Weight Loss Therapy

Introduction to Weight Loss Therapy

Weight loss therapy, such as tirzepatide, can produce substantial weight loss (mean reduction of 20.9% from baseline compared to 3.1% with placebo) in adults with obesity, and improves cardiometabolic risk factors, including waist circumference, blood pressure, and lipid profiles, as supported by the American Diabetes Association and American College of Physicians 1, 2.

Achieving >5% weight loss after 3 months typically predicts better long-term outcomes, according to the American Diabetes Association and American Association of Clinical Endocrinologists 2, 3.
Discontinuation of long-term therapy leads to regaining one-half to two-thirds of lost weight within a year, emphasizing the importance of continued therapy, as recommended by the American Diabetes Association 2, 1.

Tirzepatide should be administered subcutaneously in the abdomen, thigh, or upper arm, with rotation of injection sites with each dose, and can be administered at any time of day, with or without meals, as recommended by the American Association of Clinical Endocrinologists 4.
The initial titration for tirzepatide begins at 2.5mg weekly for 4 weeks before increasing to the 5mg maintenance dose, according to clinical guidelines 2, 5.
The initial dose of tirzepatide can be further titrated to 7.5 mg, 10 mg, 12.5 mg, and a maximum of 15 mg once weekly as tolerated, with a strength of evidence classified as high 2, 6, 1, 7.
No dosage adjustments are required for patients with renal impairment when using Mounjaro, unlike some other GLP-1 RAs 8.

Patients using oral hormonal contraception should use or add a non-oral method for 4 weeks after initiation and after each dose escalation of tirzepatide, as recommended by the American College of Obstetricians and Gynecologists 3.
Consider potential drug interactions with other medications commonly used in older adults, and assess for dehydration risk, which may be higher in older adults experiencing gastrointestinal side effects, as recommended by the American Diabetes Association guidelines 5.

The most common adverse effects of tirzepatide are gastrointestinal, including nausea (31%), diarrhea (23%), vomiting (12%), and constipation (5%) 1.
Gastrointestinal effects can be managed by starting at a low dose, titrating slowly, reducing meal size, avoiding high-fat foods, and limiting alcohol and carbonated drinks, as recommended by the American College of Endocrinology 7, 9.
There is a rare but documented adverse effect of acute pancreatitis when switching between GLP-1 agonists, and patients should be monitored closely for this condition, with a strength of evidence classified as moderate 7.

Monthly assessment during the first 3 months, then quarterly thereafter, can help track progress and identify potential issues 2.

GLP-1 receptor agonists, such as tirzepatide, reduce cardiovascular events in patients with obesity and pre-existing cardiovascular disease, with intentional weight loss associated with lower risk of adverse clinical outcomes in coronary artery disease patients, as reported by the American Medical Association and the American Heart Association 10, 11.
The European Society of Cardiology recommends BP-lowering drug treatment for people with pre-diabetes when office BP ≥140/90 mmHg or when at high risk for CVD 12.