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Valid reasons include: Inadequate weight loss on Wegovy despite 6+ months at 2.4 mg Insurance coverage change (Zepbound covered, Wegovy not) Persistent side effects on semaglutide that may improve with tirzepatide's different receptor profile Patient preference for potentially greater weight loss Invalid or questionable reasons: Switching after only 8 to 12 weeks on Wegovy (insufficient time to assess response) Switching due to transient nausea during titration (both medications cause nausea) Switching based on anecdotal reports without clinical rationale Step 2: Choose washout vs overlap strategy