1 physician's take on how weight loss drugs lead to 'phenomenal outcomes'

Weight loss drugs, or glucagon-like peptide-1 receptor agonists, seem to have taken the world of healthcare by storm — for better or for worse.

David Knieriem, MD, medical director with Toledo, Ohio-based ProMedica Physicians, recently joined Becker's to share his insight on the medications. 

Note: These responses have been edited lightly for length and clarity.

Question: How has the increasing demand for GLP-1 receptor agonists changed how you practice?  

Dr. David Knieriem: My perspective may be a little unique in that I work primarily with one insurance provider that offers very good GLP-1 agonist coverage for both diabetes and obesity. Additionally, our clinic has an excellent supporting cast with onsite nutrition and exercise specialists that allows us to maximize the efficacy of these medications and do it in a safe and responsible manner. We have seen some truly phenomenal outcomes in our patients with diabetes and obesity, and it's gratifying to help patients improve so many different health metrics related to their weight. 

These drugs are powerful and can be absolutely life-changing for patients. It admittedly adds some busywork with prior authorizations and calling around to multiple pharmacies to check on supply. The biggest challenge has been trying to help patients navigate the supply issues, which has been frustrating at times. Over time, I have become confident in identifying those patients who would benefit most from this type of treatment. However, it can be challenging distinguishing those individuals from others looking for a "quick fix" or "jump start" to weight loss. I have also heard some professionals express concern that prescribing these medications is enabling patients to "take the easy way out." However, I believe the pathophysiology of obesity is very complex with numerous genetic and environmental causes, rather than someone just lacking the willpower it takes to see results. 

The fact that the vast majority of patients who manage to lose weight on their own through lifestyle changes eventually gain it back also suggests that we need a more sustainable (perhaps easier) solution to help them achieve their goals.

Q: How do you think they will affect the field of medicine as a whole?

DK: My experience with GLP-1 agonists has been extremely positive. I believe the increasing demand for these medications is justified, but think we have to be careful with patient selection; counseling that this is part of a long-term journey in improving their health. My hope is that drug supply and insurance coverage improves over time for the benefit of society. I also think these medications are best prescribed with regular follow-ups to ensure medication tolerance and efficacy, along with some type of formal counseling on lifestyle behaviors. I am fortunate to be able to offer these services onsite, but know other providers are not as lucky. Overall, the pros far outweight the cons — and it has truly been rewarding and energizing.

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