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 Additionally, other selective 5-HT2C receptors were withdrawn from the market as well owing to unwanted effects, such as higher risk for cardiac valvular abnormalities.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.
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Cite this: Fatima Cody Stanford, Evelyn S. Marienberg. Skill Checkup: A 43-Year-Old Woman Gains Weight After the Initial Weight Loss Achieved With Diet and Exercise - Medscape - Nov 14, 2023.