I’ve had a version of the following conversation a lot lately.
Someone walks in or logs into a virtual visit and says, “I want to be on Ozempic” — or Mounjaro, or Wegovy, or Zepbound. They’ve usually done their homework. They’ve watched the TikToks. A friend has lost 30 pounds. Their cousin in California ordered some online and never had to talk to anyone. They want to know how fast I can write the script.
The honest answer is that some of these patients leave my office or virtual visit that day with a prescription. Some don’t. A few are people I tell, point blank, that a GLP-1 isn’t right for them and I don’t think they should be on one. Almost no one expects that answer. So I want to write down what’s actually going through my head when I see a new weight loss patient, because most of the GLP-1 conversation online has skipped past it entirely.
The short answer
Before I prescribe a GLP-1 receptor agonist for weight loss, I want to know your full medical and family history, the medications you’re already taking, a focused exam, baseline labs, what you’ve tried in the past, your real relationship with food and your body, and your plan for when the medication stops. If any of those raise concerns, I’d rather slow down than move fast.
Who I think shouldn’t be on a GLP-1 (or at least not yet)
This isn’t an exhaustive list, but it’s the population I see most often where the answer is “not now” or “not at all”:
- Patients with a personal or family history of medullary thyroid carcinoma or MEN2. This is a labeled contraindication. It’s rare but it’s real, and “I think my aunt had thyroid cancer” deserves more conversation, not less.
- Patients with a history of pancreatitis. The data here is messier than the warning labels suggest, but it’s a yellow flag I take seriously, especially with a recent episode.
- Patients with active or recently treated eating disorders. GLP-1s are appetite suppressants. In an eating disorder context, that’s not a side benefit, it’s a hazard. I want to coordinate with a therapist or eating disorder specialist before I touch it.
- Patients who are pregnant, planning pregnancy in the next six months, or breastfeeding. Wash-out matters.
- Patients with a BMI in the normal range who want a GLP-1 for cosmetic reasons. Off-label is one thing; off-label without a clinical rationale is another. There are people I will not prescribe to.
- Patients with severe gastroparesis, retinopathy with recent rapid progression, or unstable severe psychiatric illness without coordinated care. None of these are absolute, but each one deserves a real conversation.
There’s a longer list of “let’s get a few things checked first.” That’s most patients.
The labs and history I want before we start
For most adults, a reasonable baseline is a CBC, a comprehensive metabolic panel, A1c or fasting glucose, lipids, TSH, and a urine pregnancy test if applicable. For a lot of patients I add liver function in detail, fasting insulin and a HOMA-IR, vitamin D, and a few hormone labs depending on age and symptoms.
I’m looking for thyroid disease, undiagnosed diabetes, signs of fatty liver, kidney function that affects dosing, and any reason the standard playbook needs to change. I’m also looking at body composition, not just BMI. Two people at the same weight with very different muscle and fat profiles need very different plans.
The conversation I have about goals
I don’t ask “how much do you want to lose.” I ask why. The answers cluster:
People who want to feel like themselves again after a major life event — pregnancy, menopause, an illness, a long stretch of medication-induced weight gain.
People with metabolic disease who’ve been told for years to “just eat less and exercise” and were never offered actual help.
People who are training for something specific, or whose joints are giving out, or whose blood pressure is climbing.
People who want to look different and don’t really care about anything else.
These are not equally good fits. I’m direct about that. The first three populations usually do well on a GLP-1 inside a real primary care plan. The fourth one is a harder conversation, and we have it.
I also ask about the exit. The number of patients I meet who started a GLP-1 with a friend’s leftover pen and have no idea what comes after the medication is large. The medications work while you take them. The behaviors and the metabolic resilience you build while on them are what carry you when you stop. If you don’t have a plan for that, we make one before we start.
A note for Texans specifically
Texas has had a busy two years on compounded GLP-1s. The FDA’s resolution of the semaglutide and tirzepatide shortages narrowed who can legally compound those medications. Some Texas-based telehealth companies are still selling compounded versions in ways I’m not comfortable with, and patients sometimes end up surprised to learn what they’re actually taking.
My approach: when supply allows, FDA-approved branded medications dispensed through your pharmacy. When it doesn’t, I work with 503B-registered compounding pharmacies and I tell you which one and why. I’ll tell you, in writing, what’s in the vial. The shortcut isn’t worth the risk.
When you should see me, and when to look elsewhere
You should see me if you want a real primary care relationship and you want weight loss to be part of it. The labs are part of the visit, the comorbidities are part of the visit, the perimenopause or sleep or blood pressure are part of the visit. I follow up. If something else needs to be seen in person, my brick-and-mortar clinic in Rowlett is available — most patients never need it, but it’s there.
You probably shouldn’t see me if you want a 24-hour script with no exam, no labs, and no follow-up. The companies that do that exist. The retention numbers from those companies are bad for a reason. I’d rather lose you to one of them than become one of them.
What to do next
If you want to talk through whether a GLP-1 is right for you, you can book a virtual visit. Texas residents can usually be seen the same week. We’ll go through the history, order the labs, and decide what makes sense for you specifically.
If you’re on a GLP-1 already and the experience hasn’t matched what you were promised — side effects nobody warned you about, no plan for plateaus, no human to call when something’s off — you can transfer your care. We do that every week.
— Laura Cervantes, DNP, APRN, FNP-C
Liberty Family Care & Wellness, Rowlett, TX Care & Wellness, Rowlett, TX
This article is general medical education, not medical advice for any specific person, and reading it does not establish a practitioner-patient relationship. If you have a medical concern, please consult a licensed clinician. If you are in Texas, you can book a virtual visit at libertyfamilycare.com.
