GLP-1 medications are about to get much easier to prescribe, and that is exactly what worries the physicians managing the fallout. An internal medicine doctor who treats GLP-1 patients daily reveals what the oral Wegovy era will actually look like in clinical practice.

⏱️ Chapters:
0:00 Introduction
0:22 The miracle side of oral Wegovy
1:02 The mess Instagram doesn't show
1:34 Optic neuropathy risk and the emerging data
3:29 Why Wegovy carries more risk than Ozempic
5:07 Patient demand for the pill form
5:34 Why a prescription without a plan fails
6:25 Super Bowl ads and med spa prescribing
7:25 The dangers of skipping physician oversight
8:23 Why most patients regain weight after stopping
8:41 Understanding the root cause of weight gain
10:44 Slow titration and the 90 day habit window
12:09 Questions patients should ask before starting
14:46 Be honest with your physician
15:17 Take home messages for clinicians and patients

About this episode:
Shiv K. Goel, an internal medicine and functional medicine physician, discusses the arrival of oral Wegovy and why easier access to GLP-1 medications is both a clinical breakthrough and a prescribing crisis in the making. He covers the emerging data on ischemic optic neuropathy risk with high-dose semaglutide, the difference between Wegovy and Ozempic risk profiles, and why he never prescribes a GLP-1 without a comprehensive plan that includes slow titration, resistance training, hormonal optimization, and nutritional support. The conversation addresses the dangers of telehealth and med spa prescribing without monitoring, the emotional and metabolic consequences of abrupt discontinuation, and why treating these drugs as casual weight loss pills leads to rebound weight gain and patient harm.

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