Weight-Loss Pharmacotherapy Beyond Incretins: Patient Selection, Safety, and Real-World Decision-Making - Episode 5
Sequencing non-incretin agents and framing obesity as a chronic disease
Dr Cristancho explains how to sequence or switch among non-incretin agents and how to reframe pharmacotherapy as part of long-term, chronic disease management rather than short-term weight loss.
Non-incretin therapy sequencing should begin with a root-cause analysis of treatment failure: insufficient dose or duration, suboptimal lifestyle adherence, or genuine pharmacologic nonresponse. Dr Cristancho recommends addressing modifiable factors before labeling a regimen ineffective.
When adverse effects are the main barrier, dose adjustment or switching to an agent with a different mechanism or tolerability profile is appropriate. Prior drug exposures, comorbidity burden, and patient preferences should inform the next choice, and combination approaches may be reasonable in selected cases.
Dr Cristancho urges clinicians to explicitly frame obesity as a chronic disease requiring ongoing management. Setting expectations for sustained lifestyle measures and the potential need for long-term pharmacotherapy can improve adherence, reduce disappointment, and support continuity of care.
