By: Ryan Schulteis, M.D., Carolina Longevity
The Future of Wellness: GLP-1s – “I Was Hesitant Too”
When GLP-1 medications first started dominating headlines, I was cautious. Weight loss has never lacked for promises, and as a physician, I’m slow to embrace anything that sounds like a shortcut. For years, my approach centered on structured nutrition, metabolic testing, and carefully designed exercise programs. And those methods absolutely work — if they’re sustainable. But many people spend decades losing and regaining the same 10 or 20 pounds. At some point, the question becomes less about willpower and more about biology. If excess weight drives blood pressure, cholesterol, insulin resistance, joint pain, and cardiovascular risk — and we finally have a medication that meaningfully shifts that biology — it deserves a serious look.
The data are difficult to ignore. In the SELECT trial — more than 17,000 patients with obesity and established cardiovascular disease — semaglutide reduced heart attack, stroke, and cardiovascular death by 20%. That’s not cosmetic medicine; that’s risk reduction. These medications lower blood pressure, reduce visceral fat (the inflammatory fat around our organs), improve blood sugar regulation, and decrease overall metabolic strain. Body composition matters too. Earlier GLP-1 therapies produced weight loss that was roughly 60% fat and 40% lean tissue. Newer medications that act on multiple appetite and metabolism signals show closer to 75–80% fat loss, even in people who aren’t exercising intensely. When paired with resistance training and adequate protein, muscle loss becomes something we can manage thoughtfully rather than something we fear.
Are there side effects? Of course. Nausea, constipation, early fullness, and dehydration are the most common — and they relate directly to how the medication works. Like any therapy, this isn’t for everyone. All treatment decisions are personal and should be made in discussion with your physician. Do people need to stay on these medications forever? Not necessarily — but weight biology has a “set point,” and coming off too quickly often leads to regain, so duration should be intentional and individualized. After reviewing the evidence carefully and watching outcomes over time, I became comfortable enough to recommend these medications not casually, but confidently. Skepticism is healthy. So is allowing good evidence to change your mind.
References
https://pubmed.ncbi.nlm.nih.gov/37952131/
https://pubmed.ncbi.nlm.nih.gov/33567185/
https://pubmed.ncbi.nlm.nih.gov/39996356/
About the Practice:
Carolina Longevity is a concierge medical practice in Chapel Hill led by a board-certified Internal Medicine physician. The practice integrates traditional primary care with preventive and longevity-focused medicine.
About the Doctor:
Dr. Ryan Schulteis, M.D., is committed to helping patients go beyond simply avoiding disease. He believes that healthspan — the years lived in strength, vitality, and independence — is as important as lifespan. Every patient receives both a comprehensive medical and laboratory evaluation and an integrated assessment with physical therapy and manual therapy teams. The goal is not just to prevent decline, but to maximize function, resilience, and quality of life. Learn more about his practice at https://www.carolinalongevity.com.
Dr. Ryan Schulteis, M.D., Carolina Longevity
