By Alicia Muratore, MD
Gastroenterologist | Obesity Medicine & Clinical Nutrition | Former GI Fellow, University of North Carolina
As gastroenterologists, we are uniquely positioned to lead in the care of patients with obesity—because obesity is a gastrointestinal disease.
Obesity Is Rooted in GI Pathophysiology
Obesity is a major driver of many GI conditions we manage every day: metabolic dysfunction-associated steatotic liver disease (MASLD), gastroesophageal reflux disease (GERD), gallstones, pancreatitis, and even GI cancers like hepatocellular carcinoma and colorectal cancer. When we treat these conditions without addressing obesity, we are managing symptoms—not the underlying cause.
GI Physicians Are Already on the Front Lines
We see patients affected by obesity routinely. They are in our clinics with complications we are already treating. So why not treat the disease itself?
National guidelines increasingly support this role for GI physicians. The American Gastroenterological Association (AGA)’s POWER Obesity Care Guide provides a multidisciplinary framework tailored for GI practices. Other organizations—the American College of Gastroenterology, the American Association for the Study of Liver Diseases, and the American Society for Gastrointestinal Endoscopy—emphasize weight management, including pharmacologic and endoscopic interventions like intragastric balloons and endoscopic sleeve gastroplasty.
It’s Time to Expand GI Fellowship Training
Despite obesity’s clear impact on GI health, obesity medicine and nutrition remain minimally covered in fellowship training. Incorporating dedicated didactics, mentored clinic experiences, and training in obesity pharmacotherapy or endoscopy could be transformative for future GI physicians—and for patients.
Practical Steps to Integrate Obesity Care
- Name it early: Include obesity on the problem list and discuss it openly, especially when it’s relevant to diagnoses like MASH or refractory GERD.
- Start treatment or refer early: Whether initiating therapy yourself or collaborating with specialists, timely action matters.
- Understand billing and support: With proper documentation and follow-up, obesity-related care is reimbursable. Resources like AGA’s toolkits and the Obesity Medicine Association offer support.
Conclusion
We don’t all have to be obesity medicine specialists—but we do have to stop overlooking obesity. In 2025, being a gastroenterologist means going beyond scopes and treating root causes. That means bringing obesity into the clinical conversation—and making it part of our GI toolkit.
