In 2023, I wrote for STAT about GLP-1 shortages leading to treatment delays, interruptions, and difficult decisions about who “deserved” to get these precious medications. I struggled in particular with the ethical dilemma of robbing Peter to pay Paul: prescribing GLP-1s that are specifically approved for type 2 diabetes to people without diabetes for weight loss.

Today, my most troubling clinical dilemma is ironically due to excess GLP-1s: I’m trying to slow down runaway trains, and even spot them before they leave the station. By this I mean people who seek to reach an unhealthy and likely unsustainable body weight.

Everyone eventually reaches a weight loss plateau at the maximum tolerated dose of GLP-1 treatment. And I have had very few people tell me that the plateau weight is their Goldilocks weight. It’s not uncommon for people to become so fixated on seeing a certain number on the scale that they lose sight of having made tremendous improvements in their overall health. Almost everyone wants more weight loss, and I am learning in real time how to best support patients who have reached a weight loss plateau at a weight that is higher than they hoped at the start of treatment. I feel like I’m asking someone who trained for a marathon to feel satisfied after completing 10 kilometers.