Telehealth-only GLP-1 prescribing may improve access, but it can fall short for obesity, a chronic, relapsing disease that requires longitudinal, multidisciplinary care, not just a prescription, said Hani Charles Soudah, MD, PhD, an associate professor of medicine at WashU Medicine in St Louis, Missouri.

“The problem isn’t telehealth itself; it’s telehealth as the sole modality for a complex chronic disease,” he said.

What Research Says

A 2025 joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society recommends that before GLP-1 initiation, patients must undergo a comprehensive physical exam including muscle strength and function testing, baseline nutritional assessment, screening for eating and mood disorders, evaluation of social determinants of health, and a full lifestyle assessment, elements that are difficult or impossible to deliver through a telehealth-only encounter, Soudah said.

Plus, the World Health Organization’s 2025 guideline on GLP-1 therapies similarly calls for integrated, patient-centered care that pairs medication with behavioral and medical management, not medication in isolation.

What Aspects of GLP-1 Prescribing Require In-Person Interaction?

When managing a patient taking GLP-1 medications, Soudah said the following concerns warrant in-person assessment:

Physical exam. In-person assessment can identify gallbladder tenderness, evaluate thyroid findings when clinically relevant, and assess dehydration risk, which can contribute to acute kidney injury in patients experiencing gastrointestinal (GI) side effects.

Body composition and function. Because a portion of GLP-1-associated weight loss may come from lean mass, office-based functional testing — such as sit-to-stand, grip strength, and timed up and go assessments — can help identify patients at risk for sarcopenia. DEXA or bioimpedance testing may also be appropriate for selected patients.

Vital signs. Regular in-person checks can track modest heart rate increases associated with GLP-1 therapy and help guide antihypertensive deprescribing as weight decreases.

Weight and metabolic labs. Ongoing monitoring helps assess effectiveness and safety, including weight response, renal and hepatic function, lipid levels, and A1c levels. Early follow-up is especially important during the first several months of treatment, Soudah told Medscape Medical News.

Retinal screening. Patients with diabetes should receive guideline-recommended eye evaluation before therapy, when indicated, because rapid glycemic improvement can temporarily worsen retinopathy, he summarized.

Longitudinal GLP-1 Care Requires Ongoing Clinical Oversight

Longitudinal clinical oversight remains essential for patients receiving GLP-1 therapy for obesity, diabetes, or cardiometabolic risk reduction, said medical experts.

Micah J. Eimer, MD, clinical assistant professor, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, said “longitudinal care is critical,” while noting that it does not always have to be managed exclusively in primary care. Determining the duration of therapy requires careful shared decision-making. “Knowing when or how to stop GLPs is not straightforward and requires patient and clinician input,” he said.

For patients using GLP-1 medications for cardiovascular protection, he said, “there probably is no measurable endpoint,” whereas for obesity-related complications, clinicians must determine whether the endpoint is a weight goal or improvement in those complications. These decisions require a broad view of the patient’s health because such discussions require a comprehensive understanding of the patient’s full medical situation.

Telehealth-Only GLP-1 Prescribing Can Miss Major Risks

When GLP-1 therapy is prescribed through telehealth-only platforms without coordinated follow-up, clinically significant risks may be missed, Eimer said. There is a real risk for hypotension, which can be dangerous because patients may fall and break a hip or experience an intracerebral bleed.

Although weight loss may be a major contributor to blood pressure reduction, Eimer said the mechanism is “probably mostly weight related but not entirely,” with other potential contributors including a direct blood pressure-lowering effect of GLP-1 therapy, medication interactions, and dehydration. Medication dosing also warrants reassessment after substantial weight loss, particularly for drugs such as blood thinners, thyroid hormones, and psychotropic medications.

Furthermore, he said telehealth-only GLP-1 prescribing reflects real demand for effective obesity treatment and can improve access, especially for rural and underserved patients. But telehealth should be part of comprehensive care and not the sole model for a complex chronic disease.

What’s the Impact on Patients?

Telehealth-only management of GLP-1 therapy can leave patients without the clinical assessment needed to evaluate obesity, cardiometabolic risk, medication safety, and complications over time.

“Telehealth-only treatment with GLP-1 only for weight management has several important gaps in care that are better addressed with in-office evaluation,” said Lisa Netkowicz, MD, clinical assistant professor of family medicine and community health at the University of Wisconsin School of Medicine and Public Health and medical bariatrician at UW Health Comprehensive Medical and Surgical Weight Management Program in Madison, Wisconsin.

Those gaps include the inability to reliably obtain standardized anthropometric measurements, assess body composition, perform a physical examination, evaluate metabolic contributors to weight gain, and screen for weight-related comorbidities or psychosocial factors that may affect treatment response.

“Primary care involvement is extremely important to support patients using GLP-1 medications to treat a health condition,” Netkowicz told Medscape Medical News. “Prescribing these medications without structured lifestyle treatment risks suboptimal outcomes including muscle/bone loss, nutritional deficiencies, GI side effects causing discontinuation, and weight regain if the medication is stopped.”

Soudah and Netkowicz reported no disclosures. Eimer reported being on the advisory board for Eli Lilly.