Real Healthcare Debates from the Kitchen Table
Introduction
GLP-1 receptor agonists (GLP-1s)—like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound)—have exploded in popularity for their effects on weight loss, blood sugar control, and cardiometabolic health (shoutout to liraglutide for its admirable mechanism of action but unfortunately onerous daily dosing). For many patients, providers, and pharmacists, these medications have totally changed the weight loss and blood sugar control game. For others, they’ve simply changed the challenges inherent with using any medication.
Over dinner (and between kids screaming matches), we found ourselves deep into another kitchen table debate: What are the biggest barriers patients face on GLP-1s—and how do we help them through it?
Pharmacist Perspective (Cory)
From the pharmacy counter (ok, technically, from my pharmacist ambulatory care clinic if you are keeping score at home), what stands out most is how often GLP-1 therapy goes off the rails due to a combination of confusion, access, or poor health literacy. Some of my biggest concerns are:
- Misuse of pens and dosing errors — I’ve seen patients dial the wrong dose, skip steps in the injection process, or inject incorrectly. Compounded GLP-1s (we’re not here to debate their use…yet) sometimes don’t come in those convenient dosing pens, but instead involve a vial and syringe. Not to mention how often they arrive without proper titration guidance, which increases side effects or leads to early dropout when patients give themselves inappropriate doses.
- Titration mistakes after gaps — GLP-1 agonists are HAWT. I don’t care what my spellcheck says about how “HAWT” should be spelled or how using such slang is discordant with my age. When anything is HAWT, adequate supply becomes an issue. When these medications inevitably end up on backorder or a surprise jump in cost is a barrier, patients sometimes stop for weeks and then restart at their last dose, which is often higher than the starting dose. Cue the nausea. Just thinking about jumping into the max dose of semaglutide after being off for weeks makes me feel like throwing up. Most of the time, given a long enough gap in therapy, patients need to restart at a lower dose, but they don’t always know the risk of GI-related side effects from restarting at a high dose.
- Polypharmacy problems — GLP-1s interact with other medications. Especially other medications for blood sugar. Patients on sulfonylureas or insulin are at risk for hypoglycemia. With the weight loss that often comes with GLP-1 agonists, patients on antihypertensives are at risk of low blood pressure if adjustments aren’t made.
- Sweetened beverages sabotage results — Even with a reduced appetite, regular caloric drinks (soda, juice, alcohol) can completely undermine the best of intentions. Unfortunately, the Tik-Tok influencer who talked about how great GLP-1 agonists are, failed to mention the need for dietary modifications. Oftentimes, patients are baffled that they aren’t “eating” but still fail to lose weight because of their caloric beverage consumption.
- Cost and coverage hurdles — I don’t know if you realize this, but GLP-1 agonists aren’t cheap, and Medicare patients often take the biggest hit once their coverage gap is hit. One solution I’ve seen used is manufacturer-based patient assistance programs—they take time but can make a real difference in improving access for patients. Beyond Medicare, simply having these covered for weight loss can be a real challenge.
From my pharmacist’s perspective, GLP-1s are great tools—but they only work if patients know how to use them safely and consistently. Without proper education and support, misuse or misunderstanding can lead to unnecessary side effects, complications, and missed opportunities for the best results.
Nurse Practitioner Perspective (Cassie)
Cory makes some great points with that logical, “drugs first” pharmacy brain. But I’m thinking about what happens in real life when someone’s appetite disappears but their habits don’t.
- Undereating and protein deficiency — Patients often say, “I’m just not hungry.” This makes sense given GLP-1’s mechanism of action. But that appetite suppression is not always a win. It often means they’re underfueling, skipping meals, and not getting enough protein—especially if they aren’t exercising. This sets them up for muscle loss and possible fatigue.
- No resistance training — Weight loss from GLP-1s without strength training can lead to muscle loss, not just fat loss. Getting patients to do any sort of strength training, from bodyweight squats to resistance bands can help with maintaining muscle mass and avoiding sarcopenia.
- Worsened food tolerance — In the realm of Evidence Based Medicine, I am going to lean on anecdote here: I see more GI side effects from patients who are eating “less clean.” Oftentimes, I have heard a patient say that they ate fast food and “paid for it.” I try to recommend as much of a whole foods diet, limiting ultraprocessed junk to help give them the best chance at tolerating.
- Magic bullet thinking — Despite all the education in the world, some patients believe they don’t need to change how they eat or live. It’s not willful ignorance—it’s hope. But hope alone will not achieve or sustain the desired results from a GLP-1 agonist unless they come along with appropriate diet and exercise modificaitons.
- Unclear goals or exit plans — Many patients don’t know what happens next. Do they stay on this forever? What’s the plan if insurance stops covering it? Without an exit strategy or lifestyle foundation, they are at risk of rebounding weight gain and high blood sugar if and when they discontinue their GLP-1.
- Too much weight loss in older adults — One of the more concerning patterns I’ve seen is in older patients who lose weight too rapidly, especially without sufficient protein or movement. They end up trading excess fat for sarcopenic obesity—a dangerous combo of low muscle mass and high body fat that increases fall risk, frailty, and mortality. In these cases, more weight loss isn’t better—we have to protect muscle and mobility above all else.
Kitchen Table Consensus
We both agree that GLP-1s are powerful medications, but they’re not magic solutions. True success still depends on healthy habits, ongoing support, and realistic expectations. The biggest struggles we see often have nothing to do with the drug itself—and everything to do with education, access, behavior, and mindset.
Here’s what patients on GLP-1s need most to succeed:
- Clear titration plans, especially when restarting after an interruption in therapy
- Education on safe injection technique and proper pen use
- Monitoring and adjusting other meds to prevent hypoglycemia or hypotension
- Awareness of liquid calorie sabotage (soda, alcohol, etc.)
- Guidance on high-protein meals and the importance of strength training
- Support about appropriate diet modification to avoid side effects
- Access to manufacturer-based patient assistance programs when appropriate
- Real talk about long-term expectations, sustainability, and life after GLP-1s
Final Thoughts
GLP-1s aren’t magic—but they are meaningful. They work best when patients are guided, supported, and treated as partners in their care—not just prescription recipients. And for us? These kitchen table conversations help us blend both worlds: clinical caution and practical compassion.
When used wisely, with the right tools and teamwork, GLP-1s don’t just change numbers. They can change lives.
