GLP-1 Medications and the Missing Metabolic Evaluation (Copy)
He's not in crisis yet. But he's close — the fatigue, the blood pressure his wife's been tracking, the chest tightness he's chalked up to stress. In the Roanoke Valley, this conversation happens every day, and almost always later than it should.
Last updated: July, 2026
A lot of patients come to me already curious about GLP-1 medications, and a fair number have already tried one through a telehealth service. What they usually didn't get, before or after that prescription started, was a real metabolic evaluation. I want to walk through what that evaluation should look like, why it matters more than the prescription itself, and how I approach GLP-1 therapy as one tool inside primary care rather than the entire plan.
Why So Many Patients Arrive Skeptical
GLP-1 medications have moved from a niche diabetes treatment to something close to a household term in a remarkably short time. National tracking from Gallup found that 11 percent of U.S. adults reported currently taking a GLP-1 medication for weight loss in 2026, up from just 3 percent in 2024, and awareness of these drugs has climbed to 91 percent of the adult population.
That kind of rapid growth means a lot of prescribing has happened fast, often through platforms built around volume rather than evaluation. I hear the same complaint from new patients again and again: they were prescribed a medication after a short online questionnaire, with no bloodwork, no body composition data, and no real conversation about what was actually driving their metabolic picture. Some felt like they were buying a product, not receiving medical care.
That skepticism is fair. It's also exactly why I don't prescribe a GLP-1 medication as a standalone decision. I've written before about the difference between evidence-based care and the wellness industry shortcuts patients have often already tried, in Weight Loss Myths: What Really Works (and What Doesn't). A prescription mill, however convenient, is still a shortcut.
What Telehealth Prescribing Usually Leaves Out
The concern here isn't about the medication class itself. GLP-1 medications have real, well-documented clinical benefit for appropriate patients. The concern is about what happens around the prescription, or more often, what doesn't happen.
A few patterns show up consistently in the research on this:
Primary care physicians are frequently left out of the loop entirely. One industry analysis found that 61 percent of primary care physicians reported not being informed when their patients received a GLP-1 prescription from a third-party telehealth provider, and 50 percent said this creates real concern about continuity of care.
Discontinuation rates are high. Multiple studies report that somewhere between 37 and 65 percent of patients stop GLP-1 therapy within the first year, often for reasons that have nothing to do with whether the medication was working.
Stopping the medication without a plan tends to reverse the benefit. Clinical trial data from the STEP and SURMOUNT research programs show that patients who discontinue treatment typically regain a substantial share of the weight they lost, sometimes more than half of it within a year.
None of that is a reason to avoid these medications. It's a reason to make sure someone is actually managing the full picture, not just filling a prescription and moving on.
Where GLP-1 Medications Actually Fit in Metabolic Care
As an ABOM-certified physician, I think about GLP-1 therapy the same way I think about any other tool in metabolic medicine: appropriate for some patients, not appropriate for others, and never the entire strategy on its own. The decision to consider a GLP-1 medication should come after a full metabolic evaluation, not before it.
That evaluation is what tells me whether a patient's presentation is being driven primarily by insulin resistance, an underlying thyroid issue, sleep and stress physiology, or a combination of factors that a medication alone won't resolve. It's also what allows me to monitor a patient properly once treatment starts, so any adjustment in the plan is based on actual data rather than guesswork or a fixed script.
I go into more depth on what that evaluation includes in my broader discussion of metabolic health and why it matters more than the number on the scale. The short version: weight is one data point among many, and treating it in isolation misses most of what's actually happening in the body.
What a Real Evaluation Looks Like
Before I consider a GLP-1 medication for any patient, here's what I want in place:
A full metabolic panel, including fasting insulin, not just fasting glucose
Body composition data, since two patients at the same weight can have very different levels of visceral fat and metabolic risk
A cardiovascular risk assessment, given the known relationship between metabolic dysfunction and heart health
A thorough history of prior weight loss attempts, including what's already been tried and why it did or didn't work
A conversation about realistic goals, side effect tolerance, and what ongoing monitoring will look like
A plan for what happens if the medication is paused, adjusted, or stopped, decided in advance rather than after the fact
I intentionally leave dosing and prescribing specifics out of content like this. Those decisions depend entirely on an individual patient's labs, history, and response, and they're made in the exam room, not in a blog post.
What This Looks Like in Practice
I think of a patient who came to me after several months on a GLP-1 medication prescribed through an app. She was losing weight, but she had no idea what her baseline labs looked like before she started, no follow-up bloodwork since, and no plan for what would happen if she wanted to eventually come off the medication.
We ran the full evaluation that should have happened at the start. It gave us a real baseline, and it also gave us a plan: what to monitor, how to recognize whether the medication was actually working the way it should, and what maintaining her progress would require if she chose to stop at some point. The medication hadn't changed. What changed was that someone was finally managing the whole picture around it.
"A prescription without a plan is not a treatment," I tell patients. "It's a guess with a good marketing budget." That's the distinction I try to make clear every time this conversation comes up.
The Question Worth Asking Before You Start
If you're curious about GLP-1 medications, or you've already tried one without much oversight, the question worth asking isn't "which medication should I take." It's "who is actually managing my metabolic health, and what does the full data say." A concierge primary care relationship is built to answer that question properly, with the time a real evaluation requires. I've written more about what that model actually provides in What Is Concierge Primary Care, and Is It Right for You?
If this describes your situation, take a look at our Membership & Services page, or schedule a Meet + Greet to talk through whether a full metabolic evaluation, with or without medication, makes sense for you.
