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TREATMENTS → GLP-1DOSSIER · VOL. 0116 MIN READ
01 — THE CLASS

GLP-1s,
explained honestly.

A two-decade-old diabetes drug class that turned out to rewire appetite regulation. Not a miracle. Not a shortcut. A tool with real mechanics, real side effects, and real data. Here's the whole picture.

Semaglutide
Injectable · Wegovy/Ozempic
Dose range0.25 → 2.4 mg/wk
From$299/mo
Tirzepatide
Injectable · Zepbound/Mounjaro
Dose range2.5 → 15 mg/wk
From$349/mo
MOST POPULAR
Foundayo™
Oral · GLP-1
Dose range3 → 14 mg/day
From$149/mo
02 — MECHANISM

Four places
it actually acts.

GLP-1 is a gut hormone your body already makes. These drugs are long-acting analogs — they hit the same receptors, just harder and longer. What that looks like, organ by organ:

1
BRAIN
Reduces food-reward signaling. Cravings go quiet.
APPETITE ↓
2
STOMACH
Slows gastric emptying. You feel full on smaller meals.
SATIETY ↑
3
PANCREAS
Glucose-dependent insulin release. No hypos in non-diabetics.
GLUCOSE CTRL ↑
4
LIVER
Cuts hepatic glucose output. Downstream A1c drops.
A1c −0.7 TO −2.0
03 — EVIDENCE

The phase-3 tape.

4 LANDMARK TRIALS · PEER-REVIEWED
STEP 1
−14.9%
body weight · 68 wk
n = 1,961NEJM 2021
PIONEER 6
−0.7%
A1c · 52 wk
n = 3,183NEJM 2019
OASIS 1
−15.1%
body weight · 68 wk
n = 667Lancet 2023
SELECT
−20%
MACE risk
n = 17,604NEJM 2023
04 — WHAT CAN GO WRONG

Side effects
we won't bury.

Nausea44%
First 4 weeks. Usually resolves with slow titration.
Constipation24%
Hydration + fiber fix it for most.
Diarrhea30%
Early weeks. Message your care team if persistent.
Vomiting15%
Hold dose at current level, do not escalate.
Muscle loss~30% of loss
Protein target + resistance training required.
Pancreatitis (rare)<0.1%
Severe abd pain → ER. Mark contraindicated.
●Foundayo oral $149/mo●Compounded injectable optional●Tirzepatide available for physician evaluation●Physician-managed dose titration●Resistance-training guidance●US-licensed, board-certified physicians●Cancel any time●Foundayo oral $149/mo●Compounded injectable optional●Tirzepatide available for physician evaluation●Physician-managed dose titration●Resistance-training guidance●US-licensed, board-certified physicians●Cancel any time●Foundayo oral $149/mo●Compounded injectable optional●Tirzepatide available for physician evaluation●Physician-managed dose titration●Resistance-training guidance●US-licensed, board-certified physicians●Cancel any time
MEMBER · ANONYMIZED
Member, 0
ILLUSTRATIVE · 52-week program
OUTCOME
Trial baselines: STEP 1 (NEJM 2021) 14.9% mean weight loss on semaglutide 2.4 mg at 68 weeks; SURMOUNT-1 (NEJM 2022) 15.0–20.9% on tirzepatide; OASIS 1 (Lancet 2023) 15.1% on oral semaglutide 50 mg. Individual results vary.
WEEK 0

Pick the right molecule.

Wegovy, Ozempic, Mounjaro, Zepbound, Foundayo, compounded versions of all of them. The chat with Clyne Concierge takes the noise down to two questions: do you want oral or injectable, and what's your A1c. Your physician reviews your case from there.

Intake complete
WEEK 4

Appetite signal changes.

Per the trial literature, members typically notice the 'food noise' quieting in the early weeks. Mild nausea on dose escalation usually resolves in days. Your care team adjusts the titration based on tolerability.

Steady-state begins
WEEK 8

Expect plateaus.

Weight loss on GLP-1s is rarely linear. 1–2 week plateaus at any stage are normal. Your physician decides whether to hold or escalate based on trend and tolerability — algorithms watch the data, but humans make the call.

WEEK 12

Lean-mass intentionality.

Per the lean-mass meta-analysis (Obesity 2023), 25–39% of total GLP-1 weight loss is lean mass without intervention. Members who pair the medication with 110 g protein and 2 strength sessions per week typically keep that closer to 15–20%.

Resistance + protein plan
WEEK 26

Cardiovascular benefit accrues.

SELECT (NEJM 2023) reported a 20% reduction in MACE for semaglutide 2.4 mg in non-diabetic adults with obesity. Weight loss is the visible outcome; cardiovascular risk reduction is the bigger one.

Secondary outcomes
WEEK 52

Maintenance dose.

STEP 4 (JAMA 2021) showed members who discontinued regained ~2/3 of lost weight within a year; continued therapy maintained loss. Your physician designs every plan with a maintenance dose and off-ramp conversation from day one.

Maintenance plan
06 — WHO PRESCRIBES

Real doctors. Not a chatbot in a lab coat.

Every prescription is signed by a US-licensed physician on staff. They review the AI summary, the intake, and the bloodwork — then make the call.

Your physician
US-licensed, board-certified

Your physician is US-licensed, board-certified, and reviews every case personally.

50 STATE LIC.
07 — EVIDENCE

Twenty years of trials. Cited.

01
STEP 1: semaglutide 2.4 mg in adults with overweight
Mean weight loss 14.9% at 68 weeks vs. 2.4% placebo. 50.5% achieved ≥15% loss.
02
PIONEER 6: cardiovascular outcomes (oral semaglutide)
Oral semaglutide non-inferior to placebo for MACE in T2D adults. Established the oral cardiovascular safety profile.
03
OASIS 1: oral semaglutide 50 mg for obesity
Oral semaglutide 50 mg achieved 15.1% weight loss at 68 weeks. Comparable to injectable 2.4 mg.
04
SELECT: cardiovascular outcomes in obesity (no diabetes)
Semaglutide 2.4 mg reduced MACE by 20% vs. placebo over 39 months in non-diabetic adults with obesity.
05
SURMOUNT-1: tirzepatide for obesity
Weight loss 15.0%, 19.5%, 20.9% at 5, 10, 15 mg doses at 72 weeks. Approaches bariatric outcomes.
06
STEP 4: maintenance after GLP-1 discontinuation
Patients who stopped semaglutide regained 2/3 of lost weight within 1 year. Continued therapy maintained loss.
07
Lean mass loss meta-analysis (GLP-1 RAs)
Lean mass accounts for 25–39% of total weight lost. Resistance training + 1.4 g/kg protein attenuates by ~50%.
08 — WHEN WE WON'T PRESCRIBE

The hard no list.

About 14% of GLP-1 intakes get redirected. The bar isn't moral — it's safety arithmetic.

Personal or family history of MTC or MEN-2
Black-box warning. We will not prescribe regardless of how badly you want it.
Active pancreatitis or recent episode
Pancreatitis is a known rare complication. Active or recent disease is a hard stop.
Severe gastroparesis or gastric outlet symptoms
GLP-1s slow gastric emptying — wrong tool if your stomach is already too slow.
Pregnancy or actively trying
Wash-out period required. We pause prescriptions during a conception window.
BMI < 27 with no comorbidities
Outside the FDA indication. The risk-benefit doesn't work and we won't write it.
Unable to take protein or strength training
Without lean-mass protection, the body comp tradeoff isn't acceptable. We'd rather pass.
09 — FREQUENTLY ASKED

The questions every member asks. Answered straight.

Most members pick the pill (Foundayo) for convenience: no needles, no cold chain, daily oral. Injectables (Zepbound, compounded semaglutide) reach higher peak doses, suit members who want maximum lean preservation, or are the next step if oral doesn't suit. Your physician helps you compare based on your goals and labs.

Different molecule, different manufacturer. Foundayo™ is orforglipron, an oral non-peptide GLP-1 receptor agonist from Eli Lilly. Rybelsus® is oral semaglutide from Novo Nordisk. Both are once-daily oral GLP-1s; the molecules and trial programs are distinct.

Per the trial literature (STEP 1, SURMOUNT-1, PIONEER), most members see early loss in the first month, with the rate accelerating as the dose titrates up. Mean weight loss at 6 months tracks roughly 12–15% body weight; at 12+ months 15–20%. Individual results vary.

About 25–39% of total weight loss on a GLP-1 is lean mass — that's the literature (Obesity 2023 meta-analysis). With a protein-and-resistance plan (110+ g protein, 2 strength sessions/week), most members keep lean loss closer to 15–20%.

Pharmacologically yes, but most members find their tolerance drops dramatically. Many also find their relationship with alcohol shifts on GLP-1s, often in ways they're glad about.

Per STEP 4 (JAMA 2021), members who stopped semaglutide regained ~2/3 of lost weight within a year. Obesity is a chronic condition — most members stay on a maintenance dose long-term. We design every plan with the off-ramp in mind.

Nausea (44%) is the most common, peaks during dose escalation, usually resolves in 1–2 weeks. Constipation (24%) and diarrhea (30%) are common. Vomiting (~15%) means hold the dose. Pancreatitis (<0.1%) is rare but means stop and go to ER.

Yes. Foundayo is a daily pill — TSA-friendly. Injectables travel fine; we ship in insulated packaging and the cold chain holds for 2–3 weeks at room temperature. Consult your destination's import rules for international travel.

If your BMI is ≥30 you qualify regardless of A1c. If your BMI is 27–29 you need at least one comorbidity (hypertension, dyslipidemia, sleep apnea, or pre-diabetes). About 14% of intakes get redirected at this gate — we don't write outside the indication.

Different molecule, different manufacturer. Foundayo™ is orforglipron, an oral non-peptide GLP-1 receptor agonist from Eli Lilly. Rybelsus® is oral semaglutide from Novo Nordisk. Both are once-daily oral GLP-1s; the molecules and trial programs are distinct.

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