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Personal or family history of medullary thyroid carcinoma Multiple endocrine neoplasia syndrome type 2 (MEN2) Personal history of pancreatitis Pregnancy or breastfeeding Severe gastrointestinal disease (gastroparesis, active IBD) Chronic kidney disease (increased dehydration risk) Pre-existing cardiac arrhythmia Active gallbladder disease or history of cholelithiasis Concurrent use of other glucose-lowering medications Severe hepatic impairment The thyroid contraindication deserves more explanation than it usually gets

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Over months, significant weight loss supports metabolic health: better blood pressure, improved insulin sensitivity, and smaller waist measurements for many patients