Weight-Loss Pharmacotherapy Beyond Incretins: Patient Selection, Safety, and Real-World Decision-Making - Episode 2
Aligning non-incretin pharmacotherapy with patient goals and mechanisms of disease
Dr Cristancho describes how patient goals, time horizon, and clinical drivers of obesity guide the selection and counseling of non-incretin weight loss medications.
Clinicians are encouraged to ground non-incretin pharmacotherapy choices in explicit patient goals and timelines. Dr Cristancho recommends clarifying whether the primary objective is early appetite control, symptom relief, or gradual long-term weight reduction and comorbidity improvement. These discussions can align expectations and support adherence.
Mechanism-based selection is critical. For patients with hyperphagia or reward-driven eating, centrally acting agents that suppress appetite or modulate reward pathways may provide disproportionate benefit. Conversely, in patients with heightened cardiovascular risk or specific medication sensitivities, agent choice must carefully balance efficacy with safety.
When counseling, Dr Cristancho advises being transparent that non-incretin therapies generally yield more modest weight reductions than incretin agents but can still produce meaningful improvements in blood pressure, glycemia, and lipids. Incorporating cost and access considerations early helps to avoid disruptions and supports continuity of care.
