Recently, the Trump administration announced expanded Medicare coverage of GLP-1s for beneficiaries with a body mass index (BMI) of 35 or greater, or a BMI of 27 or greater with certain chronic conditions including prediabetes, heart disease and failure, and kidney disease.
This is a massive and needed expansion of coverage. Research has shown that this class of drugs is remarkably effective in reducing obesity and related chronic conditions such as heart disease, kidney disease, and diabetes.
But GLP-1s on their own are not a silver bullet.
Individuals often experience issues with medication tolerance, preventable side effects, and significant weight regain after discontinuing therapy — all issues that evidence-based medical nutrition therapy can address.
According to current clinical evidence and obesity management guidelines, nutrition and lifestyle therapy are essential components of GLP-1–based treatment, supporting both therapeutic efficacy and tolerability. Yet in my experience leading clinical nutrition programs across health systems and telehealth platforms, most care pathways — and payers — still treat structured nutrition support as optional rather than essential.
This represents a significant missed opportunity. We’re investing billions in pharmacotherapy while underinvesting in the clinical and payment infrastructures that determines whether those medications deliver sustainable results.
If we are going to expand Medicare recipients’ access to GLP-1s, we need to expand their access to nutrition therapy with registered dietitians.
Recent clinical guidance published in the American Journal of Clinical Nutrition underscores this, emphasizing the role of dietitian-led care in optimizing GLP-1 therapy. The American College of Cardiology has reached similar conclusions, highlighting how nutrition and lifestyle interventions improve medication effectiveness. And a review in the Journal of the Academy of Nutrition and Dietetics details how dietitians are adapting communication and care protocols specifically for the GLP-1 era.
Yet despite this growing body of evidence, many obesity and chronic disease care models still position registered dietitians as optional additions rather than core members of the treatment team. This represents a fundamental misunderstanding of what modern clinical nutrition actually is and how effective it can be for those losing weight.
The World Health Organization recently released a comprehensive report on investing in non-communicable disease prevention. Of all evidence-based prevention strategies assessed, reducing unhealthy diets proved the most impactful, yielding a 14:1 return on investment — outperforming interventions such as smoking cessation, alcohol reduction, and early disease screening.
Consider what this means in the context of GLP-1 therapy. If structured nutrition therapy improves medication adherence, reduces early discontinuation, and prevents downstream complications, the cost savings for payers compound quickly. You’re reducing medication wastage, preventing emergency department visits, avoiding the costs associated with rapid weight loss without proper clinical oversight, and — most importantly — building sustainable behavior change that persists after pharmacotherapy ends.
That’s why nutrition care should be bundled into obesity management and chronic disease pathways, not offered as an optional add-on that patients or providers must seek out separately.
We also have to cover medical nutrition therapy for those who need it most, including Medicare beneficiaries. Almost all commercial payers are already doing this, but the government needs to catch up.
For years, bipartisan solutions have been introduced in Congress to expand Medicare coverage for medical nutrition therapy and registered dietitian visits addressing obesity and other cardiometabolic conditions, but they’ve repeatedly stalled. Last month, similar legislation – the Medical Nutrition Therapy Act of 2025 – was introduced in the House to finally move the needle on expanded nutrition care coverage. This is a good first step to making sure all Americans can get access to the health services that will solve our obesity crisis once and for all.
The stakes are high. We’re not just talking about making expensive medications slightly more effective. We’re talking about whether millions of people receive the comprehensive care they need to achieve lasting health improvements, or whether we’ll achieve short-term weight loss without the behavior change that sustains it.
Photo: vgajic, Getty Images
Dr. Michele Rager is a healthcare innovator, entrepreneur, and practice leader with more than 20 years of experience at the intersection of nutrition, technology, and wellness. Her experience in owning and scaling a successful private practice informs her commitment to helping other dietitians design fulfilling, sustainable careers in private practice and beyond.
Dr. Rager has also held leadership roles with Berry Street, Season Health, and UPMC Enterprises. She brings expertise in clinical care, digital health innovation, product strategy, and team development — bridging clinical insight with entrepreneurial strategy to advance the future of nutrition care. She holds a Doctor of Clinical Nutrition from Rutgers University and is a Fellow of the Academy of Nutrition and Dietetics.
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