Medical weight loss

What we check

• Your full medical history, with particular attention to thyroid cancer in the family, pancreatitis, gallbladder disease, gastrointestinal conditions and any history of an eating disorder.
• Every medication and supplement you take. Several interact with how a GLP-1 affects you, and diabetes medication in particular usually needs adjusting.
• Whether you are pregnant, breastfeeding or planning a pregnancy.
• What you have already tried, including any GLP-1, at what dose, and how you tolerated it.

Baseline labs

• Comprehensive metabolic panel, including kidney and liver function.
• A1c, which tells us where glucose has been sitting over months rather than on the day.
• A lipid panel.
• Thyroid function.
• Anything else your history calls for.

Bring to your first visit

• A list of your current medications and doses.
• Any recent lab work you already have.
• Your insurance information, so coverage can be checked before you are surprised at the pharmacy.

Dosing starts low deliberately. The starting dose is not a treatment dose, it is there to let your body adjust, and going up faster than the schedule is the usual reason people have a bad time.

What is common

• Nausea, usually strongest in the day or two after a dose and after each increase.
• Reflux and early fullness. Food sits longer than you are used to.
• Constipation. Very common, and easier to prevent than to fix. Water and fiber from the start.
• Fatigue, often tied to eating far less than you did.

What helps

• Smaller meals, eaten slowly, and stopping at the first sign of fullness rather than pushing through it.
• Keeping fluid up. Dehydration makes almost every side effect worse.
• Staying at a dose longer rather than moving up on schedule if you are struggling. Tell us instead of quietly enduring it.

Tell us if

• You cannot keep fluids down.
• Nausea is not settling between doses.
• You are losing weight faster than about one to two percent of your body weight a week.

Appetite falls, which is the point. What you do with the smaller amount you eat is what determines how you feel and what you lose.

• Protein first at every meal. When total intake drops, protein is the thing most likely to fall short.
• Eat slowly and stop when full. Fullness arrives sooner and more suddenly than you are used to, and eating past it is what causes most of the nausea people report.
• Fluid throughout the day. Thirst signals get quieter along with hunger, and dehydration is behind a lot of the fatigue, headaches and constipation.
• Fiber daily. Constipation is easier to prevent than to treat.
• Go easy on very fatty and very large meals, particularly in the first day or two after a dose. They sit heavily.
• Alcohol hits differently. Less food, slower stomach emptying, and many people find their tolerance has changed.

Fat is lost from the face along with everywhere else. Nobody chooses where it comes off, and the face is where it shows first.

• What changes: temples flatten, cheeks lose fullness, the midface loses the support the skin above was resting on, and the lower face can start to look heavier by comparison.
• When: usually once meaningful weight has come off, so months rather than weeks.
• It is assessed at your follow-up visits rather than left for you to notice in a photograph.
• If it needs treating, the useful approach is rebuilding structure rather than filling the hollow that shows. Collagen stimulation works on the underlying support, and it takes months, which is why raising it early matters.
• Timing matters. Treating while weight is still changing quickly means treating a moving target. When in the course of your weight loss to do anything is part of the conversation.

• These medications work while they are taken. Appetite returns when they stop, and for most people so does weight. Plan for this rather than being surprised by it.
• Labs are repeated on a schedule. The point is whether the metabolic picture is improving, not only what the scale says.
• Maintenance dosing is a real option once you reach a weight you want to hold, and it is not always the highest dose.
• If you need to pause, for surgery, for pregnancy planning, or for cost, tell us and we will plan it. Stopping abruptly and restarting at your old dose is not safe.
• Before any procedure requiring sedation or general anesthesia, tell the anesthesia team you are on a GLP-1. These medications slow stomach emptying and that changes fasting instructions.