How to prepare for a first GLP-1 visit

A first visit goes better when you arrive with the facts the clinician needs rather than trying to remember them under questioning. This is true in a room and doubly true on a screen, where the clinician has nothing but what you bring. Fifteen minutes of preparation covers it.

Bring these

Your medication list, with doses. Every prescription, every over-the-counter drug, every supplement. Photograph the labels if that is easier. The clinician is looking in particular for insulin or a sulfonylurea (the labels say their doses may need reducing), oral contraceptives (the Zepbound label advises a barrier method for 4 weeks after starting and after each dose increase), and anything else whose absorption might change when gastric emptying slows.

Recent labs. Anything from the past year: A1c or glucose, kidney and liver function, lipids, thyroid tests. Ask your previous clinic for them; you have a right to copies. If you have none, the clinic should order a baseline; the pre-therapy lab checklist explains what each test is for.

Home readings, if you have them. Blood pressure from a home cuff, a few weeks of morning weights. For remote care this is the exam.

Your weight history. Roughly what you weighed at 20, at your heaviest, now; what you have tried and what happened. The AACE/ACE guideline expects this history because it shapes the plan.

Your questions. Pick from the first-call list whatever is still unanswered.

Know your answers to these

The clinician must ask these because they are in the Wegovy and Zepbound labels. Work them out in advance, including by asking family:

• Has anyone in your family had medullary thyroid carcinoma? Has anyone been diagnosed with Multiple Endocrine Neoplasia syndrome type 2? (Contraindications.)
• Have you had pancreatitis? Gallstones or gallbladder surgery? Kidney disease? (Warnings.)
• Do you have diabetes, and if so when was your last eye exam? (Retinopathy warning, Wegovy label.)
• Are you pregnant, breastfeeding, or planning a pregnancy in the next year? (The Wegovy label says to stop at least 2 months before a planned pregnancy.)
• Any surgery or procedure planned? (Aspiration warning under anaesthesia.)
• Any history of an eating disorder, depression or suicidal thoughts? (Society guidance calls for screening and coordination with mental health care.)
• Any serious allergic reaction to a medication?

"I do not know" is a valid answer, and a better one than a guess. Say it and let the clinician decide what it means.

Decide what you want before you are asked

Three things will come up, and you will answer them better if you have thought about them:

1. Brand or compounded. If you want a brand product through insurance, say so at the start; it changes which clinic can help. If you are considering a compounded product, know that it is not FDA approved and is not interchangeable with the brand, and that you will want to check the pharmacy.
2. How much follow-up you want. Monthly messages and a review twice a year, or a visit at every step. How follow-up should work gives a baseline.
3. What else you want from the program. Nutrition, training, body composition, or just the prescription. This is what separates in-person obesity medicine from a narrow program.

What the visit itself should include

A history covering the items above; an exam if in person (weight, blood pressure, waist, heart, abdomen); a review of your labs or an order for them; an explanation of the options, including no medication; and, if a drug is prescribed, written information on side effects, the warning signs that need a same-day call, how to inject, and how titration will go. If you leave, or log off, without knowing the answer to "what do I do if I cannot stop vomiting", the visit was incomplete. Ask before you go.

Printable version

The visit question list at formblendstools.com is a printable template you can fill in beforehand and bring with you.