Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (Mounjaro, Zepbound) are not the latest weight-loss fad. They are GLP-1 receptor agonists with multi-year clinical trial data documenting meaningful, sustained body composition changes in adults with appropriate clinical indications. They are also the easiest way for a chain clinic to extract a monthly subscription from someone who would do better on a different protocol.
How they work
GLP-1 agonists mimic a gut peptide that signals satiety and slows gastric emptying. In practical terms: you feel full faster, you stay full longer, and the food noise that drives most casual overeating quiets down. The medications also have effects on insulin sensitivity and fasting glucose that are independent of weight change.
Tirzepatide additionally agonizes the GIP receptor, which appears to enhance the metabolic effect. In trials it produces larger weight loss than semaglutide on average.
Who they are for
- Adults with a clinical indication for medical weight loss — typically a BMI threshold plus a co-morbidity, or an obesity diagnosis.
- Patients with metabolic syndrome, type 2 diabetes, or pre-diabetes who would benefit from improved glycemic control regardless of weight.
- Patients on a GLP-1 elsewhere who want a credentialed clinician on the chart for monitoring and side-effect management.
Who they are not for
- Adults with a personal or family history of medullary thyroid cancer or MEN 2.
- Anyone with a history of pancreatitis (relative contraindication — requires careful evaluation).
- Pregnancy, planned pregnancy in the near term, or breastfeeding.
- Patients seeking rapid loss without lab work, baseline assessment, or follow-up.
What the chain clinics get wrong
The biggest issue is titration. GLP-1s should be started low and increased slowly — usually one dose increase every four weeks. Chain clinics often move faster to lock in subscription billing at higher doses, which drives unnecessary side effects (nausea, vomiting, slowed gastric emptying) that patients then quit over.
The second issue is the cliff. Patients who lose meaningful weight on a GLP-1 and then stop without a transition plan tend to regain. A reasonable protocol includes either a maintenance dose, a taper, or a real conversation about sustainable habits. Most chain clinics do not have that conversation.
What we do differently
At Stilwell we start with metabolic labs (fasting glucose, fasting insulin, HbA1c, lipid panel, hs-CRP). We confirm the indication. We start at the lowest effective dose. We titrate slowly. We monitor side effects and adjust. We have the off-ramp conversation early.
For many patients this is the protocol that finally works. For some, the clinical reality is that another tool (sleep correction, thyroid optimization, training load adjustment, addressing an unrecognized eating disorder) is a better starting place. We tell you which one fits.
A note on cost
Brand-name GLP-1s are expensive. Insurance coverage varies. Compounded options exist and can be appropriate when sourced from an FDA-registered pharmacy. We are transparent about pricing before you start.