The hidden gaps in GLP-1RA care
- Written by: Dr Yasmin Zaidy — BSLM: Live Well East Lothian
- Published: 30th September 2026
GLP-1s can transform health but without adequate wraparound support, weight loss may come at the cost of nutrition, muscle and wellbeing.
David is a 69-year-old retired farmer whom I have had the privilege of caring for over many years. He had always lived with obesity. Four years ago, he lost his wife. Grief and loneliness consumed him, and food became a crutch; it numbed the loss, if only briefly. Over the following years, I watched his weight slowly increase.
Then, one morning, he walked into my consulting room looking like a different man. He had found himself a new girlfriend. For the first time in years, he wasn’t talking about loss. He was talking about going for walks, booking holidays and looking forward to the future. He wanted to improve his health not because someone had told him he should, but because he had found joy again.
We commenced Ozempic treatment for his diabetes and weight management. He had previously declined GLP-1RA treatment.
We discussed the contraindications, common side effects and the importance of a healthy lifestyle: a nutrient-dense diet, good hydration, portion control, resistance exercise and a daily multivitamin. Four weeks later, David returned for his GLP-1RA treatment review. He was beaming. He had lost weight. “The food noise has gone,” he said. I was pleased for him.
Then I asked him a question I ask every patient taking a GLP-1RA therapy.
“What did you eat yesterday?”
“Breakfast.”
“And after that?”
“Tomatoes.”
“Anything else?”
“No… just tomatoes.”
Not because he was trying to starve himself. Simply because he wasn’t hungry, and losing weight felt great. At that moment, something changed in my own thinking.
We prescribe a medication that suppresses appetite, yet many of our patients have never had to think about how to nourish themselves in the absence of hunger. Appetite suppression is not the same as nutritional adequacy.
We spent the rest of the consultation talking, not about dose escalation but about his daily protein intake target, preserving muscle mass, choosing nutrient-dense foods, shopping habits and why improving health should never come at the expense of nutrition.
Looking back, that conversation was probably more important than writing the prescription itself.
Four weeks ago, our Integrated Care Board gave primary care the green light to prescribe GLP-1RA therapies for obesity without first referring eligible patients to specialist Tier 3 weight management services or a federation-led prescribing service. This should have been a moment of celebration. For years, I had watched patients wait months for treatment while living with a chronic disease that affected every aspect of their health. Finally, we could offer effective treatment without unnecessary delays.
Instead of excitement, I felt apprehensive. Not because I doubt the medication. I doubt the system surrounding it.
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