• Afton M Koball, Gretchen E Ames, Karen B Grothe, Matthew M Clark, Maria L Collazo-Clavell, and Enrique F Elli.
• Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN. Electronic address: koball.afton@mayo.edu.
• Mayo Clin. Proc. 2024 Dec 4.

AbstractIncretin-based obesity management medications (OMMs) fill a treatment gap in a stepped-care model between lifestyle change alone and metabolic bariatric surgery, resulting in weight loss of 15% to 20% of body weight. Public interest in and demand for OMMs has recently increased dramatically. Unfortunately, cost and access to OMMs remain a significant barrier for many patients. Although these medications have the potential to produce large weight loss outcomes, many unanswered questions remain regarding informed choice and optimization of obesity care protocols, especially for patients with a body mass index of 35 kg/m2 or higher who may be considering various intervention options such as lifestyle changes, OMMs, endoscopic weight loss procedures, and/or metabolic bariatric surgery. When considering strategies to aid patients in decision making about obesity treatment, several considerations warrant discussion because patients may have unrealistic perceptions about risk vs efficacy and may hold numerous misconceptions about long-term behavior change and outcomes. This article outlines considerations for informed obesity treatment decision making and reviews aspects of obesity treatment specific to OMMs, including adverse effects, patient expectations for treatment outcome, equitable access to care, the impact of weight bias on patient care, the risk of weight recurrence, and the need for long-term multicomponent treatment to achieve weight loss and weight maintenance.Copyright © 2024 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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