NATIONAL HARBOR, Md.—The medical management of obesity is changing, thanks in part to new views on obesity and widespread adoption of weight loss medications. There are ways to combine medications with surgery to achieve greater weight loss for patients and novel ICD-10 diagnosis codes that can be used to increase reimbursement for obesity management, speakers said during the American Society for Metabolic and Bariatric Surgery 2025 annual meeting.
“There’s still so much stigma and bias with obesity,” said Marc-Andre Cornier, MD, the president of The Obesity Society and the director of the Division of Endocrinology, Diabetes, and Metabolic Diseases at the Medical University of South Carolina, in Charleston. Obesity should be thought of as a serious, chronic disease, he said, explaining that it results from inappropriate energy intake cues driven by a genetic predisposition to an “obesogenic” environment.
The diagnosis and staging of obesity and the selection of obesity treatments should not simply be based on body mass index, Dr. Cornier said. Instead, doctors need to continue to search for more effective yet simple ways to assess for adiposity, and treatment selection should be a shared decision with patients that takes into consideration their individual complications, racial and ethnic backgrounds, personal preferences, and psychosocial factors.
Timing of Weight Loss Drugs
Just as anticancer medications can be used before and/or after surgery to improve patient response, the same may be true for weight loss drugs when given before and/or after bariatric surgery, said Jamy Ard, MD, a co-director of the Wake Forest Baptist Health Weight Management Center, in Winston-Salem, North Carolina.
“It’s an interesting time in this space, because we now have an opportunity to do what some of us have talked about for a long time: think about the treatment of obesity as a continuum of therapy,” Dr. Ard said, describing a “growing amount” of literature in the space.
Weight loss medications may be used before bariatric surgery to reduce weight or decrease liver size before surgery to decrease operative time and perioperative risk, Dr. Ard said. A small case series found neoadjuvant use of phentermine alone or in combination with topiramate in patients with a BMI of at least 60 kg/m2 led to about a 31% total weight loss one year after surgery, compared with a 20% weight loss among patients who did not receive such medications (Surg Obes Relat Dis 2023;19[8]:832-840).
After surgery, medications are sometimes used when a patient’s treatment response is suboptimal, to gain a greater weight reduction. For example, the BARI-OPTIMISE trial found that giving liraglutide to patients who did not achieve at least a 20% weight loss one year after Roux-en-Y bypass helped them lose more than 8% body weight within 24 weeks of treatment initiation (JAMA Surg 2023;158[10]:1003-1011).
“Just because someone may not be responding fully to surgery is not a reason to say, ‘Well they probably won’t respond to an obesity medication,’” Dr. Ard said. “There’s no reason not to try combination therapy for people who you see not having an optimal treatment response, or you need to prepare them for metabolic surgery.”
Some studies are looking into giving weight loss drugs before and after surgery. A patient who needs a 40% weight reduction is unlikely to get a full response just from a gastric sleeve operation, so medications could help add a weight loss of 10% to 20% to the 20% to 25% expected from surgery. A study from this group found that giving patients with a BMI of at least 50 kg/m2 three to six months of phentermine-topiramate before gastric sleeve surgery, and resuming a month after surgery, achieved an average weight change of 67 kg two years after surgery compared to 45 kg among patients not receiving the combination therapy (Surg Obes Relat Dis 2019;15[7]:1039-1043).
A newer development is lean mass augmentation using new antibodies that impact activin and myostatin, such as trevogrumab-garetosmab, to enhance retention of lean mass and reduction of fat mass for maintenance of body weight in the postoperative state, said Dr. Ard. “Combinations with any one of our procedures could potentially lead to real dramatic changes in body composition and maintenance of body weight long term,” he said. More research into the optimal timing and sequencing of combination therapy is needed, he noted.
Coding Tips for Obesity Treatment
Obesity experts need to be familiar with a number of ICD-10 codes that they can use to up their reimbursements for medical management of patients, said Leslie Golden, MD, MPH, the CEO of Weight in Gold Wellness, an evidence-based weight health clinic in Madison, Wisconsin.
“Accurate coding really depends on what’s captured in the note,” Dr. Golden said. “If key details aren’t clearly documented, they’re unlikely to be coded appropriately. Providers have to take ownership for what’s in their notes. Your biller can’t code what you don’t explicitly document.”
For example, 99214 is the most common code used for chronic care visits addressing obesity and related conditions such as hypertension, sleep apnea, or depression. The G2211 add-on code—which recognizes longitudinal, complex care—can often be applied to reflect the type of relationship-based management obesity medicine involves, she said.
“There’s sometimes confusion that G2211 is only for the most complex visits,” Dr. Golden said. “In reality, it’s meant to capture the continuity and layered care these patients require.”
Other codes that may be relevant include 99401-99404 for preventive counseling, 99453-99454 for remote physiologic monitoring, 99424-00427 for principal care management of chronic conditions such as obesity, and G0447 for intensive behavioral therapy for obesity. “These codes recognize the time and effort spent supporting patients between visits, whether that’s documentation, coordination, or addressing prior authorizations,” Dr. Golden said.
To maximize reimbursement, she recommended documenting the time spent, the behavioral strategies used, and the specific plans or goals established during each visit—and linking those to the appropriate codes. “A few common pitfalls I see include missing add-on codes like G2211, not reviewing payor contracts to confirm coverage, and not verifying benefits before providing services,” she said.
Dr. Cornier reported receiving research funding from Amgen, Cleerly, Ionis, Kaneka, and Novartis; serves on consulting/advisory boards for AstraZeneca, Biophytis, Eli Lilly, Keros, Pfizer, Wave, and ZyVersa; and serves on a data safety monitoring board for Advarra. Dr. Ard reported receiving research funding from, and serving as a consultant to and advisory board member for, several companies including Boehringer Ingelheim, Lilly, Nestle Healthcare Nutrition, Novo Nordisk, and Weight Watchers. Dr. Golden reported serving on the speakers bureau of Currax, Lilly, and Novo Nordisk, and holding individual stocks in Lilly and Novo Nordisk. She also serves on a Novo Nordisk advisory board.
This article is from the February 2026 print issue.
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