New anti-obesity medications: With great power comes great responsibility

Highly effective new anti-obesity medications such as semaglutide and tirzepatide have led to a sea change in expectations for the treatment of obesity, giving new hope to individuals who have struggled with excess weight for years.

But prescribing anti-obesity medications is a responsibility that can’t be taken lightly. Although press coverage of Wegovy (semaglutide) sometimes implies that obesity is a simple condition with a simple treatment, obesity is in fact a complex, chronic, heterogenous, relapsing disease, and addressing it requires more than just a prescription. For primary care physicians and other health care providers who want to begin using anti-obesity medications, here are four recommendations to set patients up for success.

Encourage long-term commitment

Anti-obesity medications are intended specifically for the lifelong treatment of the chronic disease of obesity. Before starting anti-obesity medications, patients must understand that they will need to take them long term — just like individuals with hypertension or diabetes must continue their medications for the foreseeable future. If they stop, they will almost certainly regain the weight. Worse, stopping may limit their future options: if they discontinue a medication and regain weight, it is possible that the same medication may no longer work as well (or at all) the next time.

This means that individuals who are not prepared to adhere to treatment are not good candidates for these medications. Clinicians need to take the time to explain the complexities of weight regulation and how the medications function and make it clear that patients should let them know if they have any concerns or plans to stop, to allow for prompt intervention.

Create a personalized weight management plan

There’s no one-size-fits-all treatment for obesity. Medications should be prescribed as part of a highly personalized weight management plan that addresses all the factors contributing to an individual’s weight gain, as well as all the barriers preventing weight loss. Lifestyle interventions (diet, physical activity and behavior modifications) will always be critical components of any successful weight management plan, but the plan must also take into account personal and family medical history, current medications, sleep patterns, stress and previous weight-loss experience, for example.

Anti-obesity medications should be selected based on a comprehensive evaluation because different people have different needs, risk factors and comorbidities, and they respond differently to different medications. There’s no one right choice for everyone.

Providers must also create a personalized dose titration schedule and help patients make necessary changes to diet and meal timing to minimize side effects. The new medications are generally well tolerated when dose escalation protocols are tailored correctly and patients are properly supported, but inappropriate prescription can lead to more side effects, a complete lack of appetite or too much weight loss.

Close monitoring will become increasingly important with the even more powerful medications in the pipeline. With weight loss approaching bariatric surgery levels, patients are likely to experience vitamin deficiencies, for example, if not monitored carefully.

Be flexible when faced with barriers to access

Most patients cannot afford the latest anti-obesity medications without insurance coverage, and many health plans exclude obesity care. As increasing evidence demonstrates the significant health benefits of weight loss — from diabetes remission to a notably reduced risk for serious cardiac events — insurers will likely recognize that preventing weight-related health complications by directly treating obesity is less costly than waiting to treat these conditions after they develop.

In the meantime, though, providers may need to be flexible. It’s important to note that many medications in the anti-obesity armamentarium are considerably less expensive than Wegovy and can still lead to clinically significant weight loss. Numerous studies indicate that 10% body weight loss results in measurable health benefits.

Flexibility may also be needed in response to supply issues. Manufacturers are struggling to meet the soaring demand, and it’s unclear when the current shortages will be resolved, so providers need to stay up to date on availability and devise backup plans when prescribing.

If keeping abreast of prior authorization requirements, day-by-day pharmacy supply and anti-obesity medications other than GLP-1 receptor agonists sounds too intimidating, clinicians can refer their patients to an obesity medicine provider. Although there aren’t enough of us to see every patient with obesity, we welcome complex cases that require our deep expertise of every agent in the anti-obesity armamentarium. And, unfortunately, obesity medicine specialists are resigned to devoting far too many resources to insurance appeals and pharmacy intel.

Offer empathy and ongoing support

Individuals with obesity often avoid seeking health care because they’re tired of being judged for their inability to lose weight. With the new anti-obesity medications giving patients new incentive to seek treatment, now is the time for providers to redouble their efforts to cultivate an empathetic environment and win back trust among a group of patients who often feel stigmatized. Patients with obesity deserve the same compassionate and evidence-based care as those with any other chronic disease.

This also means providing ongoing support. Weight management is a lifelong effort, even with highly effective medications. Clinicians need to offer education and long-term assistance to help their patients sustain healthy lifestyle changes and manage the inevitable bumps in the road along the way.

The new anti-obesity medications are remarkably powerful, and it can be tempting to see a patient with obesity and just write a prescription. But as the saying goes, with great power comes great responsibility. Successful use of these medications requires an individualized approach and a great deal of patient education and attention. Those who provide the necessary support will be able to help their patients achieve real improvements in health and well-being.