Comprehensive Weight Loss Consult for GLP-1 Receptor Agonist Therapy
A thorough weight loss consultation for a patient requesting GLP-1 receptor agonist therapy should include BMI calculation, comprehensive metabolic panel, cardiovascular assessment, and evaluation of obesity-related comorbidities to determine eligibility and appropriateness of treatment.
Initial Assessment Components
Anthropometric Measurements
- Body Mass Index (BMI) calculation
- Waist circumference measurement
- Body composition analysis (if available)
Medical History
- Duration and progression of weight gain
- Previous weight loss attempts and outcomes
- Family history of obesity and related conditions
- Medication review (identifying medications that may contribute to weight gain)
- History of eating disorders (contraindication for some medications) 1
- Personal or family history of medullary thyroid carcinoma or MEN2 (contraindication for GLP-1 RAs) 2
- History of pancreatitis (caution with GLP-1 RAs) 2
Obesity-Related Comorbidity Assessment
- Type 2 diabetes or prediabetes status
- Hypertension
- Dyslipidemia
- Cardiovascular disease
- Sleep apnea
- Non-alcoholic fatty liver disease
- Osteoarthritis
- Polycystic ovary syndrome
- Mental health conditions (depression, anxiety)
Laboratory Tests
- Comprehensive metabolic panel (CMP) 1
- Hemoglobin A1C
- Estimated glomerular filtration rate (eGFR)
- Plasma lipids
- Thyroid function tests
- Consider additional tests based on symptoms and risk factors
Cardiovascular Assessment
- Blood pressure
- Heart rate
- ECG if indicated (especially with history of cardiovascular disease)
Eligibility Assessment for GLP-1 RA Therapy
FDA-Approved Indications
- BMI ≥30 kg/m², or
- BMI ≥27 kg/m² with at least one weight-related comorbidity (type 2 diabetes, hypertension, dyslipidemia, sleep apnea) 1
Contraindications to Screen For
- Personal or family history of medullary thyroid carcinoma
- Multiple Endocrine Neoplasia syndrome type 2 (MEN2)
- History of severe gastroparesis
- Pregnancy or planned pregnancy within next 2 months
- Breastfeeding
- History of pancreatitis (relative contraindication)
- Severe renal impairment (may require dose adjustment)
Treatment Planning
Medication Selection and Education
- Discuss available GLP-1 receptor agonist options:
- Semaglutide (weekly injection)
- Liraglutide (daily injection)
- Tirzepatide (dual GIP/GLP-1 RA, weekly injection)
- Review mechanism of action:
- Appetite suppression via hypothalamic receptors
- Delayed gastric emptying
- Enhanced satiety
- Improved glycemic control
Expected Outcomes
- Realistic weight loss goals (6.1-17.4% for non-diabetic patients, 4-6.2% for diabetic patients) 1
- Timeline for expected results
- Improvement in obesity-related comorbidities
Side Effect Management
- Common adverse effects to monitor:
- Nausea and vomiting (most common)
- Diarrhea
- Constipation
- Abdominal pain
- Dyspepsia
- Reflux 1
- Strategies to minimize gastrointestinal side effects:
- Start at low dose and titrate slowly
- Reduce meal size
- Avoid high-fat diet
- Limit alcohol and carbonated drinks 1
Comprehensive Treatment Approach
Lifestyle Modifications
- Nutrition counseling with specific caloric targets
- Physical activity recommendations (both aerobic and resistance training)
- Behavioral strategies for long-term adherence
- Sleep hygiene assessment and recommendations
Monitoring Plan
- Follow-up schedule (typically every 4-12 weeks initially)
- Weight monitoring protocol
- Laboratory monitoring as needed
- Side effect assessment
- Medication efficacy evaluation (continue only if ≥4-5% weight loss achieved after 12-16 weeks) 1
Treatment Discontinuation Criteria
- For liraglutide: Discontinue if <4% weight loss after 16 weeks 1
- For other GLP-1 RAs: Similar efficacy thresholds apply
- Intolerable side effects
- Development of contraindications
- Pregnancy planning (discontinue at least 2 months before planned pregnancy) 2
Special Considerations
Perioperative Management
- Continue GLP-1 RAs throughout perioperative period
- Adhere to recommended fasting guidelines
- Consider risk of aspiration during anesthesia
- Monitor for stress hyperglycemia 1
Medication Interactions
- Delayed gastric emptying may affect absorption of other oral medications
- Women on oral contraceptives may need additional barrier method for 4 weeks after initiation and after dose increases 1
Monitoring for Serious Adverse Events
- Pancreatitis (abdominal pain, nausea, vomiting)
- Gallbladder disorders
- Diabetic retinopathy in patients with diabetes
- Hypoglycemia (especially if on insulin or sulfonylureas)
- Acute kidney injury in patients with renal impairment 2
By following this comprehensive approach, clinicians can properly evaluate patients for GLP-1 receptor agonist therapy, set appropriate expectations, and monitor for both efficacy and safety throughout treatment.