The Prescription in Your Instagram Feed

The prescription is the easy part

There is a decent chance you have seen the ads. Hers. Ro. Found. Noom. Some version of a clean website, a smiling woman, a promise of GLP-1 medications delivered to your door in a few days after a quick online questionnaire. Maybe you have clicked on one. Maybe you have wondered if it was too good to be true. Maybe you signed up.

I am not here to shame anyone for that. The healthcare system has failed a lot of people for a long time, and when something appears that is easy and accessible and actually offers the medications that work, of course people are going to reach for it. That makes complete sense. What I do want to do is give you a clear picture of what you are actually getting, and what you are not, so you can make a genuinely informed decision.

Let's talk about what these services actually are. Hers, Ro, Found, and the others operating in this space are not medical practices in the traditional sense. They are technology platforms. They connect patients with prescribers through a questionnaire-based intake, and those prescribers are reviewing your information asynchronously, meaning they are not really talking to you. They are looking at what you typed into a form and deciding whether to send a prescription. The whole model is built around speed and volume. The prescriber on the other end of your Hers intake may be reviewing dozens or hundreds of forms that day. There is no real visit happening. There is a transaction. That matters more than you might think.

Here is what a board-certified obesity medicine physician does that a form does not.

We take a history. A real one. We ask about your family history of cardiovascular disease, your personal history of pancreatitis, gallbladder disease, thyroid cancer, eating disorders, depression, prior weight loss attempts, what worked, what didn't, and why. We ask about what you are actually eating, how you are sleeping, how much stress you are under, and whether the stress is the kind that sends you to the pantry at 10pm. We order labs and actually look at them in the context of your whole picture. We make a diagnosis, because obesity is a disease and it deserves one.

GLP-1 medications are genuinely powerful. Semaglutide and tirzepatide produce weight loss results that were unimaginable ten years ago. They are not candy. They have contraindications. Ozempic and Wegovy are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or MEN2 syndrome. They require caution in patients with a history of pancreatitis. They interact with other medications. They require dose titration that is calibrated to the individual, not the average person who filled out a form. Getting that wrong does not just mean the medication works less well. It can mean real harm.

A board-certified obesity medicine physician has completed medical school, a residency, and then passed a rigorous national examination specific to this field. We understand the biology of weight regulation, the hormonal and neurological mechanisms that drive hunger and satiety, the evidence behind every medication class, and how to think about all of it together in a single patient. We know when to use a GLP-1 and when not to. We know what to do when the nausea hits at week three. We know the questions to ask when the scale stops moving at month four. An algorithm does not know any of that about you.

There is also the continuity question. When something goes wrong with a prescription from one of these platforms, who do you call? There is usually a messaging system. There is sometimes a callback option. There is rarely a physician who knows your name, your history, and your life. When a patient at PresenceMD has a side effect, a question, or a concern, they message me directly. Not a team. Not a bot. Me. I know their labs. I know their history. I know whether the nausea they are describing is the expected adjustment period or something that needs a different approach.

This is not me telling you that convenience is bad. Telehealth is real medicine when it is practiced well. I conduct telehealth visits with my patients and they are genuine appointments. I'm going to ask you to take your blood pressure and step on a scale. I'm going to ask you what is working and what isn't. We're going to pick something to focus on every month to get a little more mileage out of your medicine. What I am saying is that there is a meaningful difference between a telehealth visit with a physician who knows you and a questionnaire reviewed by someone who will never speak to you.

There is also a compounding problem that has become urgent in this space. Many of the online prescription services, particularly during the GLP-1 shortage periods, have pivoted to compounded semaglutide. Compounded drugs are not FDA-approved. They are not subject to the same manufacturing standards, potency testing, or stability requirements as brand-name products. The FDA has issued warnings about compounded semaglutide specifically, citing reports of dosing errors and adverse events. The FDA removed semaglutide from the shortage list in early 2025, which means compounded versions are no longer legally permissible under shortage exemptions, but enforcement is still catching up. Patients have received compounded products with incorrect concentrations, contaminated vials, and no real traceability. A physician-led practice working with licensed, verified pharmacies or manufacturer-direct programs is a very different situation from a platform mailing you a vial of something from a compounding pharmacy with a long waitlist and a low price.

Here is the honest version of the cost conversation, because I know that is part of this. Yes, online prescription platforms are often cheaper at first glance. A monthly subscription to Hers or Ro might look like a bargain compared to a membership at a physician-led practice. What that number usually does not include is the cost when something goes wrong and there is no one qualified to help you navigate it. It does not include the cost of not getting the medication right the first time, cycling through doses incorrectly, or staying on a medication that is not the right fit because no one is actually watching your progress. It does not include the downstream cost of unmanaged comorbidities that a real physician would have caught in the first place.

The people who seek out these platforms are often people who have been dismissed by the medical system. Told that they just need willpower. Told that their labs look fine. Told to eat less and exercise more. I understand why a frictionless, judgment-free online service feels like a relief after all of that. It makes sense.

What I want those same people to know is that there is another option. A physician who actually has the training, the time, and the clinical judgment to take this seriously. A physician who treats obesity as the medical condition it is, with the same rigor she would bring to any other chronic disease. A physician who will still be there at month six when the real work gets interesting.

You deserve an actual doctor. Not a form.