My wife is a doctor specialized in obesity management and works in a hospital daily where patients come in with BMIs well over 40. Besides semaglutide, which isn’t availble in this part of the world yet, they also prescribe liraglutide.

I’d say that if someone is extremely obese, it’s unlikely they’ll be able to bring their weight down just through medication and counseling because most people lack the motivation or self-awareness to turn it into a lifestyle, which is KEY to keeping the weight off. In most cases, bariatric surgery would be their only option. It’s also very easy for folks to fall off the bandwagon while going on a weight loss journey - I’ve always had periods of being overweight to the point of obese since I was young and it’s been a yo-yo of getting fit and then slowly slumping back into being unhealthy over the years until I had the mental shift that it’s a lifestyle change. Getting people to this state through telemedicine may be difficult. It’s a hard space to be in but definitely one that will have an unending supply of patients due to the way the world eats these days. Let me know if I can help in any way. Best of luck!