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White patients are more likely to use online weight-loss clinics, while Black and Hispanic patients more often rely on in-person care, particularly primary care physicians

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Common Side Effects (Experienced by 20%+ of Patients): Gastrointestinal Effects: Nausea: Frequency: 30-44% depending on medication When: Most common during dose increases Duration: Usually peaks within 2-3 days of injection, improves by day 5-6 Timeline: Most severe first 2 months, significantly better by month 3-4 Management: Eat smaller, frequent meals Avoid fatty, greasy, spicy foods Stay hydrated with clear fluids Ginger tea or ginger candies Inject before bed (sleep through worst nausea) Anti-nausea medication if severe (ondansetron, promethazine) Diarrhea: Frequency: 19-30% of patients Usually mild to moderate Often improves after first month Management: Increase fiber gradually Stay hydrated with electrolyte drinks Avoid trigger foods (dairy, caffeine, high-fat) Probiotics may help Anti-diarrheal medication if severe (loperamide) Constipation: Frequency: 10-24% of patients Due to slowed GI transit Management: Increase water intake (64-80 oz daily) Add fiber-rich foods Regular physical activity Stool softeners if needed (docusate) Magnesium supplements Miralax for occasional use Vomiting: Frequency: 9-24% of patients Less common than nausea Usually during dose escalation Management: Same strategies as nausea May need to slow dose escalation Contact provider if cant keep fluids down Abdominal Discomfort: Frequency: 8-20% of patients Usually mild bloating or cramping Related to slowed digestion Management: Smaller portions Avoid gas-producing foods Gentle movement after meals Heat pad for comfort Other Common Side Effects: Fatigue: Frequency: 10-15% of patients Often related to reduced calorie intake Management: Ensure adequate protein (80-100g daily) Dont restrict calories too severely Regular sleep schedule Light exercise can boost energy Headache: Frequency: 10-14% of patients Usually mild and temporary Management: Stay hydrated OTC pain relievers (acetaminophen, ibuprofen) Usually resolves after first few weeks Injection Site Reactions: Frequency: 5-10% of patients Mild redness, itching, or swelling Management: Rotate injection sites Allow medication to reach room temperature before injecting Ice area before/after injection Usually resolves within days Serious Side Effects (Rare but Important): Pancreatitis: Risk: Less than 1% of patients Symptoms: Severe abdominal pain radiating to back, nausea, vomiting, fever Action: Stop medication immediately, seek emergency care Outcome: Usually resolves after discontinuation Gallbladder Problems: Risk: 1-2% of patients Cause: Rapid weight loss increases gallstone risk Symptoms: Right upper abdominal pain, nausea, fever Action: Seek medical evaluation May require gallbladder removal in severe cases Kidney Problems: Risk: Rare, usually from severe dehydration Symptoms: Decreased urination, swelling, confusion Prevention: Stay well-hydrated, especially during GI side effects Action: Contact provider if symptoms occur Thyroid Tumors (Black Box Warning): Risk: Seen in animal studies, not confirmed in humans Absolute contraindication: Personal or family history of MTC or MEN 2 Symptoms: Lump in neck, difficulty swallowing, persistent hoarseness Action: Report thyroid symptoms to provider immediately Hypoglycemia (Low Blood Sugar): Risk: Low when GLP-1s used alone Higher risk: When combined with insulin or sulfonylureas Symptoms: Shakiness, sweating, confusion, dizziness, rapid heartbeat Prevention: Diabetes medication doses may need reduction Action: Treat with fast-acting carbs, contact provider about dose adjustments Allergic Reactions: Risk: Very rare Symptoms: Difficulty breathing, facial swelling, severe rash, throat tightness Action: Seek emergency care immediately Contraindication for future use Side Effect Timeline: First Week: Mild nausea possible Reduced appetite begins GI changes starting Injection site learning curve Weeks 2-4: Side effects may intensify Nausea peaks for many GI symptoms most noticeable Fatigue from calorie reduction Weeks 5-8: Dose increase may temporarily worsen side effects But overall improvement from week 4 Body adapting to medication Most patients feeling better Weeks 9-12 and Beyond: Significant improvement in side effects GI symptoms mild or resolved Appetite suppression sustained Most patients tolerating well For many patients, the worst side effects are weeks 2-6, with major improvement after 2 months

These drugs were also found to cause weight loss and have been subsequently used to treat obesity