Inside the clinic: GLP-1s with Dr. Rekha B. Kumar

What It Covers

Dr. Rekha B. Kumar, endocrinologist and Chief Medical Officer at Found, explains GLP-1 medications for weight management, covering efficacy rates (90% lose 5%+ body weight on newest drugs), side effects, patient selection criteria, telehealth delivery models, and long-term treatment expectations including weight regain patterns when medications stop.

Key Questions Answered

• •Drug Efficacy Evolution: First FDA-approved GLP-1 Saxenda showed 60% response rate for 5%+ body weight loss. Newest dual agonist ZepBound achieves 90% response rate, treating significantly more patients effectively. Second-generation tirzepatide demonstrates less muscle loss compared to semaglutide, with future compounds like bimagrimab targeting preferential fat loss while increasing muscle mass.
• •Weight Regain Data: When patients with high BMI and weight-related comorbidities stop GLP-1 medications, two-thirds of lost weight returns within the first year. Lower BMI patients without significant metabolic disease may successfully cycle on and off medications, using them intermittently when weight regain occurs rather than continuous lifelong treatment.
• •Optimal Usage Protocol: Patients should use appetite suppression from GLP-1s to make deliberate food choices rather than simply eating less. Focus on high protein intake and weight training to preserve muscle mass during weight loss. The goal targets metabolic health markers and functional improvement, not lowest possible weight, as plateaus occur at different points for different individuals.
• •Telehealth Access Model: Obesity care traditionally concentrated in academic centers with year-plus wait lists. Telehealth democratizes access nationwide, particularly effective for endocrinology, obesity medicine, and psychiatry which saw volume increases during COVID while surgical specialties declined. Comprehensive platforms integrate physician prescribing, coaching support, and lifestyle modification guidance.
• •Health Equity Concern: GLP-1 medications demonstrate 20% reduction in heart disease plus benefits for neurodegenerative disease and fatty liver. High medication costs create potential two-tier health system where wealthy populations access preventative benefits while lower-income populations face continued metabolic disease burden until patent expiration enables broader access.