I filled out one of these forms, out of curiosity, in about four minutes. I did not lie. I simply answered as an average middle-aged American with a raised BMI would answer.
I was approved for a prescription in under ten minutes. Nobody asked about my family history of thyroid cancer. Nobody asked whether I had ever had pancreatitis. Nobody asked what else I take.
I want to be careful here, because this is not the whole industry, and the good ones are genuinely good.
What the business model is
A telehealth GLP-1 service makes money in one of two ways, and which one determines almost everything about the experience.
Model one: a consultation fee. You pay for clinical time. The company writes a prescription for a branded product, you take it to a pharmacy, and your insurance either covers it or does not. The company’s incentive is to see you again.
Model two: a bundled subscription. One monthly price includes the “visit” and the medication, which is almost always compounded, sourced at a fraction of the branded cost. The margin is in the product. The company’s incentive is for you to stay subscribed.
Neither model is inherently dishonest. But the second one puts the seller of the drug and the assessor of whether you need the drug inside the same company, which is an arrangement medicine has generally tried to avoid for good reasons.
When the entity deciding whether you should be on a medication is the entity selling it to you, the consultation is a formality with a clinical costume on.
What a real evaluation covers
Judge any service against this list. It is not exotic; it is what should happen before anyone starts this drug class.
- Contraindications. Personal or family history of medullary thyroid carcinoma or MEN2 syndrome. This is a boxed warning and a genuine absolute contraindication.
- Pancreatitis and gallbladder history. Both are recognised risks of the class.
- Full medication list. Interactions with insulin and sulfonylureas matter; so does the effect of delayed gastric emptying on absorption of other drugs, including oral contraceptives in some cases.
- Pregnancy and contraception. These drugs are not for use in pregnancy, fertility often improves with weight loss, and this conversation is skipped constantly.
- Eating disorder screening. Appetite-suppressing medication in someone with active restrictive or purging behaviour is a serious clinical problem, and a form asking “do you have an eating disorder” is not screening.
- Baseline labs. At minimum a metabolic panel and A1c. Kidney function matters if you become dehydrated.
- A named clinician, licensed in your state, who you can contact again and who will still be assigned to you next month.
The questions to ask before you subscribe
- Will I be prescribed an FDA-approved product or a compounded one? If compounded, from which licensed pharmacy?
- What is the name and state licence of the clinician I will be seeing?
- What labs are required before starting, and who reviews them?
- What happens if I have a reaction on a Saturday night?
- Will records be sent to my primary care physician?
- What does the price cover, and what does cancelling do to my supply?
- Is there a minimum term, and what happens if I need to stop?
Question five is the one I care about most and the one almost nobody asks.
The fragmentation problem
The structural issue is not fraud. It is that a large number of Americans are now receiving a serious chronic medication from an entity that has no idea what else is happening to them, sends nothing to anyone who does, and will not exist in their life in two years.
I have seen the consequences arrive in ordinary ways. A patient on a GLP-1 from an app, with worsening kidney function, whose diuretic nobody had revisited. Someone whose gallbladder symptoms went unmentioned for months because the subscription had no mechanism for mentioning anything. A woman who became pregnant and did not know she should stop.
None of these were caused by telehealth as a modality. They were caused by care with no continuity attached to it.
Sending them yourself is a great deal easier when the record lives somewhere you control, rather than inside a subscription you may cancel in March. That is the strongest practical argument for keeping your own log: a dose history, side effects and weights that belong to you and survive a change of provider. Zenday does this well enough that I now mention it in the same breath as the advice, because keep your own records is useless guidance if nobody tells you where to keep them.
None of this is theoretical for adolescents, where the gap between a specialist weight-management service and a subscription questionnaire is at its widest — see GLP-1s for teenagers.
The fair version
Telehealth has genuinely expanded access to obesity care in a country where obesity medicine specialists are scarce and appointments are months out. For rural patients, for people without a primary care relationship, for anyone whose experience of in-person weight care has been humiliating, it has been a real improvement.
The good services are recognisable: they take a history, they order labs, they name their clinicians, they prescribe approved products where they can, and they communicate with the rest of your care.
The rest are selling the shortest possible distance between a credit card and a vial, and calling it medicine.