SUN-725 - Rational Use of GLP-1 Receptor Agonists and Dual Agonists in Obesity (India): A Delphi Consensus

Background: GLP-1 receptor agonists and dual agonists, produce substantial weight loss along with cardiovascular and metabolic benefits in people with obesity (PwO). With semaglutide and tirzepatide now available in India, there is a clear need for guidance on their rational clinical use. However, Indian obesity practice is challenged by heterogeneity of phenotypes, comorbidities, safety considerations, uncertainty regarding long-term treatment strategies, and affordability constraints. We sought expert Delphi consensus to guide rational use of these agents for obesity in India.

Methods: A modified Delphi process with 28 panel members included two anonymous survey rounds and three structured discussion rounds. Forty-nine statements across six sections clinical efficacy (n=10), cardiometabolic/organ comorbidities (n=10), safety and tolerability (n=12), dosing and treatment course (n=7), special populations (n=6), and other considerations (n=4) were rated on a 5-point Likert scale. Consensus was predefined as ≥66% agreement (positive) or ≥66% disagreement (negative). Positive consensus was achieved for all statements (49/49).

Results: The panel endorsed ≥5% weight loss as the minimum meaningful response, with 10–15% targets for higher-risk patients. Weight regain after discontinuation was considered common, supporting individualized maintenance or longer-term strategies in relapse-prone patients. Consensus covered GI adverse-effect mitigation (dietary measures, slower titration, dose holds/down-titration, and symptom-directed therapy), ophthalmic risk counselling with prompt evaluation of new visual symptoms, precautions for gallbladder disease and pancreatitis, mental-health screening/monitoring, and thyroid-related contraindications. Dosing statements emphasized start-low go-slow titration to the highest tolerated dose, planned tapering when stopping, criteria for re-initiation in prior responders, and structured lifestyle prescriptions (protein-adequate diet and resistance training to preserve lean mass). Guidance was tailored for non-diabetic obesity, adolescents/young adults, older adults with frailty/sarcopenia, and suspected monogenic/early-onset obesity, with cost-sensitive prioritization for high-risk patients.

Conclusions: This Delphi consensus delivers an India-context framework for rational use of GLP-1 receptor agonists and dual agonists in PwO, integrating efficacy, safety, dosing, co-morbidities and health-system realities

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