Key Clinical Summary: Designing Structured Follow-up Workflows

This is a micro-learning module summary of Dr Sue Pedersen’s session which you can find here. Before participating, please read our CME and disclosure information which can be found here.

Acknowledgment: This activity is supported by an independent medical educational grant from Lilly. This online education program has been designed for healthcare professionals globally.

Introduction

Effective obesity management requires not only initiating evidence-based treatment but sustaining it over the long term. This segment focuses on how to structure follow-up in a way that protects weight-loss progress, preserves health benefits, and keeps patients engaged.

How Long Should Pharmacotherapy Continue?

The strongest evidence supports continuing obesity pharmacotherapy indefinitely, as long as it remains effective and the patient finds it acceptable. Weight commonly returns when treatment is stopped, and patients may lose associated health gains.

Patients should always remain in control of their care, but they also need a clear understanding of why long-term treatment matters: obesity is a chronic, relapsing disease, and sustained therapy helps maintain both weight loss and cardiometabolic improvement.

Case Study: Samir

Samir, a 52-year-old mechanic with a history of myocardial infarction, obesity, hypertension, and multiple vascular risk factors, began semaglutide 2.4 mg six months ago. His BMI reduced from 33 to 29 with ~10% weight loss. Despite feeling well, he now wonders whether he can stop treatment due to cost. His cardiovascular (CV) profile has improved, and semaglutide provides an additional 20% reduction in CV events in people with obesity and CV disease. This is central to the follow-up conversation.

What Happens If Pharmacotherapy Is Stopped?

Data from STEP-4 (semaglutide) and SURMOUNT-4 (tirzepatide) are unequivocal:

• Continuing treatment leads to continued or sustained weight loss.
• Switching to placebo results in rapid and progressive weight regain, with accompanying loss of health benefits.

This pattern has been consistent across all obesity pharmacotherapy trials.

Stopping treatment also risks cardiometabolic regression, including worsening glycemia, blood pressure, and lipid control.

Avoiding Yo-Yo Weight Cycles

Weight cycling (“yo-yoing”) is associated with poor health outcomes including:

• Adverse cardiometabolic changes
• Higher risk of type 2 diabetes
• Higher risk of CV events and mortality

A sustainable plan requires:

• Early, effective intervention
• Long-term pharmacotherapy paired with consistent lifestyle support
• Ongoing follow-up to reinforce adherence and troubleshoot challenges

Evidence for Sustained Benefit

Long-term data from SELECT show that weight loss with semaglutide is maintained for at least four years, even though this was not a dedicated weight-loss trial.

Real-world data in type 2 diabetes similarly show:

• Longer duration of GLP-1 receptor agonist treatment is associated with lower CV event rates.
• Stopping GLP-1 therapy significantly increases CV risk, independent of other factors.

These findings reinforce counseling Samir to continue therapy, especially given his CV history.

Guideline Recommendations

Obesity Canada guidelines advise that obesity pharmacotherapy should be used long-term when effective, alongside behavior change strategies to avoid weight regain and regression of health benefits achieved with pharmacotherapy.

Medications with strong evidence for preventing weight regain include:

• Semaglutide 2.4 mg
• Tirzepatide 10–15 mg
• Orlistat (for selected patients)

Additionally, liraglutide, orlistat and tirzepatide also have evidence for maintaining weight loss following lifestyle changes.

Where Might Samir Be Lost to Follow-Up?

To protect continuity of care, clinicians should watch for points where the patient may disengage:

• Transition from cardiologist back to family physician
• Feeling unsupported or unsure about long-term treatment expectations
• Early signs of weight regain that may undermine confidence
• Financial or access-related barriers

These moments are opportunities for targeted support.

What Does Ongoing Care Look Like?

There is no single "gold standard", follow-up must be tailored to setting, capacity, and patient preference. However, key principles include:

• More frequent follow-up improves adherence and long-term success
• Proactive outreach when patients miss appointments or medication renewals appear without visits
• Early intervention at any sign of waning motivation or rising weight

The goal is to maintain an open, supportive channel that keeps patients engaged in treatment.

Conclusion

Effective obesity care demands a commitment to evidence-based treatment that doesn’t stop once weight loss is achieved. The goal is broader than the number on the scale: it’s about improving metabolic, mechanical, mental, and quality-of-life outcomes that truly matter to the patient. Sustained success depends on ongoing follow-up and meaningful support, ensuring patients remain engaged, confident, and empowered throughout their long-term treatment journey.