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Who responds best to CagriSema Ideal candidates: Significant obesity (BMI 30-40+) Previously plateaued on GLP-1s alone Need maximum weight loss Good GI tolerability Metabolic syndrome or diabetes Commitment to long-term use Excellent responders: Higher baseline weight (more to lose) Good adherence to protocol Combine with diet/exercise Younger patients (better metabolism) No significant medication interactions May respond less optimally: Very low starting weight (BMI 30%): Nausea (most common) Decreased appetite (intended effect) Constipation Fatigue (especially first months) Common (10-30%): Vomiting (if nausea not managed) Diarrhea (alternating with constipation) Abdominal pain/discomfort Headache Dizziness Less common ( 40 with comorbidities Insurance covers surgery Want permanent solution Don't want ongoing injections Sourcing cagrilintide and semaglutide Obtaining these peptides requires understanding current availability