Best practices in patient care. A tale of two practitioners.

Image by ChatGPT. Article by John Cummings, Founder, BodySite.com

I’ve spent more than twenty years working with doctors and nurses across weight loss care, primary care, integrative health, and metabolic clinics of all shapes and sizes. If you stay in this space long enough, patterns start to reveal themselves—not just in patient outcomes, but in how practices approach care.

I founded BodySite over 10 years ago. And something’s been nagging at me.

Over the past eighteen months, as GLP-1 therapies have exploded into the mainstream, one pattern has become impossible to ignore. And this isn’t just something I noticed about GLP-1’s or about weight loss in general.

Across thousands of clinicians using our platform, we’re watching two completely different models of care emerge. From the outside (mostly the marketing on practice websites), both appear to be offering the same service. On the inside, they couldn’t be more different.  We have the data.

It has become, quite literally, a tale of two practices.

It started as an inquiry into why some practices stop using BodySite, blaming the platform, the market, or even their patients — when things don’t work out.  Why would that happen when thousands of other practices have used BodySite for over 10 years successfully in the same business footprint, practice type and practice size?

On what has become an enormously successful platform that has helped nearly 1 million patients, losing practices over time is to be expected—it’s called “churn”—but we knew something else was going on.  Especially when some of the patients of practices that left the platform, reached out independently to us asking for referrals to other practices who were using BodySite.

So we set out to investigate what was really happening.

Chapter One: The Spark

No one can deny what GLP-1 medications have done for patients. For the first time in decades, people who had nearly abandoned the idea of meaningful weight loss are watching the scale move, their labs improve, and their confidence return.

For many patients, that spark matters as much as—if not more than—the physiology. Belief is a powerful accelerant. Compliance increases. Hope increases. Engagement increases. And clinicians finally have a pharmacological tool that can match the seriousness of the disease.

I read a very well written LinkedIn post on the topic by a health care leader recently who I have a lot of respect for and part of what she said also inspired this article.  Michelle Leary, ND, IFMCP said in her post that  “. . . pretending GLP-1s are ‘just weight-loss drugs’ misses the point.  . . .  Yes, muscle loss can happen if patients simply eat less without adequate protein, resistance training, and body-composition tracking.

That’s not a drug failure; that’s poor implementation.“See Dr. Leary’s post here.

Overweight and obesity have always been complex, multifactorial, behavior-linked, environment-sensitive, often identity-based, and—crucially—longitudinal.  Or to put it more succinctly, it’s complicated. The GLP-1 revolution didn’t change that.  It just shined a light on it. And as the founder of a lifestyle change platform, it really crystallized the implementation gap for me. We saw it for years across a lot of practice types, but then having thousands of practices using the same core tool (GLP-1 medications), we finally had a true case study in what practices were doing right, or not.

Chapter Two: The Fork in the Road

As early GLP-1 successes rolled in, many practices expected that patient momentum would carry itself. But then something interesting happened: both patient and practice outcomes began to diverge dramatically.

One cohort of clinicians on our platform reported that their patients were thriving. And their practices were too. We saw some practices on the platform upgrade their subscriptions multiple times to accommodate patient bases of 2,000 or 3,000 patients in one practice. Weight loss was sustained, strength was preserved, metabolic health improved, and patients continued progressing even after medication adjustments or discontinuation. And they kept referring new business to those practices.

A second cohort reported the opposite.  Their patients disengaged, regained some or all of the weight, didn’t track or journal, and showed little interest in lifestyle change or education about it. Many of the clinicians in this cohort blamed motivation; others blamed patient compliance; others concluded that “patients just want the shot.” And still others claimed on behalf of the patient: “they don’t like the information” or “they didn’t find the tracking helpful” or some other reference to the platform.

Both groups had the same medications, the same general diagnoses, and similar patient motivations and populations. The difference wasn’t the GLP-1. It was the model of care.

And here’s what was really bugging me and my team.

All of these doctors had access to the same tools on BodySite.

So we dug into the usage data . . .

The Two Models

Practice A: Prescribe and Partner with the Patient

Practice A generally describes the practice type that used GLP-1 or a related weight loss methodology but treated obesity as a chronic condition requiring partnership, guidance, structure, accountability, and monitoring. They assumed the medication was the beginning—not the intervention.

And here’s how we knew.

When we analyzed the data, these practices consistently used tools that enabled personalized care at scale. They:

• sent one-click broadcast messages weekly with tips, recipes, or brief educational videos;
• hosted live group video sessions for up to fifty patients, creating community and shared momentum;
• ran HIPAA-compliant group discussions where patients could ask questions, share challenges, and celebrate successes;
• used automated reminders and alerts for tracking weight, biometrics, movement, and injections;
• layered structured programs for nutrition, movement, strength, and lifestyle habits over the medication protocol to ensure muscle was retained and that lifestyle habits were learned;
• emphasized to patients that GLP-1’s were not permanent;
• monitored patient trends over time and intervened early when progress stalled;
• used discounts on future medications, supplements and labs in exchange for compliance with tracking, accountability and participation; and
• created follow up programs for people to transition to life without GLP-1 medications.

These clinics didn’t rely on willpower. They built environment, structure, visibility, and accountability—factors repeatedly shown in the literature to influence adherence and long-term success.  And they found that they could treat more patients with less work because most of this was automated and in a lot cases, delegated to a community of patients who relied on each other with the practitioner as more of teacher or group leader.  Hands on, but effortlessly.

Practice B: Prescribe and Move On

The Practice B cohort treated obesity as a prescription event. Once the medication was provided, the clinician’s role was effectively over unless the patient self-initiated follow-up.

These practices tended to:

• place patients on simple drip education sequences;
• assume interest alone would sustain engagement;
• provide little or no structured guidance beyond verbal advice;
• have no mechanism for tracking or reinforcement;
• allow accountability to collapse by default;
• attribute poor outcomes to patient disinterest or lack of motivation.

Whereas Cohort A had large number of patients, active message, group and tracking data counts, Cohort B often had only a handful of patients enrolled, actively engaged or involved in bilateral communications.

From the outside, both practices claimed to “offer GLP-1 programs.” But the underlying intervention was fundamentally different. One clinic was practicing chronic care. The other was mostly just facilitating the purchase of medication and giving patients access to automated digital content without additional support or incentive to engage.

What the Evidence Says

This divergence we found on BodySite aligns with what researchers are now reporting in the literature. A major systematic review published in The BMJ aggregated dozens of studies involving over 9,000 adults and found that once weight-loss medications are discontinued, most patients regain weight, often returning close to baseline within approximately two years without ongoing lifestyle and behavioral support.

Other studies have shown that weight regain can occur faster following GLP-1 therapy than after structured diet and exercise programs alone. And new data is raising concerns about the ratio of fat loss to lean mass loss, which has enormous implications for long-term metabolic health and maintenance.

In other words: the medication can drive the initial loss. But it cannot build the scaffolding that keeps it. Patient compliance is a very complex animal.  But passionate practitioner involvement is simple. And it doesn’t require extra work—just a realization that the tools are available and the willingness to ask for help from peers in how to use them better.

The Identity Question

To be clear, when we look at these two models, there are no “good patients” and “bad patients,” or “good” versus “bad” practices. What we found were two different identities emerging within the same field. And I feel convicted to help more practices see it the way Cohort A sees it.

One identity says: My job is to help this patient navigate a chronic metabolic condition over time.

The other says: My job is to provide access to a medication and let the patient take it from there.

Both identities are defensible. Prescribing the correct medication has been the core of primary care for as long as I remember. But the identity that sees a relationship with the patients outside the clinic and the prescription, is what we believe is the future of medicine.

The Infrastructure Problem

Before anyone takes this as a critique of any clinicians or practice methodology, let me be clear: personalized care at scale is almost impossible without the proper infrastructure.

Practitioners could never have been expected to deliver weight and obesity care comprehensively and at scale using paper, verbal instructions, sporadic check-ins, email newsletters, and patient grit alone.  But the infrastructure is here now.

Clinicians need to use the structured programs, education modules, monitoring tools, communication channels, automated nudges, and shared metrics that are available. Without those systems, the workload collapses back onto the provider, and the provider inevitably stops offering it.

The lesson of GLP-1s is not that patients don’t want guidance. It’s that guidance must be systematized to exist at all. And it’s now possible to do just that.

The Future of Care

The future belongs to Practice A.

We would like to help as many practitioners as possible to get there.

P.S. If you’re not already familiar with what BodySite includes today, here’s a quick overview of the tools we’ve built specifically to support the kind of care I’ve described above:

• Structured programs and care plans for weight management, metabolic health, and lifestyle change that you can customize to your protocols.
• Easy care plan builder for personalized, specific instructions and support tailored to meet individual needs.
• Turnkey libraries, resources and done-for-you courses that keep your guidance organized and accessible between visits.
• Broadcast messaging so you can send one-click weekly tips, recipes, reminders, and short educational notes to all enrolled patients.
• Group video sessions for up to 50 patients, making it easy to create community, answer questions, and reinforce key habits at scale.
• HIPAA-compliant discussion groups where patients can share wins and challenges while your team guides the conversation.
• Automated reminders and alerts prompting patients to track weight, biometrics, activity, nutrition, and injections.
• Connected wearable device integrations to increase patient compliance.
• Patient tracking dashboards that show trends over time so you can intervene early when progress stalls.
• Follow-up pathways to support patients as they transition off GLP-1s into long-term maintenance care.

These are the kinds of tools we see the most successful practices using every day to turn prescriptions into lasting change.

— John