GLP-1 Therapy: A Clinical Practice Guide

The GLP-1 Opportunity

GLP-1 receptor agonists are the most in-demand category in weight management medicine. Patient interest is unprecedented, and the market is projected to reach $100 billion by 2030. Practices that offer GLP-1 therapy are seeing dramatic patient volume increases and significant revenue growth.

Patient Selection Criteria

Proper patient selection is critical for outcomes, safety, and practice reputation. Not every patient requesting GLP-1 therapy is an appropriate candidate.

• ✓BMI ≥ 30 (obese) or BMI ≥ 27 with at least one weight-related comorbidity
• ✓Failed lifestyle intervention alone — diet and exercise attempts documented
• ✓No contraindications: personal/family history of MTC, MEN2, pancreatitis history
• ✓Thyroid screening: TSH and calcitonin baseline recommended
• ✓Metabolic panel baseline: HbA1c, fasting insulin, lipids, liver enzymes
• ✓Psychiatric screening: history of eating disorders, suicidal ideation

Dosing Protocols

Slow titration is key to tolerability. The most common mistake providers make is escalating dose too quickly, leading to severe GI side effects and patient dropout.

• ✓Semaglutide: Start 0.25mg weekly x4 weeks → 0.5mg x4 → 1.0mg x4 → 1.7mg → 2.4mg
• ✓Tirzepatide: Start 2.5mg weekly x4 weeks → 5mg x4 → 7.5mg x4 → 10mg → 12.5mg → 15mg
• ✓Extend titration if GI symptoms are significant — patient tolerance over speed
• ✓Consider lower maintenance doses once target weight is achieved

Managing Side Effects

GI side effects (nausea, constipation, diarrhea) are the primary reason patients discontinue. Proactive management includes dietary guidance, anti-nausea strategies, and proper expectation setting during the initial consultation.

• ✓Nausea: eat smaller meals, avoid fatty/fried foods, ginger supplements, ondansetron PRN
• ✓Constipation: increase fiber, magnesium citrate, adequate hydration
• ✓Ensure adequate protein intake (0.7-1g/lb) to minimize muscle loss during rapid weight loss
• ✓Monitor for gallbladder issues — ursodiol prophylaxis for rapid weight loss

Combining GLP-1 With Peptide Therapy

GLP-1 therapy creates an entry point for broader optimization. Patients losing weight on semaglutide often become interested in body composition optimization (GH peptides), skin quality during weight loss (GHK-Cu), metabolic support, and hormone optimization. GLP-1 can be the gateway to a comprehensive wellness practice.

Documentation & Compliance

Thorough documentation protects your practice. Record BMI, comorbidities, failed interventions, informed consent, side effect counseling, and ongoing monitoring. AI tools can generate SOAP notes and clinical documentation that meet these requirements efficiently.