It's Not Easy Saying No to Weight Loss Drugs

Charles P. Vega, MD


September 21, 2023

To focus on issues of prescribing in primary care, I'm presenting a clinical scenario drawn from my own practice. I'll tell you what I plan to do, but I'm most interested in crowdsourcing a response from all of you to collectively determine best practice. So please answer the polling question and contribute your thoughts in the comments, whether you agree or disagree.

A High School Reunion

You are seeing a 38-year-old man whose reason for visit states "weight loss." He feels well overall and quickly gets to the point: "My high school reunion is coming up in 4 months, and — I know this is vain — but I really want to look my best. I was chubby in high school, and I really want to show them that I'm living my best life."

You quickly review his chart with him. He has no chronic medical illnesses. He takes no medications. His exam and vital signs today reveal the following:

  • Temperature: 36.5 °C(97.7 °F)

  • Pulse: 75 beats/min

  • Blood pressure: 120/74 mm Hg

  • Respiratory rate: 14 breaths/min

  • Oxygen saturation: 96% on room air

  • BMI: 27; waist circumference: 100 cm

He underwent lab testing 1 year ago with no evidence of dysglycemia, and he had a healthy lipid profile, among other normal results on his comprehensive metabolic panel.

You ask permission to discuss his weight and he grants it. You then ask for him to tell you about his journey with weight, and he relates the following:

"I've always struggled with weight. I can feel anxious or sad at times, and then I tend to eat more. I exercise about once per week, walking around the track. I know that I could do better, and I was just hoping for one of those injected drugs to kick-start my weight loss."

The patient is unmarried and lives alone. He is a software engineer. He says he does not use nicotine products, alcohol, or other drugs.


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