GLP-1 medications (semaglutide as Ozempic or Wegovy, tirzepatide as Mounjaro or Zepbound) are the most effective non-surgical weight-loss tools available, with average weight loss in trials of 15-22% over 12-18 months. They also meaningfully reduce cardiovascular events in patients with cardiometabolic disease. The right candidate is someone with significant weight to lose, metabolic disease (or significant risk), and an understanding of the trade-offs: GI side effects, lean mass loss without resistance training, cost, and the question of what happens when you stop. Fishtown Medicine prescribes GLP-1s thoughtfully inside a longer relationship rather than as a single transaction.
In the last 3 years, GLP-1 medications have gone from a niche diabetes drug to the most-prescribed weight-loss intervention in modern medicine. They work, and the trial data on weight loss and cardiovascular outcomes is strong. They have also created a chaotic market in Philadelphia: telehealth mills shipping compounded semaglutide, MedSpa clinics offering injections without baseline workup, primary care practices declining to prescribe them at all, and patients in the middle trying to sort out what to believe.
This page is how Fishtown Medicine in Philadelphia approaches GLP-1s: who they help, who they do not, the workup, the monitoring, and the long-arc plan that most clinics built around these medications skip.
What GLP-1 medications are
GLP-1 (glucagon-like peptide-1) is a hormone the body produces in response to eating. It slows gastric emptying, reduces appetite, improves insulin sensitivity, and signals satiety. The medications in this class are synthetic versions or related compounds that act on the GLP-1 receptor.
The main players in 2026:
- Semaglutide - marketed as Ozempic (for type 2 diabetes) and Wegovy (for weight loss). Weekly injection.
- Tirzepatide - marketed as Mounjaro (for type 2 diabetes) and Zepbound (for weight loss). Acts on both GLP-1 and GIP receptors. Weekly injection. Generally more potent than semaglutide.
- Liraglutide - older daily injection, generally less effective for weight loss than the weekly options.
Compounded semaglutide and tirzepatide became widely available during the FDA-declared shortage of the brand-name products. With the shortage resolved, compounded versions are increasingly subject to regulatory scrutiny, and quality varies substantially by compounding pharmacy. We discuss this openly with patients who are using compounded versions.
What the data shows
The pivotal trials (STEP for semaglutide, SURMOUNT for tirzepatide) show:
- Average weight loss of 15-22% over 12-18 months with the higher-dose protocols.
- Significant improvements in HbA1c, lipid profile, blood pressure, and inflammatory markers.
- Cardiovascular outcome trials (SELECT for semaglutide) showed meaningful reductions in major adverse cardiac events in patients with established cardiovascular disease.
- Beneficial effects on liver fat, sleep apnea severity, knee osteoarthritis pain, and a growing list of other endpoints.
The data on weight regain after stopping is consistent: most patients regain a substantial portion of lost weight within a year of discontinuation. For most patients this works as a long-term medication rather than a short-term boost.
Who is a good candidate
The clearest indications:
- Patients with type 2 diabetes (semaglutide and tirzepatide are excellent diabetes medications independent of weight loss).
- Patients with obesity (BMI ≥ 30) and significant weight to lose, particularly with cardiometabolic risk factors.
- Patients with overweight (BMI 27-30) plus a weight-related comorbidity (hypertension, dyslipidemia, sleep apnea, fatty liver).
- Patients with established cardiovascular disease and elevated BMI - the SELECT trial data is compelling here.
Menopause is its own common trigger for stubborn weight gain, and GLP-1s can help when they fit the picture. Menopause Weight Gain and GLP-1s walks through where they help and where hormone changes matter more.
Patients we approach more cautiously:
- Patients with a history of pancreatitis (relative contraindication).
- Patients with personal or family history of medullary thyroid carcinoma or MEN2 (contraindication).
- Patients with active gallbladder disease (gallstone formation is more common on GLP-1s, particularly during rapid weight loss).
- Patients with significant disordered eating history.
- Patients with severe gastroparesis.
Patients we usually do not treat with GLP-1s:
- Patients with a small amount of weight to lose (like 10 pounds for a metabolically healthy adult). Cosmetic-tier weight loss is not the appropriate indication.
- Patients who have not engaged with the upstream drivers (sleep, training, nutrition, alcohol). The GLP-1 results are dramatically better in patients who are also training, so we want that foundation in place before starting.
What a full workup includes before starting
Fishtown Medicine
A 90-minute conversation with Dr. Ash. A written plan you can actually follow.
- Comprehensive history. Weight trajectory, prior weight-loss interventions, eating patterns, GI history, family history (particularly thyroid, pancreatitis, MEN2), gallbladder history.
- Baseline labs. CBC, CMP, HbA1c, fasting lipid panel with ApoB, TSH, vitamin D, lipase, sometimes a liver fibrosis screen (FIB-4) if NAFLD is suspected.
- Baseline body composition. DEXA or at minimum body weight and waist circumference. Lean mass loss is the main risk to manage here.
- Conversation about resistance training and protein. Without serious resistance training and adequate protein intake, GLP-1 weight loss includes a substantial lean-mass loss component. The patients who do best are training hard while losing weight.
- Conversation about cost and coverage. Insurance coverage for Wegovy and Zepbound is highly variable in Philadelphia plans. Brand-name pricing without insurance is roughly $1,000-1,300/month. We help patients sort out the cheapest path.
How GLP-1 treatment works at Fishtown Medicine
After the baseline workup, we typically start at the lowest dose (semaglutide 0.25 mg weekly, tirzepatide 2.5 mg weekly) and titrate up monthly as tolerated. Most patients reach a maintenance dose between 1 mg and 2.4 mg semaglutide or 5-15 mg tirzepatide depending on response and tolerability.
Monitoring includes:
- Weight, blood pressure, and lab follow-up at 3-month intervals for the first year.
- HbA1c re-check at 3 months if diabetic.
- Symptom check for GI side effects, gallbladder symptoms, and signs of pancreatitis.
- Periodic body composition reassessment (every 6-12 months if available).
We discuss the long-arc plan early: this is usually a long-term medication, the right exit strategy is not "stop suddenly," and the resistance training and nutritional foundation built during the weight loss is what makes maintenance possible.
We do not prescribe compounded semaglutide or tirzepatide. We use brand-name FDA-approved formulations exclusively because the compounding-pharmacy quality control is variable and the regulatory environment is in flux.
What it costs
Membership at Fishtown Medicine covers all visits and ongoing management; see pricing for current rates. The clinical management of GLP-1 treatment is covered inside the membership. The medications themselves are billed through pharmacy:
- With insurance coverage: copays range from $25 to several hundred dollars per month depending on plan and prior-authorization status.
- Without insurance: brand-name semaglutide and tirzepatide run roughly $1,000-1,300/month at most Philadelphia pharmacies. Manufacturer savings programs and patient assistance programs can reduce this for some patients.
Compounded versions (which we do not prescribe) typically run $200-500/month.
Key Takeaways
- GLP-1 medications produce 15-22% weight loss in trials and meaningful cardiovascular benefit in the right patients.
- The best results come when patients are also doing serious resistance training and eating adequate protein.
- Compounded versions vary in quality; brand-name FDA-approved formulations are the safer choice.
- This is usually a long-term medication; most patients regain weight after stopping.
- Fishtown Medicine prescribes GLP-1s inside a longer primary care relationship rather than as a single transaction.
Related Services and Reading
- Metabolic Health in Philadelphia - the broader metabolic framing.
- Medical Weight Loss - the deeper guide.
- Ozempic vs Metformin - tool selection.
- Visceral Fat Playbook - what we are trying to lose.
- Fasting Protocols - the alternative or complementary approach.
- Direct Primary Care in Philadelphia - the membership context.
- Peptides: What's Approved, What's Gray Market, and What's Dangerous - GLP-1 RAs are FDA-approved peptide drugs; this is the wider clinical context for the peptide universe including the compounded GLP-1 question.
- Stroke Prevention in Philadelphia - the cerebrovascular case for GLP-1 RAs in T2D with cardiovascular risk.
Frequently Asked Questions
Common Questions
Deep-Dive Questions
Ready when you are
Dr. Ash reads every intake himself, and answers questions personally - usually within a few hours.
