Obesity: Primary Care Physicians at the Center of Obesity Management

Article produced in collaboration with Eli Lilly

The family physician is often the first to spot overweight, even when a patient comes in for a completely different issue. From there, care starts that doesn’t end with shedding pounds: obesity is a chronic, progressive, and relapsing disease that requires ongoing clinical attention, long-term management, and, when needed, collaboration among multiple professionals. Getting to know the person—their history and habits—makes the family doctor a crucial point of reference.

The first appointment in the office

From back pain to a blood pressure check, from a sick note to a visit for a completely different problem, there are many reasons a person might see their family doctor. Often it is during these visits that an overweight condition becomes apparent, with the patient not fully aware of it. According to ISTAT data for 2025, 46.4% of Italian adults are overweight: 34.8% are overweight and 11.6% have obesity.

“It’s up to us to help the patient recognize the issue without shaming them,” explains Gianmarco Marrocco, a family physician and vice-secretary of the FIMMG Rome provincial chapter. “Obesity isn’t just about appearance: it raises the risk of diabetes, cardiovascular disease, breathing problems, and sleep disorders. After a clinical assessment, our job is to work with the patient to design a treatment plan that starts with lifestyle changes—especially healthy eating and physical activity—and, when needed, may include pharmacological therapies. Early intervention can make a big difference.”

The assessment begins with the patient’s history and measurements of weight, height, body mass index (BMI), and waist circumference. When useful, a deeper dive into body composition can be performed. Laboratory tests are used to explore any potential comorbidities, tailored to the patient’s characteristics.

A tailored care plan

«Guidelines provide essential references, but you have to tailor them to each patient,” continues Marrocco. “What matters are family history, other health conditions, the medications being taken, eating habits, work, sleep, and the real possibility of being physically active. We can’t offer the same path to everyone.”

A forty-something with a BMI of 31–32, without significant complications, can be managed by the family physician with periodic checkups and a personalized plan. When the overall picture is more complex due to comorbidities or the need for specific assessments and treatments, collaboration with a specialist comes into play. The decision to involve a specialist isn’t determined solely by BMI, but by the comprehensive evaluation of the patient.

Lifestyle remains central to treatment

Diet, movement, and sleep quality are integral parts of the treatment. The family doctor can help the patient set realistic goals, taking into account their life circumstances: for someone working on shifts or spending long hours driving, changing routines can be more challenging. “Regular physical activity and proper nutrition are essential, as is attention to sleep. But we cannot reduce obesity to mere willpower: it is a multifactorial disease that requires ongoing listening and support. The patient must not be left on their own.”

When indicated, pharmacologic therapy supplements lifestyle interventions and broadens treatment options. In appropriate cases, surgical treatment can also be considered. “New pharmacological therapies are a valuable resource, which complements—not replaces—attention to nutrition and movement. The goal isn’t quick results: it’s to improve health and sustain benefits over time,” emphasizes Marrocco.

Collaboration across the community

In managing obesity, consulting with an endocrinologist can be helpful, and when necessary, contributions from a nutritionist and a psychologist. A pharmacist can also help guide the patient: faced with clear obesity or when pharmacologic therapies or weight-loss supplements are being considered, they may suggest turning to your family doctor for a proper clinical assessment. The family doctor isn’t just the first filter before the specialist. They are the professional who follows the person over time, knows their comorbidities, tracks treatment progress, and coordinates different interventions. Care can be shared, but the patient must have a stable point of reference. In this light, Territorial Functional Aggregations (AFT) can also promote greater collaboration among colleagues and more continuous patient management, enhancing the trust-based relationship with one’s physician.

Prevention and access to care

Prevention starts in childhood. It is important to strengthen dialogue between pediatricians and family doctors, also through a comprehensive and easily accessible Electronic Health Record, so useful information isn’t lost as patients transition to adulthood. Families should also be involved in nutritional education and in promoting physical activity. “Medical training must keep pace with new evidence and treatment possibilities,” concludes Marrocco. “Law 149/2025 has recognized obesity as a chronic, progressive, and relapsing disease, laying the groundwork for access to diagnostic and treatment pathways within the LEA. The challenge now is to translate this recognition into truly accessible and continuous care pathways. Preventing and treating obesity means improving people’s quality of life and gradually reducing the burden of complications on the National Health Service.”