Are you a candidate for GLP-1 therapy?

The two-minute self-assessment.

Before any of the nuance, the FDA-labeled criteria for the obesity indication of semaglutide (Wegovy) and tirzepatide (Zepbound) are clear. You are eligible if you meet either:

• BMI ≥ 30, or
• BMI ≥ 27 with at least one weight-related comorbidity — type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, or non-alcoholic fatty liver disease.

Tirzepatide is also FDA-approved for obstructive sleep apnea in adults with obesity (regardless of weight goals). Semaglutide is approved as adjunct therapy for type 2 diabetes and for cardiovascular event reduction in patients with established CV disease.

What we order before the first prescription.

No GLP-1 prescription leaves the practice without a baseline panel. The labs serve three purposes: confirm eligibility, identify confounders, and establish a baseline against which response is measured.

If labs surface confounders (subclinical hypothyroidism, hypogonadism, B12 deficiency), we treat those first — often, weight starts moving before any GLP-1 is added.

Cases that require extra thinking.

• Type 1 diabetes. GLP-1s are not FDA-approved for T1D and are used off-label in select cases. We coordinate closely with the patient's endocrinologist and require glucose monitoring (CGM strongly preferred).
• Post-bariatric patients. GLP-1s are increasingly used for post-surgical regain. Different titration approach — patients are often dose-sensitive. We review prior surgical records and pre-surgery weight trajectory.
• Patients on insulin. Hypoglycemia risk increases when GLP-1s are added. Insulin doses typically need to come down. We coordinate insulin adjustments at every dose escalation.
• Patients on warfarin / anticoagulants. Slowed gastric emptying can affect drug absorption. We coordinate INR checks and anticoagulant timing.
• Patients on thyroid replacement. Levothyroxine absorption requires fasting; GLP-1s slow gastric emptying. We adjust timing to maintain absorption.
• Patients with prior pancreatitis. Relative contraindication. Discussed case-by-case based on cause, severity, recovery, and risk-benefit profile. Often we will not prescribe.
• Patients planning surgery. Anesthesia societies recommend holding GLP-1s for 1 week before procedures requiring sedation due to gastric content concerns. We pause therapy when surgery is scheduled.

Candidate selection, asked and answered.

I have Hashimoto's hypothyroidism. Am I disqualified?

No. Hashimoto's is not a contraindication. The MTC and MEN-2 contraindications refer specifically to medullary thyroid carcinoma — a rare cancer — and the genetic syndrome that predisposes to it. We screen family history at intake.

I had pancreatitis 10 years ago. Can I still do this?

Maybe. We review records, identify the cause (gallstones vs. alcohol vs. medication-induced vs. idiopathic), and discuss risk-benefit case-by-case. Single remote pancreatitis with a clear cause is often acceptable. Recurrent or recent pancreatitis is usually not.

Do you prescribe to patients without a high BMI?

Off-label prescribing for patients with BMI < 27 is rare and case-specific. We do not provide GLP-1s for cosmetic micro-weight-loss. Insurance will not cover, and the long-term risk-benefit calculation is unfavorable.

I'm pregnant — what about postpartum?

GLP-1s are contraindicated in pregnancy. Postpartum, we wait until breastfeeding has concluded (or the patient has chosen formula) before initiation. Pregnancy itself often shifts the metabolic picture; we re-evaluate everything 6 months postpartum.

I'm on Adderall / a stimulant. Does that change anything?

Stimulants suppress appetite. Adding a GLP-1 produces compounded appetite suppression and increased risk of inadequate caloric/protein intake. We can prescribe but typically dose conservatively and monitor protein adequacy carefully.

My family doctor prescribed it but won't manage it. Can you take over?

Yes, frequently. Transfers of care for GLP-1 management are routine. We obtain prior records, redo baseline labs (often we add tests primary care did not order), and continue therapy with our monitoring protocol. New-patient consultation is in-person at our Dalton clinic; subsequent visits can be telehealth across Georgia.

What does this cost out-of-pocket?

Drug cost is paid through your pharmacy and varies by insurance, manufacturer savings programs, and current pricing. The Limitless clinical management — consultation, labs, follow-up, peptide and hormone adjuncts — is membership-based or per-visit. We provide a transparent quote during the consultation.