For people with type 2 diabetes and overweight or obesity, weight loss may help them manage their diabetes and improve health outcomes. The Food and Drug Administration (FDA) has approved several weight-loss medications, also known as anti-obesity medications, that may help some people with type 2 diabetes and overweight or obesity manage their weight.

In a recent publication in JAMA Internal Medicine, Dr. Susan Yanovski, Senior Scientific Advisor for Clinical Obesity Research at NIDDK, and Dr. Jack Yanovski, Chief of the Section on Growth and Obesity at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), offer guidance for incorporating FDA-approved weight-loss medications in a primary care setting.

Here are some key points diabetes health care professionals can take away from this publication.

Lifestyle changes are the foundation of weight-loss.

Lifestyle changes—such as improving eating patterns and physical activity levels—are an essential part of weight management. Lifestyle changes are key with or without using other strategies for managing weight, such as weight-loss medications or weight-loss surgery, also called metabolic and bariatric surgery.

To lose weight, people must consume fewer calories than they need to maintain their current weight, and there are various healthy eating patterns that can help them do this. When providing nutrition counseling, tailor recommendations to your patient’s preferences, overall health status, specific nutrition needs, and whether they have other health conditions. If possible, consider referring them to a registered dietitian for additional support.

The Physical Activity Guidelines for Americans (PDF, 14.5 MB)  recommends getting 150 minutes of moderate-intensity physical activity, such as brisk walking, per week. However, some people may need more physical activity to manage their weight. At first, physical activity goals should be modest. Encourage your patients to start small, and then increase over time.

On their own, lifestyle changes may result in moderate weight loss. In the JAMA Internal Medicine paper, Drs. Yanovski noted that on average, people undergoing intensive lifestyle intervention may lose 5% to 9% of their body weight within the first year, but not everyone experiences this much weight loss. Of those who lose weight, most regain some or all the weight over time.

Weight-loss medications may help some people with type 2 diabetes manage their weight.

All FDA-approved weight-loss medications have been approved for use in people with type 2 diabetes. However, experts recommend prescribing diabetes medications that also help manage weight, including

• glucagon-like peptide 1 (GLP-1) receptor agonists, semaglutide and liraglutide
• dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist, tirzepatide

According to Dr. S. Yanovski, GLP-1 receptor agonists and dual GIP and GLP-1 receptor agonists may be more effective for losing weight than other weight-loss medications. This class of medicines may also have a positive effect on other obesity-related conditions, such as heart disease, kidney disease, and sleep apnea.

“Anti-obesity medications may play a role in bridging the gap between what we can achieve with lifestyle treatments and more invasive procedures like bariatric surgery,” said Dr. S. Yanovski in a recent interview.

Use shared decision-making when considering weight-loss medications in a treatment plan.

Weight-loss medications may help many people with type 2 diabetes and overweight or obesity lose weight, but they are not right for everyone.

The JAMA Internal Medicine paper describes when to consider weight-loss medications as part of your patient’s treatment plan, including an easy-to-follow flow chart for additional guidance. “We wanted to provide an actionable roadmap to primary care physicians for how they can help their patients and integrate obesity care into their clinical practice,” said Dr. S. Yanovski.

Before suggesting weight-loss medications, take a thorough medical history, including asking about other health conditions or medications that could contribute to weight gain. Be sure to also review the FDA prescribing information for warnings, drug interactions, or other special precautions before recommending a specific medication.

Talk with your patient about their personal preferences as well as any barriers to taking the medication, such as access and cost. Use shared decision-making to see whether adding weight-loss medications or other treatments such as bariatric surgery to lifestyle changes may be helpful.

During treatment, be sure to monitor how well your patient is tolerating the medication and watch for unwanted side effects. When starting weight-loss medications, other medications—such as blood pressure medications, sulfonylureas, or insulin—often need to be adjusted to lower the risk of possible complications such as low blood pressure or low blood glucose levels.

To avoid weight regain, people may need to continue taking weight-loss medications, even if they reach their weight loss goals. You may need to help your patients consider other weight-loss options if the medication is stopped because of side effects or other factors. More research is needed to develop strategies that may help people maintain their lost weight.

Do you incorporate weight-loss medications in your diabetes care practice? Share in the comments below.