Getting ready for expanded access to obesity medications

You've seen her—the 52-year-old woman who picks up her prescription near closing time, hoping the pharmacy is quiet. She's an appropriate candidate—her prescriber followed the evidence — but she's carrying shame that we might unintentionally reinforce.Or the 37-year-old man who jokes, "So I'm starting the “celebrity” drug — taking the easy way out." He's watching your face to see if you'll laugh along or reassure him. Even a polite chuckle can confirm the stigma he expects. Those few seconds at the counter set the tone for whether he feels understood as he starts this therapy.The landscape for incretin-based obesity medications in Canada is changing quickly. With patent protections for semaglutide recently ending, generic versions are expected to enter the market over the coming year, which could improve affordability and access. Use of dual incretin therapies such as tirzepatide is rising, backed by growing evidence for cardiometabolic benefits and potential improvements in conditions like heart failure, sleep apnea and metabolic liver disease. More Canadians living with obesity will soon have greater access to these therapies.That should be good news.Adherence and the role of trustReal-world persistence with incretin-based therapies is challenging. In a large cohort study, about two-third of patients without diabetes stopped treatment within a year. Early drop-off also happens - in one real world study about 3% stopped within the first month due to side effects.Cost and tolerability matter, but quieter barriers are often relational. When people sense hesitation or judgment from their health care providers, they stop asking questions. They don't mention the nausea that derailed their titration. Or they just quietly stop the medication. We often frame adherence as a "patient problem" —but how we educate, normalize and support patients matters just as much.When we frame these medications as tools for metabolic health rather than shortcuts to weigh loss, patients engage differently—and are more likely to continue treatment.How our words shape trustReal example: A patient asks about coverage. Your assistant runs it through and says across the counter, "Yeah, it's not covered—maybe there's a manufacturer card online," then calls you over.What they might hear: Maybe I don't need this badly enough.Better: "This is a chronic condition, so let's check your plan. There are some manufacturer programs, and lower-cost options may be coming soon. We'll try to find something sustainable."The frame mattersObesity is a chronic disease driven by appetite dysregulation, not willpower. We use person-first language for diabetes and hypertension. And for mental health and substance use disorder. We can do the same here. Consider these approaches to the conversation Starting therapy: "This medications works on appetite regulation in your brain. Early nausea is common — there are ways to manage it. Call anytime if you need help with titration. Cost concerns: "Let's see what's covered today. There are some manufacturer programs now, and generics are coming soon. We’ll try to make this sustainable."Slower progress: “The health benefits with these medications often show first in blood sugar, blood pressure, and energy. It's about your overall metabolic health, not just the number on the scale. Guilt or embarrassment: "There’s no need to apologize for treating a medical condition. Medication for chronic disease is smart, not 'cheating.'"Listening between the linesPatients don't always say what they mean:"My friend lost more weight" can mean I’m worried I’m failing."I probably don't need it that badly" could mean I don't feel like I deserve help.Those early pickup conversations — initiation, titration, first renewals — are perfect moments to reduce stigma and build trust. Access is expanding —are we ready?As incretin-based and dual-incretin therapies become more accessible—generics coming, formularies expanding, evidence strengthening—more Canadians will be prescribed these medications.That creates real opportunity and responsibility. Pharmacists will increasingly be relied upon for education, management, and follow-up as obesity pharmacotherapy moves further into primary care. Every interaction is a chance to normalize treatment through person-centred communication — listening first, asking open questions, tailoring advice to what matters most to that patient.Evidence and access create the opening. How we communicate shapes the path forward.

Getting ready for expanded access to obesity medications

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