With so many different GLP-1s that are available now, how do you decide which GLP-1 to prescribe for the patient that's sitting in front of you?

It's money, insurance coverage, and expectations.

Obviously, this is not so straightforward, but let's say I have a patient with class II obesity, a BMI over 35 for folks who are listening, and they have obstructive sleep apnea.

They are on CPAP.

So that kind of patients where you need more weight loss, more fat loss, more visceral fat loss, and you want this OSA protection, you go with tirzepatide with i- which is Zepbound or Mounjaro, because Mounjaro has been proven to be excellent for OSA.

If you have a patient who has class I obesity, let's say a BMI of 32 and heart attack, you know, three years ago, then semaglutide would be the way to go.

Why? Because you don't need that much weight loss, and you have strong data and FDA approval for semaglutide to prevent the-- for secondary prevention of cardiovascular disease.

How do you think about dosing the GLP-1s at an individual patient level? Is that something that there, there's a set of guidelines on yet?

Yeah.

Nine years.

Yeah.

So when you and I, we started in this world, we were all about prevention.

But prevention had this very narrow definition of avoiding heart attacks or the incidence of type 2 diabetes.

But in the last 10 years, the whole prevention world, in terms of, like, real outcomes, have expanded outrageously.

Now we have outcomes for liver disease, dementia, even delaying the incidence, I'm not saying preventing because no one can say that, but delaying the incidence of certain autoimmune diseases, you know, even obesity.

But what I'm hearing from you is no, actually, things are starting to change a little bit.