jons shares that one of the most common misconceptions he addresses with patients is concern about rebound weight gain after stopping GLP-1 medications.
“Studies have shown some weight regain, but not complete regain, after discontinuation,” Jons said. “We spend a lot of time in our clinic focusing on long-term weight-loss maintenance, and that can significantly reduce the likelihood of regaining weight for many patients.”
Pitts adds that many of her patients express “deep gratitude” for the opportunity to participate in the pilot, sharing that the resulting weight loss often leads to a ripple effect in other areas of their health and daily life.
Although GLP-1 medications have been transformative for many participants, Pitts emphasizes that the UI Weight Management Clinic’s approach is multifactorial. The team integrates nutrition therapy, behavioral and lifestyle modifications, physical activity, and—when appropriate—pharmacologic treatment. GLP-1 medications are just one component of a comprehensive treatment plan, yet they often improve patients’ capacity to implement the other foundational aspects of care.
“GLP-1s have encouraged a more integrated and holistic approach to treating obesity,” Pitts said. “While lifestyle and behavior change remain foundational, these medications enhance a patient’s ability to implement and sustain those changes. They often provide the momentum and confidence patients need to stay engaged in their health journey.”
A patient-centered philosophy
An essential part of effective obesity treatment is the philosophy clinicians bring to understanding their patients’ health. A 2021 study across six Western countries found that adults in weight management frequently experienced weight stigma from health care providers. And these experiences were linked to internalized weight bias—a phenomenon where patients absorb and apply negative societal attitudes to themselves. Internalized bias is strongly associated with avoiding medical care, feeling judged, delaying checkups, and reporting lower-quality care. UI Endocrinologist Katie Robinson, MD, PhD, recently published an observational review examining how provider communication, physical examinations, and the built environment of a clinic can contribute to experiences of weight stigma. [More on Robinson’s study coming soon].
Jons and Pitts both prioritize understanding patients’ lived experiences and view obesity as a condition shaped by the interplay of genetics, biology, environment, and social determinants of health. Their focus is on helping patients navigate the health challenges associated with obesity in ways that meaningfully improve quality of life.
“Everybody weighs what they weigh for different reasons, and they have different challenges—including health related issues that require different approaches to weight loss,” Jons said. “My basic philosophy is to understand why someone’s body has changed over time, to identify the barriers each patient faces, and to consider these in the context of their life and health.”
Pitts, who joined the Weight Management team in February 2020, shares this perspective. She has also witnessed what she describes as “tremendous growth” within the program and in her own clinical evolution.
“One of the most important lessons I’ve learned is that conversations about weight are often difficult and deeply personal,” Pitts said. “Many patients have faced discrimination and weight bias, so it’s essential to create a safe, empathetic space. I emphasize that obesity is not simply a matter of choice—it’s a complex, multifactorial condition. Effective treatment takes time, patience, and individualized adjustments. It’s truly more of a marathon than a sprint, with progress coming from consistent, sustainable changes.”
Both clinicians say they are encouraged by the pilot program’s early momentum and are committed to providing the highest-quality care as the program continues over the next 18 months.