Obesity Specialist Shares Guidelines for Determining GLP-1 Treatment Eligibility

As debate intensifies over the widespread use of GLP-1 medications, medical experts are offering clearer guidance on who might benefit from these popular weight-loss drugs.

Body composition testing, rather than simply tracking weight loss, should be the determining factor when considering GLP-1 medications, according to obesity medicine specialist Dr. Rocio Salas-Whalen. The New York City-based expert and author of “Weightless” emphasizes that the number on the scale fails to tell the complete story of a person’s health status.

“Losing weight on the scale doesn’t translate to being healthy. It’s more about body composition,” Salas-Whalen explained in a recent interview. “Maybe you were losing muscle, maybe you lost water, maybe you lost a little bit of fat.”

Body composition machines, available in many medical offices and some fitness centers, measure three critical health markers: skeletal muscle mass, body fat percentage, and visceral fat. These metrics provide a comprehensive picture of what might be contributing to health issues or maintaining wellness.

“I perform a body composition on everybody who walks through the door,” said Salas-Whalen. “I want to see your visceral fat, which is the fat that surrounds your internal organs. It’s pro-inflammatory fat, which increases insulin resistance and hyperinsulinemia.”

Visceral fat, which accumulates around internal organs, is particularly concerning as it produces inflammatory substances that can contribute to various health conditions, including diabetes and cardiovascular disease.

Body fat percentages should ideally remain around 28% or below for women and 20% or lower for men, according to Salas-Whalen. Meanwhile, skeletal muscle mass—the muscle built through diet and exercise—plays a crucial anti-inflammatory role in the body.

“Muscle is an anti-inflammatory organ,” she noted. “It also decreases insulin resistance and consumes 80% of your glucose.”

The rapidly growing popularity of GLP-1 medications, which include brands like Ozempic, Wegovy, and Mounjaro, has raised concerns about their appropriate use. These drugs were initially developed for diabetes management but gained widespread attention for their effectiveness in weight loss. The pharmaceutical industry has seen unprecedented demand, leading to supply shortages and a surge in compounding pharmacies producing alternatives.

Salas-Whalen cautions against the casual use of these medications, particularly through online purchases without medical supervision. “It’s not safe to use a medication that you don’t have a requirement for,” she warned.

Despite this cautionary stance, Salas-Whalen suggests many people might actually qualify for these medications based on their body composition results. “Every patient’s journey is going to be different, but I can tell you most people need it rather than don’t… a lot of people will actually benefit from a GLP-1 than not.”

The World Health Organization has weighed in on this issue, conditionally recommending GLP-1 therapies—including liraglutide, semaglutide, and tirzepatide—for long-term treatment of adults with obesity, defined as having a BMI of 30 or higher. Importantly, the WHO does not endorse these as general-use medications for everyone regardless of health status.

Medical professionals continue to stress that the goal should not simply be weight loss but achieving healthy body recomposition—reducing harmful fat while maintaining or building muscle mass. This nuanced approach requires professional guidance and individualized treatment plans.

As these medications become more accessible, health experts emphasize the importance of comprehensive medical evaluation before starting treatment. Understanding one’s unique body composition provides crucial insight into whether GLP-1 medications might offer genuine health benefits beyond just cosmetic weight loss.