Ready to Prescribe a GLP-1 Medication? Please Dive Deep Into the Patient's History First, Advises John Bonnet, MD,

As the use of glucagon-like peptide-1 receptor agonists (GLP-1s) for management of overweight and obesity continues to grow, an increasingly bright light is revealing that pharmacotherapy alone is not sufficient to achieve long-term weight loss success. The incretin-based antiobesity medications don't work in a vacuum and without the support of individualized and intentional lifestyle strategies, patients may not realize the full benefits of treatment, could experience avoidable adverse effects, or even abandon treatment altogether.

Jonathan Bonnet, MD, MPH, is coauthor of a new joint advisory titled “Nutritional Priorities to Support GLP-1 Therapy for Obesity,” a collaboration among members of the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. The multidisciplinary guidance for clinicians managing patients on GLP-1s for obesity covers a wide range of therapeutic considerations, including how to manage the ubiquitous GI side effects, how to protect against muscle loss, and the importance of monitored protein intake and resistance training as standard parts of the treatment plan.

In a recent interview with Patient Care©, Bonnet focused specifically on the critical role of a thorough, detailed initial patient history for a successful weight loss outcome. Before even considering a GLP-1 medication prescription, a clinician must understand the patient's history with weight loss and weight gain, dieting, emotional relationship with food, impact of life events on body weight, exercise preferences, and so much more. In the short video above, Bonnet details the elements of a comprehensive history and explains why each is essential to creating an individualized weight management program with the greatest opportunity for success.

Jonathan Bonnet, MD, MPH, is the program director of medical weight loss at the Clinical Resource Hub Weight Management Center at Palo Alto Veteran's Affairs in Palo Alto, California. He is also an associate professor (affiliate) at Stanford University School of Medicine, and serves on the board of the American Board of Lifestyle Medicine. Bonnet is board-certified in family, sports, obesity, and lifestyle medicine.

The following transcript has been lightly edited for style and flow.

Patient Care: So an essential starting point, the advisory says, before you begin prescribing a GLP-1 is to do a really thorough baseline nutritional assessment and screening. Is this an element of clinical management that you think could be overlooked before GLP-1s are started?

Johnathan Bonnet, MD, MPH: It's challenging because I do obesity medicine as a specialty, so I have more time to focus on patients and really dive into their history. But there are really critical pearls that you would want to get, even if you're a primary care doctor. So understanding what a person's weight loss or weight gain journey has been is essential, and includes understanding key triggering events or times in life, or if starting a medication caused a weight change.

If people have a history of eating disorders and honestly, it's not overly difficult to develop a disordered eating pattern if people are trying to do very extreme things. That can lead to nutrient deficiencies. So a lot of it is really understanding the history of the patient and what has gotten them to the state that they are in.

You also have to understand what is driving their obesity? Is it sleep deprivation? Is it overconsumption of ultra-processed foods? Lack of activity? Is it medications? Is there a mental health problem, like underlying depression, anxiety, something else, that’s really driving a lot of the increased food intake and weight gain? And if you don't take the time to understand those things, you're just throwing out a drug that's going to reduce appetite without necessarily addressing some of the foundational problems that could be causing this in the first place.

[Without this history] I think you're also missing the point. We're here to help improve the health of patients, right? And weight is one thing, and obesity is a chronic condition, but there's also so much more wrapped into what good health is. And again, addressing all those other factors, the lifestyle factors, is, I would say, equally important to make sure we get it right.

So again, just to give somebody a drug just because you see an elevated BMI would really be a mistake. There are also some contraindications and things to using the drugs as well. There are a few medication interactions. So you could easily miss those if you're not being thoughtful. All those are part of a comprehensive history you want to take with a patient before you prescribe an antiobesity drug for them.