Hormonal & Metabolic

GLP-1 medication after the prescription: the protocol nobody discusses

Name: GLP-1 medication after the prescription: the protocol nobody discusses
Creator: Dr Martin Galy

Dr Martin Galy

Co-Founder & Director of Wellness & Longevity

11 April 2026·6 min·Vol. VII · 09

A green apple beside a measuring tape illustrating the subject of metabolic health care at 23MD

Most GLP-1 prescribing addresses the first six months. The next twenty-four are where the work actually is. A GLP-1 medication can reduce appetite and body weight in a way few other interventions can, but the medicine does not decide what kind of weight is lost, what happens to the metabolism underneath, or what the body does when the prescription ends. Those three questions are the protocol, and in most settings nobody is asking them.

The first six months: what the medication does on its own

Early weight loss on a GLP-1 medication is largely mechanical. The medicine slows gastric emptying and acts on appetite signalling in the brain, so the patient eats less without the effort that usually accompanies eating less. That is the medication working as intended, and for the first six months the patient is mostly a passive observer of a process the drug is driving.

This phase is also where the published evidence is strongest. In the largest trial of a weekly GLP-1 medication for weight management, participants lost around 15 per cent of their body weight over 68 weeks when the medicine was combined with lifestyle support (Wilding et al., STEP 1 DEXA substudy abstract). The numbers are real. The problem is that the trial ended where the clinical question begins.

What the medication does not decide: muscle, metabolism and the exit

Body composition scans from the same trial programme showed that lean body mass fell by just under 10 per cent in absolute terms while fat mass fell by around 19 per cent (Wilding et al., STEP 1 DEXA substudy abstract). The ratio of lean mass to fat mass improved, which is good news, but a tenth of a person's muscle is not a trivial loss, particularly for anyone over forty-five, for whom muscle is also bone protection, metabolic rate and the ability to recover from illness.

The second finding is the one that should shape every prescription. When the medication was withdrawn after 68 weeks and participants were followed for a further year, they regained about two-thirds of the weight they had lost. The cardiometabolic improvements seen on treatment reverted towards baseline for most measures over the same period (Wilding et al., STEP 1 trial extension, 2022). Stopping the medicine without a plan, in other words, returns most patients to roughly where they started, minus some muscle.

So the next phase is about three things: preserving muscle while fat is lost, recalibrating the metabolism so that it does not simply wait for the appetite signal to return, and planning an exit that does not end in rebound. This is where most prescribing fails patients, because it requires measurement, time and clinical attention that a repeat prescription does not.

The 23MD protocol for GLP-1 support

At 23MD a GLP-1 medication is never the whole treatment. It sits inside a measured metabolic programme, led by a doctor, with a defined beginning and a defined end.

The programme recommends to begin with a baseline DEXA bodyscan. This shows how much of the patient's weight is fat, how much is lean tissue, where the fat sits and what the bone density is. Without that baseline it is impossible to say later whether the weight lost was the weight that should have been lost.

Body composition can then be measured serially after that, and progress monitored in this way. A patient losing weight at a satisfactory rate on the scales can be losing it from the wrong compartment. Monthly measurement allows the dose, the training and the nutrition to be adjusted before a problem becomes established.

Patients also receive

a resistance training prescription. Muscle that is loaded is muscle the body is less willing to give up, and resistance work is the single most effective counter to the lean-mass loss seen in the trials. The prescription is specific to the individual and is reviewed as body composition changes.
a protein target, set for their lean mass and their training, because appetite suppression makes it easy to under-eat protein without noticing.

A metabolic panel is run quarterly so that insulin sensitivity, lipids, thyroid function, pancreatic and liver enzymes and inflammatory markers are tracked alongside the weight, not assumed from it.

Finally, withdrawal is tapered towards an agreed end point. The end point is agreed at the start, and the taper is paced so that appetite, training and nutrition have time to take over the work the medication was doing.

Who this is for, and who it is not for

GLP-1 support at 23MD is for adults with a genuine metabolic case for it: excess fat mass with evidence of metabolic strain, such as insulin resistance ( especially with PCOS/PEMS) , raised visceral fat or weight-related health conditions, who are prepared to train, eat to a target and be measured. In the UK, national guidance recommends these medicines only within a specialist weight management service, as an adjunct to diet and physical activity, and for a maximum of two years (NICE TA875 summary). That framing, with its emphasis on multidisciplinary care and a time limit, is close to how we think about it.

What we will not do

We will not prescribe a GLP-1 medication without a metabolic work-up. and advice about alternatives methods if GLP1's and unsuitable.

What to expect from a consultation

A consultation with Dr Galy begins with history, body composition and blood work. Some patients leave with a metabolic programme that does not involve a GLP-1 medication at all. Those who are suitable leave with a baseline, a training and protein prescription, a monitoring schedule and an agreed end point. Suitability is a clinical judgement made in person, and nothing in this article replaces it.

If you are already taking a GLP-1 medication prescribed elsewhere and want the measurement and structure around it, or if you are considering one and want to know whether it is the right tool for you, read more about metabolic and weight optimisation at 23MD or book a consultation.