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Caution is warranted when: Weight is stable but distress is high Fatigue, hormonal symptoms, or GI issues are the main concern Under-eating or nutrient deficiency is already present Muscle and bone mass are low, or frailty risk is high There is sarcopenia risk, especially in older adults BMI is in the normal range and use would be off-label without a clear medical rationale In these cases, building nutrition adequacy and strength first may improve symptoms and long-term health more than appetite suppression

Its going to be very hard for people not to accept the value of these drugs, particularly tirzepatide and future dual agonists, if we show they reduce cardiovascular morbidity and mortality, says Dr