These medicines are not for everyone, and part of responsible practice is saying so. They are not used in pregnancy, when planning pregnancy or breastfeeding, and require caution or avoidance with a history of pancreatitis, gallbladder disease, or a personal or family history of medullary thyroid carcinoma (MTC) or MEN2. They are also not appropriate for people at a healthy weight who simply want to drop a few kilograms quickly — a request we see often and frequently decline.
Dr Rachel Ho on patient selection: “Two things make me cautious. First, muscle and facial volume: rapid weight loss strips lean mass and can hollow the face — the gaunt, prematurely-aged look that can follow rapid weight loss. I would rather lose weight a little slower and protect muscle with adequate protein and resistance training than chase a dramatic before-and-after. Second, commitment: I ask patients to treat this as a partnership. If someone wants a prescription with no intention of changing habits or returning for review, I do not think I am helping them, and I will say so.”