This protocol applies to drug-induced obesity when initial obesity pharmacotherapy — a glucagon-like peptide-1 receptor agonist or dual GIP and GLP-1 receptor agonist — has been tried and the treatment target was not achieved.
Prior therapy: Semaglutide or tirzepatide (GLP-1 receptor agonist or dual GIP/GLP-1 receptor agonist) was initiated at the lowest dose and uptitrated based on tolerability and response.
Goal not achieved: Greater than 5% weight loss within 3 months was not reached — indicating non-response and triggering escalation to this next step.
The protocol calls for intensification with additional or alternative pharmacologic agents drawn from several distinct drug classes. The full agent selection, sequencing, and clinical decision criteria are in the structured protocol.
In people with diabetes not reaching weight treatment goals, modify or intensify treatment with additional approaches, including structured lifestyle management programs, metabolic surgery, and additional or alternative pharmacologic agents.
Should use of these medications not result in achievement of weight management goals, or if they are not tolerated or are contraindicated, other obesity treatment approaches should be considered.
Unless clinical circumstances (such as poor tolerability) or other considerations (such as financial expense or individual preference) suggest otherwise, those who achieve sufficient early weight loss upon starting a chronic obesity pharmacotherapy (typically defined as >5% weight loss after 3 months of use) should continue the medication long-term.
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