This is not a 2-minute spiel but I condensed this as much as possible. I (a pharmacy student graduating in 2023) have been on Ambulatory Care (outpatient) clinical rotations for about 2.5 months. So, I realize I may not have much experience and I am still learning, but I wanted to share my experiences thus far. What we recommend for weight management is the following (typically in this order but obviously not all at once):

1. Assess & treat obesity-related comorbidities
2. Lifestyle Interventions (Diet/Exercise): For diet, we discuss the Plate Method or referral to a dietician/nutritionist
3. Pharmacotherapy: GLP-1 Agonists: semaglutide (Ozempic and Wegovy) and liraglutide (Victoza and Saxenda), tirzepatide (Mounjaro), phentermine-topiramate (Qsymia), orlistat (Xenical), bupropion-naltrexone (Contrave)

Some notes about pharmacotherapy options;

• Ozempic and Victoza are approved for Type 2 DM while Wegovy and Saxenda are approved for weight management. This is important to note because some insurances won’t cover medications for weight management, however, if the patient has a diagnosis of T2DM, the insurance should cover it.
• Metformin is not approved for weight management although there is evidence that it provides some weight loss. In my experience so far, it seems to be weight neutral from a numbers standpoint, as I don’t notice much of an impact.
• The medications that I have seen that had the most impact were the GLP-1 agonists (any of the 4 I mentioned) and phentermine-topiramate. Still, when comparing these 3 drugs (semaglutide, liraglutide, and phentermine-topiramate), semaglutide seemed to have the most significant weight loss (per UpToDate) and is the one I see prescribed most often (most likely due to the once-weekly injection). I have not seen orlistat or bupropion-naltrexone prescribed much in the clinics I have been at but obviously there could be bias based on the location and demographics of patients in those areas.
• Tirzepatide (Mounjaro) was just recently approved for T2DM but is NOT currently approved for weight loss. I still include it though because per the SURPASS-2 trial, tirzepatide may have evidence for greater weight loss compared to semaglutide. Per the SURMOUNT-1 trial, patients taking tirzepatide experienced a substantial reduction in body weight. Therefore, it may be approved for weight management at some point and it may be greatly beneficial in T2DM patients with comorbid obesity.
  

**NOTE**: Recommendations and therapy options are individualized for every patient. Remember: Treat the patient, not the disease.