GLP-1 medications gain popularity for weight loss
New York endocrinologist Rekha Kumar, MD has been prescribing GLP-1s for weight management for 20 years, long before they became popular. She recalls a time when patients were hesitant to try them and wouldn’t disclose their use to others. Now, she says, patients often express a desire to start the medication, with some even feeling left out if they’re not on it.
Dr. Kumar recently attended the State of Aesthetics Roundtable in New York, where she discussed the evolution of GLP-1s with dermatologists, plastic surgeons, and brand partners, including Novo Nordisk, the company behind Ozempic and Wegovy. The company’s next potential option, CagriSema, a once-weekly shot that pairs semaglutide with cagrilintide, is currently under FDA review.
From Secret to Status
Before the FDA approved GLP-1s for weight management, doctors like Dr. Kumar prescribed diabetes medications off-label, and patients were often resistant. They would see the pen and needle and associate it with insulin, which they didn’t want to take. Those who did try the medication often kept it a secret, even when they experienced significant success.
Dr. Kumar’s earliest success stories were with young women who had what is now called PMOS (formerly PCOS). These patients experienced resumed cycles and improved skin, but required close monitoring. They would often report feeling normal for the first time, which was a significant improvement in their quality of life.
The SELECT trial, which studied the effects of Wegovy (semaglutide) on heart disease, was a turning point in convincing skeptical physicians of the medication’s benefits. The trial found that Wegovy reduced the risk of major cardiovascular events in adults with heart disease and overweight or obesity. This led to the FDA adding the benefit to Wegovy’s label in 2024.
The Trial That Changed Minds
Dr. Kumar believes that the SELECT trial’s findings were a major factor in changing the minds of primary care physicians (PCPs) who had previously been dismissive of the medication. The trial’s results showed a 20 percent reduction in heart attack, stroke, and cardiovascular death, which demonstrated the real biology behind the medication.
Before the trial, many doctors would stop the medication once a patient reached a healthy weight, only to see them regain the weight later. The trial’s findings helped to convince doctors that the medication was not just a quick fix, but a legitimate treatment option for weight management.
Today, there are more options available for taking GLP-1s, including a once-weekly injection, a higher-dose version, and a daily pill. Dr. Kumar advises patients to use branded products whenever possible, as compounded versions can be more expensive and may not offer the same level of quality control.
Dr. Kumar attributes the persistence of compounded versions to the experience and care that patients receive, rather than just the price. Successful GLP-1 treatment requires frequent visits, dietitian support, exercise physiologist guidance, and behavioral support, which can be difficult to scale in a traditional brick-and-mortar practice.
Austin, TX plastic surgeon Johnny Franco, MD, who has lost 90 pounds on GLP-1 medication himself, agrees that the support and care surrounding the medication are essential. He hears from patients who have been prescribed the medication without adequate follow-up or support, which can lead to poor results and dissatisfaction.
Dr. Kumar notes that many GLP-1 patients are now finding their way to aesthetic practices, where doctors are seeing the effects of the medication on facial volume, skin, and hair. New York dermatologist Amanda Doyle, MD cites a small 2025 imaging study that found patients who lost 22 pounds on GLP-1s could lose up to 7 percent of their facial volume.
While not all dermatologists and plastic surgeons need to prescribe GLP-1s, Dr. Kumar believes that they should have a close connection or collaboration with a qualified provider to ensure that patients receive the best possible care.
Dr. Kumar emphasized the importance of a qualified provider in determining the best course of treatment for each patient. She noted that GLP-1s are not suitable for everyone and can cause side effects, most commonly gastrointestinal issues.
Dr. Franco agreed with Dr. Kumar, emphasizing the need for a collaborative approach to patient care.
