Individualizing Obesity Treatment in Primary Care: An Expert Discussion

The Endocrine Society's recent scientific statement identified differences in treatment response and individualized treatment targets as central research priorities in the new era of obesity medicines.¹

Daniel J. Drucker, MD, a professor in the Department of Medicine at the University of Toronto and corresponding author of the statement, told Patient Care Online that prescribing semaglutide or tirzepatide is only one part of obesity care. In the video above, he described an individualized visit that begins with a clinical history, physical examination, existing complications, treatment expectations, and the patient's own goals. In the video above, he also urged clinicians to consider nutrition, activity, psychological distress, blood pressure, kidney function, cardiovascular health, and lipids alongside medication choice.

His answer connects 2 questions: how to tailor a treatment plan and how to judge whether it is working. A young adult with obesity and few established complications may primarily seek weight reduction. A patient whose symptoms are dominated by osteoarthritis, sleep apnea, or cardiovascular disease may need additional outcomes tracked. Drucker also raised reproductive goals as an example of why the same percentage weight change cannot serve as the only measure for every person. These examples are clinical scenarios; the choice of drug and its labeled indication still depend on the individual patient's circumstances, according to Drucker.

The evidence for condition-specific outcomes varies by drug and population. In the 68-week STEP 9 trial, 407 adults with obesity and symptomatic knee osteoarthritis were randomized to semaglutide 2.4 mg or placebo, both with lifestyle counseling. Mean body weight fell 13.7% versus 3.2%, and the WOMAC pain score improved by 41.7 compared to 27.5 points, respectively.² That study supports assessing pain and physical function in a patient with knee osteoarthritis; it does not mean every obesity medicine has demonstrated the same effect.

Relevant disclosures for Drucker include Amgen, Alnylam, AstraZeneca Inc, Crinetics, Eli Lilly, General Medicines Inc, Kallyope, Metsera, Pfizer Inc, Protagonist Therapeutics Inc, Roche, and Sanofi and speaking fees from Novo Nordisk Inc.

References

1. Jastreboff AM, Drucker DJ, Ard JD, et al. Obesity science, research gaps, and opportunities in the new era of obesity medicines: an Endocrine Society scientific statement. Endocr Rev. Published online September 9, 2026. doi:10.1210/endrev/bnag025
2. Bliddal H, et al. Once-weekly semaglutide in persons with obesity and knee osteoarthritis. N Engl J Med. 2024;391:1573-1583. doi:10.1056/NEJMoa2403664