Mira Tadros, DO, spearheaded SOS—Mount Sinai’s Obesity & Sleep program—streamlining patient care.
By Sree Roy
After seeing many people with sleep apnea who also had obesity in her medical practice at Mount Sinai in New York, Mira Tadros, DO, identified an opportunity to streamline patient care.
Tadros envisioned a more comprehensive program where sleep medicine and weight management seamlessly converged, rather than sleep patients cycling through separate appointments for obesity management. On an individual level, Tadros, by then already board-certified in internal medicine and sleep, pursued board certification in obesity medicine. On an institutional level, she proposed a holistic sleep and weight optimization program housed at Mount Sinai.
In April 2025, the Mount Sinai Obesity & Sleep (SOS) program became a reality. Its timing even proved fortuitous: the program’s debut came on the heels of the US Food and Drug Administration’s approval of tirzepatide (Zepbound) for treating moderate to severe obstructive sleep apnea—the first GLP-1 to receive such an indication.
“The goal is to provide comprehensive multidisciplinary care for patients with obesity and comorbid sleep disorders,” says Tadros, who added board certification in obesity medicine to her credentials in November 2024. “The FDA approval of tirzepatide certainly helped expand patient access to pharmacological therapy and accelerated the program’s impact.”
For Tadros, who is also an assistant professor of medicine in pulmonary, critical care, and sleep medicine at the Icahn School of Medicine, the program is designed to meet the broader reality she sees in clinical practice. While its core focus is obesity and obstructive sleep apnea, she notes that many patients with other sleep disorders—such as shift workers with circadian rhythm disturbances—also struggle with weight and may benefit from guidance on nutrition and meal timing. By integrating sleep health with lifestyle and metabolic care, SOS aims to improve outcomes across a wider patient population.
It also offers a model for how sleep physicians can broaden their practice to address the interconnected drivers of sleep and metabolic disease.
Building Internal Support
Launching a new program required more than clinical expertise, of course—it demands institutional buy-in. Here, Tadros found herself in a good place. Her department at Mount Sinai actively conducts research into obesity and obstructive sleep apnea, making colleagues receptive when she proposed the integrated approach.
“My department was very appreciative,” Tadros recalls. “Given that weight management options are also expanding, they were actually very supportive when I brought up the idea.”
Sleep physician Jing Wang, MD, clinical director of Mount Sinai’s sleep program, remembers her reaction to the proposal as “excitement upon excitement.”
“We really were very excited to have her expertise,” Wang says. “The key being she’s part of the sleep program—she’s a sleep medicine-trained physician with this additional layer of expertise. It was really exciting for her to be able to bring this additional tool and avenue for management and fold it into the existing program.”
Training the Sleep Team
Tadros is the only physician in her department with both sleep and obesity credentials. To make the program work at scale, she needed to train her colleagues to prescribe weight-loss medications like tirzepatide for sleep apnea patients.
Tadros designed and led internal workshops covering medication prescribing protocols, monitoring requirements, indications, and contraindications. She created templates and handouts to standardize care. She presents at faculty conferences, discussing cases and addressing both clinical management and backend logistics.
Essentially, Tadros “distilled some of what she learned in her obesity fellowship and training and delivered it in a clinically concise way to our faculty,” Wang says. “She’s really served as a teaching, educational resource. If I have a clinical question, I often reach out to her. I see other faculty members doing that as well.”
The result: multiple sleep-boarded physicians at Mount Sinai can now prescribe Zepbound for patients with obstructive sleep apnea. More complex cases or patients with specific comorbidities get referred to Tadros or the weight management clinic, but the basic prescribing capability has been distributed across the team.
Operational Adjustments
Integrating obesity management required workflow changes that sleep physicians considering similar programs should anticipate. Medications like tirzepatide demand monthly follow-up visits during initiation and dose titration.
“Establishing a structured workflow that would allow for that is really key,” Tadros advises. She suggests leveraging advanced practice providers or clinical pharmacists to handle these frequent touchpoints, checking on tolerance, weight loss progress, adherence, and side effects.
The program also depends on collaboration with registered dietitians. While sleep physicians routinely provide dietary and exercise counseling, patients starting GLP-1 medications benefit from more comprehensive nutritional guidance focused on adequate protein and fiber intake.
“In the sleep world, we’re used to doing some dietary counseling, exercise counseling, but when a patient gets started on medication like tirzepatide, getting more comprehensive nutritional counseling gets a bit more nuanced,” Tadros says. “Patients really do benefit from seeing a dietitian.”
Mount Sinai already employed a dietitian within its pulmonary, critical care, and sleep division. For physicians without existing dietitian access, she recommends the Academy of Nutrition and Dietetics’ “find a nutrition expert” tool at eatright.org, which offers a searchable national database of credentialed dietitians by location, specialty, and telehealth availability.
Expanded Educational Materials
Tadros also revamped patient education materials. She created tirzepatide-specific handouts covering the mechanism of action, benefits, and side effects. After-visit summaries in the electronic health record now include QR codes linking to Zepbound resources.
New nutrition handouts emphasize small, frequent meals over large ones, adequate protein and fiber intake, and proper hydration. Exercise materials stress resistance training to maintain muscle mass during weight loss. Side effect management guides help patients navigate common gastrointestinal issues like nausea or constipation.
Clinic rooms now stock demonstration pens—needleless devices showing how to unlock the pen and hold it for the required 10-second injection. Nurse visits are available for patients wanting guidance with their first injection.
Navigating Insurance Hurdles
Prior authorization remains a challenge, though Mount Sinai’s dedicated authorization team helps. Tadros emphasizes careful documentation as critical for approvals: results from a recent sleep study confirming moderate to severe apnea (by apnea-hypopnea index), both OSA and obesity diagnosis codes, documentation ruling out contraindications, and notation of weight-related comorbidities like hypertension or fatty liver disease.
“I also tend to document any previous weight loss attempts, including lifestyle modifications or past medications,” Tadros says. When medications get denied, a letter of medical necessity explaining the clinical rationale can support the appeal process.
Advice for Sleep Physicians on Streamlining Weight Optimization
For sleep physicians interested in prescribing Zepbound, Tadros recommends starting with education. The American Academy of Sleep Medicine offers webinars and podcast episodes providing guidance. The Obesity Medicine Association hosts similar educational resources.
Before prescribing, establish workflows supporting monthly follow-up visits and cultivate collaborative relationships with primary care providers and other specialists. Tadros also underscores approaching weight discussions sensitively.
“I always ask patients for permission to discuss weight before we even talk about it,” she says. Then, she keeps the focus on their goals, centering the conversation around what they hope to improve—such as mobility, cholesterol levels, or, in some cases, reducing CPAP reliance—rather than on a number.
Win-Win for Physicians and Patients
For Wang and other faculty members, the program has enhanced professional satisfaction. Being able to directly affect weight change in patients with good efficacy, using cutting-edge therapies that have captured medicine’s attention, feels meaningful.
“From a provider perspective, it’s really broadened the provider horizon,” Wang says, adding, “patients have really been happy to have it. So it’s just been all positive.”
As GLP-1 medications and other pharmacologic options continue expanding, Tadros expects the program to evolve. Multiple medications are in the research pipeline for both obesity and sleep apnea, likely bringing broader therapeutic choices within the next year.
For now, the Mount Sinai model provides a practical template: integrate rather than separate, train colleagues systematically, mobilize resources, and maintain patient-centered care as the guiding principle. It’s an approach Tadros and her colleagues hope will inspire similar programs at other institutions. Wang reflects. “It’s really good for not only provider enrichment but also for patient care.”
