Helping Patients Navigate GLP-1 Therapy: Practical Strategies for Pharmacists

Obesity is a complex, chronic disease that requires a multifaceted approach to achieve long-term weight maintenance and reduce associated risks, such as cardiovascular disease. As the use of GLP-1 receptor agonists expands, so does the need for comprehensive care strategies that combine pharmacotherapy with sustainable lifestyle interventions.

Pharmacy Times® interviewed Katherine H. Saunders, MD, DABOM, an obesity physician at Weill Cornell Medicine and co-founder of FlyteHealth, a software and clinical services company works to democratize access to medical obesity treatment. Saunders discusses the critical role of dietary and physical activity counseling, the importance of pharmacist involvement in patient education, strategies for managing adverse effects (AEs) and adherence challenges, and emerging insights on the long-term safety and durability of GLP-1 therapies.

Pharmacy Times: How do evidence-based dietary and physical activity strategies enhance the effectiveness of GLP-1 therapies in long-term weight management and cardiovascular risk reduction?

Katherine H. Saunders, MD, DABOM, is an obesity physician at Weill Cornell Medicine and co-founder of FlyteHealth, a software and clinical services company works to democratize access to medical obesity treatment, in New York, New York.

Katherine H. Saunders, MD, DABOM: When we counsel patients on lifestyle modifications, we focus less on weight loss and more on weight maintenance and health outcomes.Obesity is a progressive disease and weight maintenance is never a smooth road.A sustainable dietary strategy and a regular physical activity regimen are critical components of an effective long-term weight maintenance plan to reduce the risk of weight gain.

Pharmacy Times: What role can pharmacists play in counseling patients on lifestyle modifications while on GLP-1 therapy, and how can we ensure patients receive consistent, accurate information across the care team?

Saunders: Pharmacists can play an important role in counseling patients on lifestyle modifications. Pharmacists and the other members of the care team should be trained in evidence-based obesity medicine and aligned on treatment protocols.

Pharmacy Times: For patients who experience tolerability issues such as gastrointestinal AEs, what practical strategies can pharmacists recommend to help them stay adherent to GLP-1 therapy in the long term?

Saunders: Most gastrointestinal AEs can be mitigated or completely avoided with appropriate prescribing to well-selected patients, thoughtful counseling, and close monitoring. A lot of the AE hype in the media is a result of inappropriate prescribing and insufficient education and support. Dose titration should be personalized based on effectiveness and tolerability.For example, the dose of a medication shouldn’t be increased if a patient is losing weight quickly and/or experiencing AEs. Instead of stopping a medication, patients should be encouraged to contact their prescribing providers if they have AEs that are more than mild and/or persistent. Safe and effective medical obesity treatment requires problem solving and fine tuning, and pharmacists can play a huge role in this process.

Pharmacy Times: Are there emerging data on long-term safety and durability of GLP-1 medications when combined with lifestyle interventions, and how should pharmacists integrate these insights into patient care planning?

Saunders: GLP-1 medications are not new. The first GLP-1 receptor agonist was approved by the FDA in 2005, so we have 2 decades of data. In terms of safety, the risk/benefit profile of any medication should be carefully considered for each individual patient. In terms of durability, patients should be encouraged to continue taking their medication(s) and continue their lifestyle interventions long-term to maintain their weight and health outcomes.

Pharmacy Times: What are some of the most common misconceptions patients have about GLP-1 medications, and how can pharmacists proactively address these during counseling?

GLP-1 therapy injection pens. Image Credit: © Edugrafo - stock.adobe.com

Saunders: GLP-1 medications are a critical tool for us, but not every patient needs a GLP-1. GLP-1 are not often first- or second-line treatments for our patients because our clinicians have success with medications from the entire obesity armamentarium, many of which are covered by insurance, less expensive, and widely available.

Obesity treatment has become synonymous with a GLP-1 prescription in a bubble, but effective and sustainable obesity treatment requires so much more. Individuals with obesity who want the best care should seek out a trained care team that practices comprehensive, personalized, evidence-based obesity medicine and doesn’t promise GLP-1s for all.

Pharmacy Times: For patients who discontinue GLP-1 therapy due to cost or insurance coverage changes, what recommendations can pharmacists offer to maintain weight management progress and cardiovascular risk reduction?

Saunders: Obesity is a chronic disease, so GLP-1 medications need to be taken long-term just like antihypertensives. Before a patient discontinues a GLP-1 medication, they should be encouraged to contact their prescribing clinician to discuss alternative options. This is a scenario we face every day because of insufficient coverage and high cost. If we can’t get our first-choice medication, we always have back-up plans.