Most people who come to me about weight have already tried. Usually many times, often with real success for a while, and somewhere along the way they were told that regaining it was a discipline problem. That framing is wrong, and it is why so many people arrive apologizing.

Body weight is defended. Lose enough of it and the systems governing hunger, fullness and energy expenditure push back, and they do not get tired the way willpower does. That is measurable physiology rather than a metaphor, and it explains how the same person can lose thirty pounds three separate times and finish heavier than they started.

What changed in the last few years is that we finally have medicines acting on that regulation rather than on resolve. The GLP-1 drugs work in a way nothing before them did. They are also expensive, widely misunderstood, and very often prescribed with far less follow up than they need.

How I approach it

I am board certified in obesity medicine by the American Board of Obesity Medicine and I practice entirely by telemedicine. In practice that means I prescribe medication when it is the right fit for the person in front of me, alongside nutrition, activity and the ordinary work of changing what happens between visits. Neither half does much alone.

The format suits this work better than people expect. Obesity medicine is mostly conversation, dose titration and follow up. Your labs happen wherever is convenient for you. What actually determines the outcome is whether someone is paying attention in the weeks between appointments, and that has nothing to do with being in the same room.

Two things I will say plainly, because they get glossed over in most of what you will read. These medicines cost you muscle along with fat unless protein and resistance training are deliberately protected. And stopping them usually means regaining, because the underlying regulation has not changed. Anyone telling you otherwise is not being straight with you.

Where to start

Is Obesity a Brain Problem? How the Body Controls Weight
Begin here. Why body weight is defended, and what that means if you have lost weight and regained it.

Foundayo vs. the Wegovy Pill
Two weight loss pills are now FDA approved. How they differ, and who each one suits.

Wegovy 7.2 mg: Who Should Consider the Higher Dose?
When going up is reasonable, and when it is not.

Do Ozempic and Zepbound Cause Muscle Loss?
The real risk separated from the noise, and what actually protects against it.

GLP-1 Skin and Nerve Pain
Side effects that get less attention, and when they need to be evaluated.

Why Weight Loss Plateaus Happen and How to Break One
What is actually happening when the scale stops moving.

Wegovy and Zepbound Cash Pay Prices Without Insurance
What these cost without coverage, and the options when insurance stops paying.

Compounded Semaglutide and Tirzepatide
What to know before using a compounded version of either drug.

Everything else

There are more than fifty articles here on weight and metabolic health, covering childhood obesity, weight stigma, the microbiome, exercise, supplements, weight cycling and treating obesity after sixty five. The full archive is here.

If you want to know what a video visit can and cannot do for this, that is on the telemedicine page.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This site is for educational purposes only and does not constitute individual medical advice. Always consult your own physician about your specific situation.