GLP-1 Agonists for Chronic Weight Management

Candidate profile

Adults with BMI ≥30, or BMI ≥27 with at least one weight-related comorbidity (type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea), who have not achieved adequate response to lifestyle intervention.

Approach

Escalating weekly subcutaneous dose of a GLP-1 or GIP/GLP-1 agonist, titrated over 16 weeks to minimize GI adverse events, combined with structured lifestyle support (nutrition, resistance training, sleep).

Protocol

• Semaglutide: 0.25 mg weekly × 4 weeks → 0.5 → 1.0 → 1.7 → 2.4 mg maintenance.
• Tirzepatide: 2.5 mg weekly × 4 weeks → 5 → 7.5 → 10 → 12.5 → 15 mg maintenance.

Expected trajectory

Weight loss curve is approximately linear for the first 40 weeks, flattening between weeks 52 and 68. Mean 68-week reductions: ~15% (semaglutide 2.4 mg), ~20% (tirzepatide 15 mg).

Monitoring

Baseline and quarterly: weight, waist circumference, blood pressure, HbA1c, lipid panel, liver function. DEXA or BIA at baseline and 6-month intervals to track lean-mass preservation.