College students may plan an appointment during winter break and inquire about GLP-1 medications. What should a primary care physician (PCP) do if such a patient hasn’t had a recent physical or video visit? Keep these points in mind when evaluating a young adult’s medical status and use of GLP-1 medications.

Explain the Realities of the Medication

Some college students may be drawn to GLP-1s because of social media trends or rapid weight-loss results. During your discussions, share realistic information with these young adults.

“It’s helpful to start by setting expectations,” said Meghana Rani Anugu, MD, assistant professor of medicine, Division of General Internal Medicine, Emory University School of Medicine, and a PCP at the Emory Clinic, Atlanta. Delve a deeper to learn what is motivating the interest in trying this class of medications.

“Inquire if people have qualitative or quantitative goals,” Anugu said. “I try to help people move away from quantitative goals and reflect on more qualitative goals. I do not care about weight; I care about decreasing one’s fatty mass and increasing the amount and quality of muscle mass.”

Is the Student a Suitable Candidate for a GLP-1?

Anugu provided the following guidelines for your assessment protocol.

Take time to do a comprehensive weight history. Discuss health history with the patient and check the chart.

Understand an individual’s weight journey. Determine if there arechanges in weight that correlate to life events or initiation of medications.

Consider screening for monogenic causes of obesity. Again, health history is important to look back on.

Screen for disordered eating. Consider binge eating, restrictive eating patterns. “This is particularly important amongst college age patients,” added Anugu.

Track gastrointestinal (GI) issues. Understand if individuals currently have gastroesophageal reflux disease or constipation that may increase the risk for side effects, she said.

Set Up Proper Follow-Up for Case Management

Since college students may not be able to see PCPs for monthly or bi-monthly follow-ups, telemedicine could work. But be sure to check your specific state regulations.

“On that note, I think prescribers need to come up with a general framework on how often to see patients for chronic weight management,” Angui said. “I would strongly recommend every 4-8-week video visit to check in regarding side effect profile, clinical effect, titration, optimizing nutrition and physical activity, etc.”

The college scenario presents unique issues to consider, and each college student is different regarding their activities, living situation and health habits, etc.

“It is tough to predict how people will respond to this class of medications,” she Anugu. “Some patients are ‘super responders.’” 

She instructs her own patients to decrease food or meal portion size by 50%-75% and recommends eating slowly and mindfully to mitigate side effects of nausea and acid reflux. “Individuals generally eat significantly less on these medications, so it’s important to be intentional with what you are eating,” she added. “Eat your protein-rich, fiber-rich items on your plate first, you will not have room for much else. Anecdotally people have more GI side effects when consuming alcohol or fatty/fried foods, so I would avoid when starting the medication and reintroduce slowly as tolerated.”

What Are Short-Term Steps for College Students?

Be straightforward when offering directives with college students who plan to begin taking GLP-1s. Suggest more walking, mindful eating, avoid late-night eating that can cause acid reflux, and try to increase weight training in the gym, said Sriram Machineni, MD, director, Fleischer Institute Medical Weight Center, Montefiore Einstein in Bronx, New York.

The challenge of food costs is on the minds of many, not just college students.

“Ask them to focus on getting protein in the form of eggs, Greek yogurt, roast chicken, turkey or beans,” said Machineni. They can also rely on frozen vegetables that can be sauteed or steamed for sides and starches including whole grain pasta, whole grain bread or brown rice, he said.

Another tip: encourage meal prepping on the weekend that can save them money, and so they don’t have to order greasy take-out. Short-term tweaks can lead to long-term change. “It’s essential to take a long-term approach for weight management and emphasize strategies to get adequate nutrition when erratic eating patterns are a norm,” Machineni said.

Anugu reported no disclosures. Machineni consulted for Eli Lilly, Novo-Nordisk, Pfizer, AbbVie, Rhythm Pharmaceuticals, Neurogastrx, and served on scientific advisory boards of Eli Lilly, Neurogastrx, Rhythm Pharmaceuticals, and AbbVie.