Seeing Beyond GLP-1: A Systems View of Sustainable Obesity Care
Abstract
Introduction:
Glucagon-like peptide-1 (GLP-1) receptor agonists represent a major therapeutic advancement, producing substantial weight loss and rapidly reshaping clinical practice, commercial markets, and policy discussions. Their accelerating adoption, however, is unfolding alongside decades of public health progress to address the complex drivers of obesity. Without integration into a broader systems-based approach, growing reliance on GLP-1 therapies risks reinforcing a reactive, treatment-driven model of obesity management that is costly, difficult to sustain, insufficient for addressing root causes, and likely perpetuating existing health inequities.
Methods:
Drawing on a synthesis of existing literature and emerging clinical evidence, we apply Habits of a Systems Thinker to examine: (1) the promises and pitfalls of growing dependence on GLP-1 therapies; (2) how a systems thinking lens can illuminate unintended consequences and reveal overlooked leverage points; and (3) how dietitians and other healthcare providers can strengthen systems-based dietetic practice to promote health equity, enhance obesity care delivery, and support lasting health outcomes.
Results: We identified dominant mental models, gaps in system connections, and feedback loops that shape both obesity management and the integration of GLP-1 therapies. We also highlight potential unintended consequences and outline opportunities to adapt and act strategically within the obesity care system.
Conclusion: Dietitians hold a critical yet underutilized role, constrained by structural barriers. Fully leveraging their expertise will require system-level changes, including integrating training on a systems approach to GLP-1 therapies; strengthening connections to local and regional food resources to improve access to healthy foods; advocating for reimbursement reforms that support dietitians' contributions to comprehensive, systems-oriented obesity care; and elevating dietitians' roles as citizens to advance equitable obesity care.
Summary:
- GLP-1 therapies represent a meaningful advancement in obesity treatment, but their long-term effectiveness depends on integration within a comprehensive, multidisciplinary care model that addresses the behavioural, environmental, and structural drivers of obesity that pharmacotherapy alone cannot resolve.
- A systems thinking lens reveals critical gaps, feedback loops, and unintended consequences in the current obesity care landscape, including how fragmented healthcare systems and inadequate reimbursement structures limit the potential of GLP-1 therapies.
- Dietitians are uniquely positioned to strengthen systems-oriented obesity care by bridging pharmacotherapy with individualised nutrition counselling, food access initiatives, and advocacy for payment reforms and policies that support sustainable outcomes beyond active GLP-1 therapy.