Takeaway
This new class of weight loss drugs is not a magic fix. Work with patients to set realistic goals, start low and titrate slowly, and counsel on GI risks.
Lifelong Learning in Clinical Excellence | November 21, 2025 | 2 min read
By Yuval Pinto, MD, Johns Hopkins Medicine
Dave, a former Army ranger whose mobility was stolen by a roadside bomb in Baghdad, wheeled himself into the clinic with a smile. “It’s the first time I can stand on my feet and not use my wheelchair.” His weight had reached 320 pounds over the years, and despite increasing his exercise and working on his diet, nothing worked. After a few months on a carefully titrated GLP-1 protocol, 50 pounds dissolved. “I can see my feet again,” he told me and, for the first time since his injury, Dave wasn’t just surviving—he was living.
Britney’s diabetes felt like a losing battle. Desperate for control, she agreed to try a GLP1RA/GIP medication. After taking the medication for few months, a dose increase led to relentless vomiting that sent her racing to the ER at 2 AM, where she lay on a hospital bed wondering if this “wonder drug” would kill her. The medication that promised liberation had become her nightmare. She learned too late that these types of medications, sometimes, are not gentle. They are precision instruments that should not be mishandled.
These are two stories based on real patients’ stories. Same drug, same treatment—but completely different outcome. Here are a few things to keep in mind when considering GLP1RA for weight loss:
1. GLP1RA are tools—not a magic fix.
Obesity is a complex chronic disease caused by many factors and thus requires different types of solutions. Although GLP1RA are powerful tools, nutrition, sleep, mental health, and exercise are the foundations for healthy living. Improving those is the cornerstone for healthy weight loss.
2. Define co-morbidities and set up expectations.
Patients may sometimes have unrealistic weight loss expectations and aren’t aware of the reversible nature of their obesity complications. Sharing these obesity-associated conditions and educating the patient will help arrive at a realistic weight goal.
3. Follow up frequently.
Losing weight is a challenging process and prone to weight fluctuation. Frequent follow-up provides accountability, close monitoring, and can prevent extreme changes in weight.
4. Track progress.
Weight loss encompasses far more than the number on the scale. Tracking body composition over time and lab values of common obesity-complications (such as hypertension, diabetes, hyperlipidemia) will provide more insight on improvement.
5. Refer.
Given its complexity, some patients may not respond to standard care. In such cases, referring to a multidisciplinary center might be the best next step.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.