Skill Checkup: A 43-Year-Old Woman Gains Weight After the Initial Weight Loss Achieved With Diet and Exercise

Fatima Cody Stanford, MD, MPH, MPA, MBA, FAAP, FACP, FAHA, FAMWA, FTOS; Evelyn S. Marienberg, MD


November 14, 2023

Glucagon-like peptide-1 (GLP-1) agonists have been shown to promote weight loss in patients with or without type 2 diabetes and are the Food and Drug Administration (FDA)-approved for chronic weight management. GLP-1 is a physiologic regulator of appetite and calorie intake, and the GLP-1 receptor is present in several areas of the brain involved in appetite regulation. Recently, the FDA approved tirzepatide, glucose-dependent insulinotropic polypeptide (GIP) receptor and GLP-1 receptor agonist, for chronic weight maintenance in adults with obesity. This once-weekly injectable is currently approved as a therapy (in conjunction with diet and exercise) for type 2 diabetes.

Insulins are not approved for weight management; in fact, they have been associated with weight gain. Melanocortin-4 receptor agonists are approved for weight management in patients with rare genetic conditions (ie, proopiomelanocortin, proprotein convertase subtilisin/kexin type 1, and leptin receptor deficiencies). The selective 5-HT2C receptor agonist lorcaserin was approved by the FDA in 2012 but was taken off the market in 2020 because of potential cancer risk. Additionally, other selective 5-HT2C receptors were withdrawn from the market as well owing to unwanted effects, such as higher risk for cardiac valvular abnormalities. However, direct use of 5-HT2C receptor positive allosteric modulators in precision medicine is currently being studied.

The patient returns for an office visit and expresses her motivation to try a new approach to weight management, along with a commitment to eating healthfully and exercising. The two discuss the possibility of adding a GLP-1 agonist.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.