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Severe or multi‑system metabolic disease: Significant obesity plus diabetes, MASLD, OSA, or clustered cardiovascular risk factors, where every extra few percentage points of weight and risk reduction matter. Patients who need maximum, not moderate, change: Those aiming for 20%‑plus loss to qualify for surgery, offload joints, or defuse high‑stakes diagnoses in a defined time window. Patients who can handle tighter structure: People willing to tolerate stronger appetite suppression, closer titration, and more lab and nutrition oversight in exchange for bigger, faster shifts in body weight and cardiometabolic markers. Who leans toward semaglutide
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