GLP-1 Medications: A Physician's Honest Assessment

Semaglutide and tirzepatide have changed the clinical landscape of obesity medicine. Average weight loss in the pivotal trials, 15% to 21% of body weight, exceeds anything previously achievable without surgery. These are genuinely important medications, and for the right patient they are transformative.

They are also being prescribed, in much of the market, with a haste that concerns me: no metabolic workup, no body-composition tracking, no muscle-preservation strategy, and no plan beyond the next refill.

First, a genuine indication and a real workup. Weight is a symptom; the workup identifies what is driving it, insulin resistance, hypothyroidism, sleep apnea, medication effects, and whether a GLP-1 is the right tool at all.

Second, lean-mass preservation from day one. Rapid weight loss without resistance training and adequate protein predictably sacrifices muscle, the very tissue that protects metabolic health and functional longevity. We track body composition with DEXA, not a bathroom scale.

Third, an exit or maintenance strategy. These medications work while you take them; weight regain after abrupt discontinuation is well documented. A responsible plan addresses dose, duration, tapering, and the behavioral architecture that has to be in place before the dose comes down.

GLP-1 therapy is neither a shortcut nor a scandal; it is a powerful clinical tool that deserves the same rigor as any other serious medication. If a provider will prescribe it after a five-minute questionnaire, that tells you everything about the medicine you would be receiving.