A 46-year-old man is seen in a family medicine clinic for weight management. He has completed 6 months of a structured lifestyle program (calorie-restricted diet, regular physical activity and behavioural therapy) and lost only 2 kg. His weight is 118 kg and height is 1.78 m (BMI 37 kg/m2). He has hypertension treated with ramipril and dyslipidemia treated with atorvastatin. HbA1c is 5.6% (4.0-6.0) and TSH is normal. He has no personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, no history of pancreatitis or gallstones, and does not take insulin. He wants the most effective option available and is willing to use injections.
| Heart rate | 78/min |
| Respiratory rate | 14/min |
| Temperature | 36.8 °C |
| O2 saturation | 98%, room air |
| Blood pressure | 138/84 mm Hg |
Question 1 of 6
Which one of the following is the most appropriate pharmacotherapy to add to continued lifestyle intervention?
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