GLP-1 medications are powerful drugs. They have indications and contraindications. As with all medications, they come with risks.
Appropriate and targeted screening is essential before starting patients on these medications and intermittently while treating them.
Key Things in the Medical History to Think About Before Prescribing (not an inclusive list):
Do they have obesity (BMI > 30) or pre-obesity with a cardiometabolic comorbidity?
Do they have a personal or family history of medullary thyroid cancer?
Do they have a personal or family history of multiple endocrine neoplasia type 2 (MEN 2)?
Do they have a history of pancreatitis?
Are they at high risk of developing pancreatitis?
Do they have a history of gastroparesis or are they at high risk of developing it?
Are they at high risk of developing nonarteritic anterior ischemic optic neuropathy (NAION)?
Do they struggle with nausea?
Do they struggle with constipation?
Do they have binge eating disorder (BED) or any other eating disorder?
Do they have a history of dysregulated eating?
Are they using oral contraceptives (women only)?
Are they at risk of an unplanned pregnancy (women only)?
Are they taking any medications that lower serum glucose that may need to be deprescribed or have the dose lowered to prevent hypoglycemia?
Are they taking any medications to lower blood pressure that may need to be prescribed or have the dose lowered to prevent hypotension?
Key Things in the Social History to Think About Before Prescribing (not an inclusive list):
Are they prepared to give themselves injections?
Can they keep the medication refrigerated?
Are they mentally/emotionally prepared to take the medication long-term to prevent weight regain?
Can they afford to take the medication, both short-term and long-term?
Do they have the appropriate tools to manage side effects if they occur?
Do they have a strong support network to help them during their weight-loss journey?
Have they had a thorough psychological workup to screen for any underlying issues (such as a history of physical and/or sexual abuse) that may have contributed to the weight gain and may bubble up to the surface during active weight loss?
Key Laboratory and Biometric Data to Review Before Initiating Anti-Obesity Medications (not an inclusive list):
Complete Blood Count (CBC)
Complete Metabolic Panel (CMP)
Fasting Lipid Panel
Hemoglobin A1C (Hgb A1C)
Fasting Insulin
Thyroid-Stimulating Hormone (TSH)
Body Mass Index
Body Fat Percentage (DEXA, Bioimpedance, skin calipers)
