What information should be documented when starting weight loss medications?

Documentation Requirements When Starting Weight Loss Medications

When initiating weight loss medications, comprehensive documentation should include baseline measurements, comorbidities, medication-specific parameters, and a monitoring plan to ensure safety and track efficacy. 1

Essential Documentation Elements

Baseline Anthropometric Measurements

• Weight (in kg or lbs)
• BMI calculation
• Waist circumference
• Document weight stability in the 3-6 months prior to starting medication 1

Medical History and Comorbidities

• Weight-related comorbidities (hypertension, T2DM, dyslipidemia, obstructive sleep apnea)
• Previous weight loss attempts
• Cardiovascular disease history (especially important for sympathomimetic agents) 1
• History of pancreatitis (contraindication for GLP-1 agonists) 1
• Personal or family history of medullary thyroid carcinoma or MEN type 2 (contraindication for tirzepatide) 1
• History of glaucoma (contraindication for phentermine-topiramate) 1
• History of seizure disorders (contraindication for bupropion) 1
• Psychiatric history including suicidal ideation (relevant for some medications) 1

Medication-Specific Parameters

• For GLP-1 agonists (semaglutide, liraglutide): Document baseline glucose levels, especially if patient is on insulin or sulfonylureas 1
• For phentermine-topiramate: Document baseline serum bicarbonate 1
• For naltrexone-bupropion: Document baseline blood pressure 1
• For all medications: Document potential drug interactions with current medications 1

Laboratory Values

• Comprehensive metabolic panel
• Lipid profile
• Hemoglobin A1c (especially for patients with diabetes or prediabetes)
• Thyroid function tests if clinically indicated

Treatment Plan Documentation

• Selected medication with rationale for choice
• Starting dose and titration schedule
• Expected weight loss goals (typically 5% of body weight at 12 weeks) 1
• Planned duration of therapy
• Monitoring schedule (monthly for first 3 months, then every 3 months) 1
• Criteria for discontinuation (e.g., <5% weight loss at 12 weeks for most medications) 1

Informed Consent Elements

• Discussion of expected weight loss (typically 5-10% of body weight) 1
• Common side effects of the specific medication
• Serious adverse events to monitor for
• Understanding that obesity is a chronic disease requiring long-term treatment 1
• Acknowledgment that medication is an adjunct to, not a replacement for, lifestyle modifications 1

Medication-Specific Monitoring Documentation

For Phentermine

• Document heart rate and blood pressure at each visit
• Document sleep patterns and mood changes
• Document that patient is not taking MAOIs or other sympathomimetic amines 2
• Document absence of contraindications: pregnancy, nursing, CVD, hyperthyroidism, glaucoma, agitated states, history of drug abuse 1

For GLP-1 Agonists (Semaglutide, Liraglutide)

• Document hydration status, especially if taking insulin or sulfonylureas
• Document absence of symptoms of pancreatitis or gallbladder disorders 1
• Document titration schedule and patient tolerance

For Phentermine-Topiramate

• Document heart rate, blood pressure
• Document serum bicarbonate levels
• Document absence of suicidal ideation 1

Follow-up Documentation Requirements

• Weight changes at each visit
• Percentage of total body weight lost
• Medication adherence
• Side effects experienced
• Changes in comorbid conditions
• Adjustments to medication dosage
• Decision to continue or discontinue therapy based on response

Common Pitfalls to Avoid

1. Inadequate baseline documentation: Failing to document all relevant comorbidities and contraindications before starting therapy
2. Missing drug interactions: Not documenting potential interactions with current medications
3. Lack of monitoring plan: Not specifying the frequency and parameters for follow-up
4. Insufficient documentation of efficacy criteria: Not clearly stating when medication should be discontinued if ineffective
5. Overlooking medication-specific monitoring: Each weight loss medication has specific parameters that should be monitored

Remember that documentation should support that pharmacotherapy is being used as an adjunct to lifestyle modifications, not as a standalone treatment 1. The goal is not only weight reduction but improvement in weight-related comorbidities, which should be tracked and documented throughout treatment.