This protocol applies to patients with obesity from excess calories who have completed intensive lifestyle intervention but have not reached the target weight reduction.
The prior treatment — high-frequency nutrition, physical activity, and behavioral counseling (at least 16 sessions over 6 months, targeting a sustained daily energy deficit) — did not achieve the goal of 5–7% weight loss from baseline, monitored at least every 3 months during active management. Failure to reach this target is the trigger for escalation to this protocol.
Target outcome: More than 5% weight loss after 3 months of pharmacotherapy, assessed at least monthly for the first 3 months and at least quarterly thereafter.
DOI: 10.2337/dc26-S008
Obesity pharmacotherapy should be considered for people with diabetes and overweight or obesity along with lifestyle changes.
In people with diabetes and overweight or obesity, the preferred pharmacotherapy should be a glucagon-like peptide 1 receptor agonist or dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptor agonist with greater weight loss efficacy (i.e., semaglutide or tirzepatide), especially considering their added weight-independent benefits.
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.
Upon initiating medications for obesity, assess their effectiveness and safety at least monthly for the first 3 months and at least quarterly thereafter.
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