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Dr Ian Neeland Explores Semaglutide Alternatives and Strategies in Cases of Nonresponse


Aside from semaglutide, alternate weight loss routes include other anti-obesity medications, chronic weight management programs, or obesity medicine specialists, said Ian Neeland, MD.

According to Ian Neeland, MD, both patients and physicians should recognize the importance of comprehensive weight management beyond medication, as the conversation with patients not responding to semaglutide may involve dose escalation, a potential medication switch, or modifying behavior and lifestyle patterns depending on individual context and reasons for lack of success.

Neeland serves as director of cardiovascular prevention and codirector of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease at the University Hospitals Harrington Heart & Vascular Institute, as well as associate professor of medicine at Case Western Reserve University School of Medicine.


For patients with obesity who are looking to lose weight and feel like they’ve tried everything, what would you advise them to do if you could not ensure they would have consistent access to semaglutide?

There are other anti-obesity medications out there on the market. Semaglutide is not the only one. Certainly, it's very effective and one of the most effective ones, but there are other options. So, I'd encourage patients to speak with their doctor about those options, and if their primary care doctor is not educated about those options or proficient, then a referral to a chronic weight management program or an obesity medicine specialist—for which those are increasing in number of that specialty—is really important. Obesity medicine specialists, beyond just prescribing the drug, can do many, many more things in terms of access to behavior modification plans, access to lifestyle modification counseling, and resources.

So, I would say comprehensive weight management is such an important aspect beyond just the drug itself. I've had plenty of patients who are on the drug and have not lost weight because all the other aspects of weight management have not been utilized by that patient, whereas I've had patients who are very involved and are kind of doing all the lifestyle issues and behavioral changes and being very successful. It's not just the drug that's going to help the patient, it's everything surrounding it. And I would say, even if you can't get semaglutide or a GLP-1 [glucagon-like peptide-1] receptor agonist, there are other anti-obesity medications that are FDA approved and can be effective for weight management for patients.

How does the conversation go with patients who are not responding to semaglutide?

It depends on why we think it may not be working and what we can try to do about it. So, one could be that the dose achieved is not high enough for the patient, so dose escalation may be an option. Another potentiality is that they're just not responsive to this particular brand of medication, so potentially a switch to a different GLP-1 or GIP [glucose-dependent insulinotropic polypeptide] agonist would be appropriate for that. And sometimes, it's kind of modifying the behavior and the diet. Sometimes people will be on the drug but not change their dietary patterns or lifestyle, so that would cause an issue in terms of the efficacy of weight loss they can achieve.

It really just depends on the context and the reasons why patients may not be as successful on the drugs. But now we have different options, and that's one area where potentially switching from one to a different agent can be beneficial.

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