GLP-1 receptor agonists in primary care: readiness, equity, and the risk of a two-tiered obesity treatment landscape.

Glucagon-like peptide-1 receptor agonists have transformed obesity pharmacotherapy by producing substantial weight loss and, for semaglutide in patients with established cardiovascular disease, reducing major cardiovascular events. Integrating these therapies into primary care is constrained by gaps in provider training, clinical inertia, weight bias, high treatment costs, and fragmented insurance coverage. Racial and ethnic minority groups, low-income communities, and publicly insured patients are less likely to receive or fill prescriptions despite the disproportionate burden of obesity-related diseases. This narrative review examines primary care readiness, structural determinants of access, disparities in prescribing and use, real-world adherence, and policy options for these drugs. Without coordinated action, these therapies may reinforce a two-tiered treatment landscape in which access reflects socioeconomic advantages rather than clinical needs. Equitable implementation will require aligned reforms in coverage and pricing, workforce development, person-centered care, and long-term treatment support.