We've been in a lot of conversations lately about GLP-1 medications. Semaglutide works. We've seen it clearly in our patients. But we keep landing on the same observation: the medication quiets appetite. It doesn't answer the question underneath it.
That question is why you're eating more than your body actually needs. And we're becoming more convinced that until you answer it, the results from any weight loss intervention are going to be harder to sustain.
The food journal nobody is keeping
Dr. Shannon Kennedy, one of our internal medicine physicians, put it plainly in a recent team discussion: the most interesting thing about a food journal isn't what you ate. It's why.
"I'm eating at 8pm because my blood sugar crashes at night and I feel terrible" is a different problem than "I'm eating at 8pm because the kids are finally asleep and this is the one thing I've been looking forward to all day." Both are real. Neither gets fixed by eating less.
If food has become a way to manage stress, fill empty time, or soften the edges of a life that feels relentless, reducing how much you eat removes the tool you've been using. The underlying dynamic stays put.
This is what we mean when we say GLP-1s are one piece of the picture. A food journal that tracks why instead of what would tell us a lot more about where to actually focus.
Bodies aren't uniform
Erin Kosak, FNP, our nurse practitioner, pushed back on something worth pushing back on: the idea that thinness is the universal goal, and that carrying extra weight is simply a failure of discipline.
Genetics matter. So does epigenetics. Research shows that people whose grandparents or parents lived through famine eras carry different metabolic tendencies in their DNA: tendencies toward holding onto fuel, storing more, releasing less. That's not a character flaw. It's an adaptation that kept their family alive.
Bodies hold weight differently based on genetics, hormones, stress history, and other variables that aren't visible on a food log. The number on the scale isn't the whole story. What feels good in your body (how you move, how you sleep, how much energy you carry through the day) is a more honest target than a specific size.
A different way to think about it
Misti Borgestad, FNP, CNM, came back from a medical missions trip in the Philippines with an observation that stuck with all of us. In the Philippines, being called fat is a compliment. It means you have enough. It means you're not struggling.
The cultural frame we're all operating in here shapes what we think our bodies are supposed to look like, and how we feel when they don't match that image. Disentangling health from aesthetics is real work. What we want for our patients is simpler: to live with intention and feel free in their bodies.
Misti Borgestad, FNP, CNM · Remedy Wellness, reflecting on medical missions work in the Philippines
What this looks like in practice
We've been building the mindset piece more deliberately into how we support patients on GLP-1 programs. That means asking not just what you're eating but why. It means looking at what else might be driving appetite: hormones, sleep, stress load, blood sugar patterns throughout the day. It means not treating appetite suppression as the finish line.
If you're already on semaglutide or tirzepatide and feel like something is still missing, if the medication is doing its job but the deeper habits or feelings around food haven't shifted, this is worth talking about. And if you're considering a GLP-1 medication and want to understand the full picture before you start, we'd rather have that conversation early.
Reach out at team@remedycharleston.com or schedule a free 15-minute call to get started.