GLP-1s Went From Secret to Status Symbol, Obesity Doctor Says

By Daniel Okafor

New York endocrinologist Rekha Kumar, MD was prescribing GLP-1 medications off-label for weight management 20 years ago, when patients hid the fact they used them. Today she hears the opposite. "I went out to lunch and I was the only patient not on this. I want this," a patient told her.

Kumar spoke at NewBeauty's first The State of Aesthetics Roundtable in New York, which she attended as a guest of Novo Nordisk. Dermatologists, plastic surgeons and brand partners joined the table, including Novo Nordisk, the maker of Ozempic and Wegovy. Its next potential option, CagriSema — a once-weekly injection pairing semaglutide with cagrilintide, a long-acting version of the hormone amylin — is under FDA review.

How did patients and doctors change their minds?

Before any GLP-1 carried FDA approval for weight management, doctors prescribed diabetes medications off-label. Patients resisted. "Even the smartest patients, when they saw the pen and they saw the needle, they were like, 'That's insulin. I don't want to do this,'" Kumar said.

Those who succeeded stayed silent. "We would see patients that would have tremendous success, and they would tell other people that they got that way from various lifestyle intervention programs, but we obviously knew the truth," she said.

Her earliest success stories included young women with what is now called PMOS (formerly PCOS), whose menstrual cycles resumed and skin improved. She stressed these patients needed close monitoring. Still, she said, "they would say things like, 'This is the first time I feel normal.'"

The turning point for skeptical physicians was cardiac data. Novo Nordisk's SELECT trial of Wegovy (semaglutide) found the drug reduced the risk of major cardiovascular events in adults with heart disease and overweight or obesity, and in 2024 the FDA added that benefit to Wegovy's label. "The SELECT trial that showed a 20 percent reduction in heart attack, stroke and cardiovascular death actually convinced the PCPs that there was real biology here," Kumar said.

Before that, many doctors dismissed the medication as cheating or stopped it once a patient hit a healthy weight. "And then they'd regain all the weight," she said.

What does this change for sourcing and care?

The options keep widening. Wegovy now comes as a once-weekly injection, a higher-dose Wegovy HD for patients already on treatment, and a daily pill for people who would rather skip needles.

Kumar's advice on sourcing is simple. "I would always say to use a branded product if you can," she said. Compounded versions surged during shortages that have since ended, and with direct-to-consumer pricing on some branded options, some people now pay more for a compound than for the brand.

So why do compounds persist? Kumar argues patients pay for the experience, not the price. Successful treatment requires "frequent visits, dietitian, exercise physiologist, behavioral support, very hands-on care" — more touchpoints than a typical office visit allows. Telehealth scaled what brick-and-mortar practices could not. "I think that the reason compounds are still around aren't price, but rather the experience around the care they're getting," she said.

Austin, TX plastic surgeon Johnny Franco, MD, a guest of Novo Nordisk who has lost 90 pounds on GLP-1 medication himself, described what happens without that support. "They said, 'Sure.' They sent a prescription. I never heard from them again. Every month, they just increased my dose. I told them I'm sick. They said they sent in some Zofran. Like, that was it," he said, quoting patients.

Where do aesthetic doctors fit in?

Many GLP-1 patients now land in aesthetic practices. New York dermatologist Amanda Doyle, MD cited research on facial volume during GLP-1 weight loss. "If you lose 22 pounds, you can lose up to 7 percent of your facial volume," she said, citing a small 2025 imaging study of the midface.

Other observations are earlier-stage. "This is anecdotal, admittedly," said Beverly Hills, CA plastic surgeon Charles Galanis, MD of patients on GLP-1s, "their skin is different." Dermatologists also flagged hair thinning and stressed protein intake and strength training to protect muscle.

Must every dermatologist and plastic surgeon prescribe? Kumar doesn't think so. "I don't think they should have to, but I think that they should have either some very close connection, collaboration or somebody in the office," she said. Franco agreed: "If you don't want to prescribe it, partner with somebody, but don't just let them go."

New York dermatologist Doris Day, MD framed the long view. "This is a lifelong approach," she said. "It's not just to get to this point and then you'll stop."

GLP-1s carry side effects, most often gastrointestinal, and they are not right for everyone — the decision belongs with a qualified provider. For Kumar, the bigger story is expanded possibility. "There was a time when your biology or your genetics was your destiny," she said. Her hope is that idea becomes history.