Practical use of GLP-1-based medications in obesity clinics

This chapter is a practical, clinic-oriented guide to the everyday use of GLP-1-based medications for obesity, written to support the decisions clinicians make from the first visit through long-term management. It focuses on the four agents FDA-approved for chronic weight management at the time of writing, liraglutide, subcutaneous and oral semaglutide, tirzepatide, and orforglipron. After briefly grounding the reader in the incretin-based mechanisms that account for these agents' efficacy and cardiometabolic benefits, the chapter concentrates on the tasks that occupy the obesity clinic: identifying appropriate candidates and using body mass index alongside measures of central adiposity; conducting a structured pretreatment evaluation to screen for contraindications and establish baseline monitoring parameters; recognizing and managing the class-wide and agent-specific adverse effects; and selecting an agent by matching its efficacy and comorbidity-specific indications to the individual patient. Detailed, individualized dose-titration strategies are provided to optimize tolerability while avoiding both over-aggressive escalation and treatment inertia, along with practical guidance on managing missed doses, concomitant medications, and treatment interruptions. The chapter closes by framing obesity as a chronic, relapsing disease: drawing on randomized withdrawal trials showing that weight loss and cardiometabolic gains largely reverse when treatment stops, it offers guidance on counseling patients, sustaining therapy through plateaus and coverage disruptions, and approaching tapering or discontinuation when it becomes necessary.