Journal of general internal medicine
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The number and complexity of obesity treatments has increased rapidly in recent years. This is driven by the approval of new anti-obesity medications (AOMs) that produce larger degrees of weight loss than previously approved AOMs. Unfortunately, access to these highly effective therapies and to integrated team-based obesity care is limited by intra-/interpersonal patient, institutional/practitioner, community, and policy factors. ⋯ Without multi-level intervention, these barriers to care will deepen the existing inequities in obesity prevalence and treatment outcomes among historically underserved communities. As General Internal Medicine (GIM) physicians, we can help our patients navigate the complexities of evidence-based obesity treatments. As care team leaders, GIM physicians are well-positioned to (1) improve education for trainees and practitioners, (2) address healthcare-associated weight stigma, (3) advocate for equity in treatment accessibility, and (4) coordinate interdisciplinary teams around non-traditional models of care focused on upstream (e.g., policy changes, insurance coverage, health system culture change, medical education requirements) and downstream (e.g., evidence-based weight management didactics for trainees, using non-stigmatizing language with patients, developing interdisciplinary weight management clinics) strategies to promote optimal obesity care for all patients.
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Behavioral health care access is inadequate and new primary care-based strategies are needed to meet the rising demand. Behavioral health integration (BHI) models, such as collaborative care (CoCM) or the primary care behavioral health (PCBH) model, are often touted as actionable and sustainable solutions. The intent of such models is to bring behavioral health expertise into medical settings with the aims of improving outcomes, increasing treatment capacity, and reducing stigma. ⋯ Recent encouraging developments include technical assistance opportunities for MBC implementation and emerging payment models that emphasize MBC. However, concerns remain surrounding the limitations of existing MBC billing codes. Ultimately, with continued advocacy and thoughtful policy decision-making, MBC has the potential to be a solution to the current behavioral health crisis.
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In 1984, Chevron deference was established by the US Supreme Court in Chevron U. S. A., Inc. v. ⋯ In June 2024, the Supreme Court's ruling in Loper Bright Enterprises v. Raimondo effectively ended Chevron deference, altering the judicial landscape with significant implications for US healthcare. In this commentary, we discuss the various potential benefits and challenges that the US healthcare system will face in a post-Chevron landscape while also considering the ways in which clinicians will be expected to help address these obstacles.