Weight-Loss Pharmacotherapy Beyond Incretins: Patient Selection, Safety, and Real-World Decision-Making - Episode 1
Non-incretin harmacotherapy in an incretin-dominated obesity landscape
In this segment, Cagney Cristancho, MD, outlines why non-incretin pharmacologic options remain essential in obesity care despite the rapid expansion of incretin-based therapies.
This segment underscores that non-incretin agents remain indispensable because access and cost often constrain use of incretin therapies. Even when incretin agents are clinically appropriate, insurance coverage, prior authorization requirements, and high cost can preclude initiation or continuation. Dr Cristancho frames these barriers as system-level drivers of non-incretin prescribing rather than a simple hierarchy of efficacy.
Patient selection for antiobesity medications beyond incretins should follow established criteria: BMI ≥30 kg/m² or ≥27 kg/m² with at least 1 weight-related comorbidity. Dr Cristancho stresses the importance of documenting prior structured lifestyle efforts and their limitations, both to justify pharmacotherapy and to contextualize expectations.
The segment reminds clinicians to integrate patient preference—especially regarding oral vs injectable formulations—into early decision-making. Non-incretin agents offer diverse mechanisms and routes of administration that can align with patients who decline injections or cannot access incretin therapies, supporting a pragmatic and patient-centered obesity care model.
