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Dr. Crotty: 
This is CME on PACE-CME and ReachMD. I'm Dr. Michael Crotty, and here with me today is Dr. Ana Cebrián Cuenca. In this episode, we're going to discuss some practical tips for medication use in patients living with obesity and treating their obesity.  

Ana, have you any practical tips we could give prescribers to improve the patient's adherence, tolerance, and journey on these medications?

Dr. Cebrián:
Yes, Michael, I have four blocks of tips that I can tell you. First of all, take it on the right schedule. Most GLP-1s, as you well know, are weekly injections, so it is very important to pick a consistent day or time to improve adherence. Second, manage nausea and digestive side effects. We must advise our patient to eat small, frequent meals instead of large portions; avoid greasy, spicy, or heavy meals; and stay hydrated and drink slowly. Third, inject correctly for best absorption. We must use subcutaneous injection sites like the abdomen, thigh, or upper arm; rotate sites to prevent irritation; and, if using an autoinjector, make sure the full dose is delivered before removing it. And, four, and I think the most important of the tips, is set realistic expectations. Weight loss varies from person. Patience is key, and it can take weeks to see full benefits. 

Dr. Crotty:
That's fantastic, and all very practical tips. I couldn't agree more with you. I think when we're counseling patients around the use of these medications, it’s not a transactional consultation; it's very much kind of sharing andunderstanding with people what to expect when starting on these medications. 

And I think reinforcing that patterns of eating, food choices, fluids—all of these things are incredibly impactful as far as the side effects that they might experience and also quality of life and health. So prioritizing protein, prioritizing fiber to maintain muscle mass and gut health. And, again, focusing on nutrition, sleep, stress, and all those life interventions that are vital for our health. Rather than focusing on those things for weight loss, we're focusing on them for health because perhaps the medication is managing the underlying biology, and the patterns of eating and the food choices are for quality of life and to reduce side effects.

If you have a patient, and, despite talking about dosing and slow dosing of medication, they're still having significant side effects, what would you consider doing with that patient?

Dr. Cebrián:
I would explain to him very well how to manage foods and how to manage secondary effects. We have, here in the presentation, small tips just to eat small amounts regularly, do slow dose changes to initially tolerate, minimize high-fat and processed foods to reduce the risk of nausea or diarrhea, and prioritize protein, fiber,and water. We also must encourage him just to start with resistance exercises, which reduce also the nausea and improve the weight loss. Of course, eat slowly without distraction; take care with fizzy drinks, alcohol, or spicy foods; and avoid eating late in the evening. 

I think these practical tips are very useful for the patient. And we must address, when we start this medication with the patient, we must explain very well the benefits of the medication but also explain the possible adverse effects they can have and how to manage them. That, I think, is very important in the conversation.

Dr. Crotty:
Yeah, I think that's fantastic. I think for me, also, perhaps reducing the dose of a medication can be helpful or maybe switchingfrom a daily injectable to a weekly injectable, switching to a different medication, or a medication with a different mechanism of action could be helpful for the patient, too. So lots of practical tips there as far as managing health and reducing side effects of these obesity medications. 

We hope those tips are useful, and thank you for joining us today.

Dr. Cebrián:
Thank you very much. I think supporting patients through these steps can improve their experience and long-term success. Thank you.

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