The surge of demand for GLP-1s is likely very common in your practice, and during your follow-up discussions with patients, they may often share their progress on the medication. But some patients may share that they are not hitting weight-loss markers they thought they would. Some may even compare the rate of their weight loss to that of others they know.
As a primary care doctor, responding to this rhetoric is part of your role. Here are some thoughts about messaging and directives to offer patients to get these conversations started and how to respond to feedback.
Share Realistic and Science-Based Outcomes
Taking a proactive approach can help your patients manage their weight-loss expectations.
“It can be difficult for patients when they aren’t losing weight as quickly as they expected while taking a GLP-1 medication,” said Caroline Collins, MD, MBA, DipABIM, chief of concierge medicine at Emory Healthcare and an assistant professor at Emory University School of Medicine, both in Atlanta.
Before starting treatment, Collins recommends having a detailed conversation about what a healthy rate of weight loss looks like and how to set realistic expectations.
“I explain that the typical goal is about 0.5-2 lb per week, and that losing weight more quickly than this can actually be counterproductive,” she said. “The aim is to lose fat tissue, not muscle mass.”
Slow and steady weight loss is generally safer, more sustainable, and better for long-term health, Collins said.
Relay That Outcomes Vary From Patient to Patient
It’s also vital to advise that each patient responds differently to GLP-1 medications.
“Factors such as genetics, metabolism, sleep quality, nutrition, exercise habits, and other medications can all influence results,” said Collins.
Also, patients require different doses of GLP-1 medications to see results, so advise your patients that it may take time to find the right dose for them.
The dose of medication during initiation and titration is essential, said Amin Sabet, MD, an endocrinologist at UMass Memorial Medical Center in Worcester, Massachusetts.
“Some patients may not respond simply because they remain on a dose that is too low,” said Sabet. “Typically, if the medication is well tolerated, I escalate the dose of semaglutide or tirzepatide from the starting dose to the next dose after 4 weeks. If it continues to be tolerated but remains ineffective, I will continue to advance the dose, often at 4-week intervals, until an effective and well-tolerated dose is reached.”
Addressing Patient Concerns
When patients share that their progress doesn’t match what they’ve heard from others, a starting point should be to halt the comparison.
“Comparing their experience to someone else’s can set unrealistic expectations, especially since factors like starting weight, lifestyle, and medical history all play a role,” Collins said.
Pivot the conversation and encourage them to focus on their own markers. Applaud and suggest that they take notice of their own progress, such as better energy, improved sleep, reduced appetite, or more stable blood sugar levels, which can all indicate that their body is responding well, even if the number on the scale changes more slowly, Collins said.
Collins suggests this messaging:
“I can tell this feels discouraging, but you’re still making progress, even if it’s not showing up on the scale yet. Let’s look at the positive changes you’re noticing and continue building the habits that support your body’s response to the medication.”
GLP-1 Is Just Part of Their Weight-Loss Solution
Ultimately, it’s key to advise your patients that GLP-1 medications are a tool.
“Lasting results come from combining the medication with consistent, sustainable lifestyle changes,” said Collins. “By helping patients understand the normal variability in response and dosage needs, focusing on measurable improvements in body composition, and celebrating overall wellness, we can keep them encouraged and engaged in their journey toward better health.”
Ultimately, each patient’s response varies based on dose tolerance, biology, and lifestyle factors. “Setting realistic expectations, monitoring side effects, and supporting sustainable habits help patients achieve meaningful, long-term progress,” said Collins.
Do Some Patients Not Respond to GLP-1s?
Randomized controlled trials of GLP-1-based medications currently on the market have included a group of individuals who did not respond to the drug, defined as less than 5% weight reduction, said Sabet. “It is not rare,” he said.
Sabet cited two examples: In STEP-1, weekly treatment with semaglutide 2.4 mg failed to cause at least 5% weight loss in 14% of patients, and in SURMOUNT-1, tirzepatide 15 mg failed to cause at least 5% weight loss in 9% of individuals.
Furthermore, many different physiologic perturbations can contribute to obesity, said Sabet.
“We think that whether a particular medication is effective in treating obesity depends first and foremost on whether that medication addresses the specific underlying pathophysiology for a given patient,” he said.
He also provided other markers that could affect a patient’s response to GLP-1s.
“In general, we tend to see more weight loss with GLP-1-based medication treatment in patients who are female, those who do not have diabetes, and those who are heavier prior to treatment,” said Sabet. “But we see a broad spectrum of responders ranging from high responders to nonresponders in each of those groups.”
Collins and Sabet reported no disclosures.