Read this first
This pathway is newer than the rest and it is being opened deliberately early. Its structure, its safety rules and the targets it sets you were written and signed by a clinician. The weekly reading was not: it is built from published research and every claim in it is numbered to the paper it came from, but no clinician has reviewed it yet. You will see the same line at the foot of each document. If something in it reads wrong to you, tell your coach: that is exactly what we want to hear at this stage.
Who this is for
Adults currently taking semaglutide, liraglutide or tirzepatide for weight management, at any point in titration or at a maintenance dose. Source of the prescription does not gate entry: telehealth and compounded supply are in scope, and establishing a continuity clinician becomes a named task in module 1 rather than a condition of enrolling. We ask who prescribes it, because every safety step in this pathway ends with contacting them, but not having one does not stop you enrolling. If you take insulin or a sulfonylurea, your coach confirms your prescriber knows you are here before you start: eating less on this medication raises the risk of a low, and the two effects add up. Members who have already stopped belong in GLP-1 Maintenance, which is not built yet.
What brings people here
Member reports current use of a GLP-1 receptor agonist or GLP-1/GIP co-agonist for weight management on the Whole Health quiz (item I5), or tells a coach they have started one. Members already in Weight Loss who begin a medication move here rather than running both.
Clinical framework
OneVillage-developed; no clinician playbook.
How the 24 weeks run
Baseline assessments, your first SMART goal, and the 1:1 that sets up everything after it.
Specialist coaches rotate in, and sessions come thickest here. One change at a time, in the domains your baseline flagged.
Re-score, refresh the care plan, and check in 1:1 on what is and is not working.
The remaining domains, at a lighter cadence, and the work of making the early weeks hold under pressure.
Final re-score, relapse prevention, and the plan for what happens next.
When your sessions fall
The program is built in four-week modules. Sessions come thickest at the start, when what you decide matters most, and step down as things settle. That is 16 sessions of 45 minutes across 24 weeks, counting the visit before week 1.
That is the schedule this pathway is being built to. The sessions you can book today are the ones in the written weeks listed below.
| Module | Weeks | Sessions | Cadence |
|---|---|---|---|
| Module 1 | Weeks 1 to 4 | 3 | weekly to every 10 days |
| Module 2 | Weeks 5 to 8 | 3 | weekly to every 10 days |
| Module 3 | Weeks 9 to 12 | 3 | weekly to every 10 days |
| Module 4 | Weeks 13 to 16 | 2 | every other week |
| Module 5 | Weeks 17 to 20 | 2 | every other week |
| Module 6 | Weeks 21 to 24 | 2 | every other week |
Week by week
- Before you beginBefore you begin
Your pathway starts with a 45-minute visit with Cindy Cathcart, your Whole Health Coach. Before it, read week 0 and complete your baseline questionnaires: the mood screens, a three-day record of what you ate, and the three function measures we will repeat at weeks 12 and 24. Week 0 also says plainly what this pathway promises and what it does not, and it does not promise a weight. Nothing here is a test and nothing is graded.
- Week 1Starting well: the titration window
Why the stomach and bowel side effects track your dose rather than arriving at random, and why the week after a dose goes up is the worst week to judge the whole treatment. What the trials actually reported, including the inconvenient numbers. Which of the standard nausea advice is evidence-backed and which is expert opinion: we tell you which is which rather than letting you find out later. The gallbladder, and why upper right abdominal pain is on the same-day list. And why your coach will decline a dose question every time, and what she will do instead.
- Week 2Eating when you are not hungry
The problem underneath the side effects: you are eating about a third less, and your requirements did not fall with your appetite. That flips the question from what to leave out to what to put in first, because you will run out of appetite before you run out of plate. The protein number, where it comes from, and what it rests on, which is research in people losing weight without these medications. What 25 to 35 g looks like in real food. Who the target does not apply to. And why fiber supplements are out here, even though the evidence for them in ordinary constipation is real.
- Week 3Starting to train
The resistance prescription, and the floor underneath it: one set per movement pattern, twice a week, about ten minutes, which is a real session and not a failed one. Why resistance work rather than walking alone, from a trial where every group lost the same weight and only the lifting groups kept the muscle and the bone. Joint-friendly substitutions offered by default, and the four things that stop a session. Two rules specific to your medication that are ours, not the literature's. And what you are actually training for right now, which is protecting rather than building.
- Week 4Holding the line
Module 1 closes with the thing most likely to end your treatment, which is not a side effect. It is cost, coverage or supply, and it arrives without warning. What the persistence studies actually show, including that they disagree with each other. The first 72 hours if your access changes, which is our clinical guidance and carries no citation because no research exists on it. And choosing your action number now, while it is still abstract, so a rise later prompts a conversation rather than a disappearance.
Who you will work with
Your Whole Health Coach takes your first visit and closes every module, so it is the same person from the first session to the last. The specialists below lead the weeks where their work is the focus.
Professionally, Cindy has been a clinical nurse for nearly a decade. She served in both clinical and administrative capacities throughout her career and holds a Master's degree in Nursing Leadership. As a staff nurse, nurse leader, and quality improvement specialist, she led multidisciplinary teams in academic medical settings throughout Boston, New York, and Ohio to deliver high-quality care to patients across complex diagnoses.
Tonia is a Doctor of Physical Therapy, Integrative Nutrition Health Coach, and Certified McKenzie Spine Specialist with over 25 years of experience helping clients heal from pain, injury, and chronic conditions. She specializes in spine care, orthopedic rehabilitation, and restoring strength and vitality through personalized, science-based treatment.
What we work on
| Domain | What this pathway does |
|---|---|
| Nutrition & Metabolism | 25 to 35 g of protein at each of three eating occasions, which is the operative instruction. Behind it sits a range of 1.2 to 1.5 g per kg a day, measured against a reference weight rather than your actual one. The target is carried across from research on protecting muscle during weight loss generally: it has not been tested in people taking these medications. It does not apply if you have advanced kidney disease. |
| Movement & Mobility | Resistance training 2 sessions per week minimum, 3 preferred, all major muscle groups, 8 to 12 reps at roughly two reps in reserve. Progress reps before load, load before sets. Floor for a deconditioned member: one set per movement pattern, twice weekly, about 10 minutes, framed as the thing that counts. Train after the meal of the day you eat best, not fasted. In the difficult days after a dose increase, the floor session is the target rather than the full one. |
| Sleep & Recovery | Escalation weeks disturb sleep. Tracked, not treated as a separate problem. |
| Stress & Resilience | Appetite suppression removes a coping mechanism before anything replaces it. Named early rather than after a lapse. |
| Mind & Mood | PHQ-9 and GAD-7 at weeks 0, 12 and 24. Disordered eating screened at baseline: restriction, purging and secret eating are on the prompt escalation list. |
| Preventive care | Weight weekly if you want to, never daily, and never as the main measure. What this pathway reports back is function: strength, sit-to-stand and gait speed. |
How progress is measured
These are the validated tools this pathway uses: at your first visit, at the mid-program review, and at the end.
| Tool | Cadence | Owned by |
|---|---|---|
| Sit-to-stand, gait speed, grip | Wk 0, 12, 24 | Physical Therapy |
| Protein per meal, 3-day record | Wk 0, 12, 24 | Nutrition Coach |
| Resistance sessions completed | Weekly | Member + WHC |
| Weight | Weekly, opt-out | Member |
| PHQ-9 + GAD-7 | Wk 0, 12, 24 | WHC; LCSW reads |
| Access check: any change in supply or coverage | Every coach contact | WHC |
The research behind this pathway
This pathway was built from the guidelines and studies below rather than from a clinician playbook. They are listed so you can read them yourself: every one is a real, published paper and the number at the end of each line is its PubMed ID.
Guidelines this pathway follows
- Nutritional priorities to support GLP-1 therapy for obesity · American College of Lifestyle Medicine, American Society for Nutrition, Obesity Medicine Association and The Obesity Society
The joint advisory this pathway is shaped around: managing side effects, preventing nutrient shortfalls when intake drops, and protecting muscle and bone with resistance training and enough protein. PMID 40445127
- Optimizing GLP-1 therapies for obesity and diabetes management · International Symposium on Diabetes and Nutrition working group
Where the protein and training targets come from. It is expert consensus rather than a trial result, and this pathway says so wherever it uses the numbers. PMID 41322078
- Definition and Diagnostic Criteria for Sarcopenic Obesity · ESPEN and EASO
Why this pathway measures what you can do, in strength and sit-to-stand, rather than reporting a muscle number it cannot measure. PMID 35196654
Key studies
- Wilding JPH et al. (2021). N Engl J MedOnce-Weekly Semaglutide in Adults with Overweight or Obesity
1,961 adults over 68 weeks. Average weight change was 14.9 percent against 2.4 percent on placebo, and nausea and diarrhea were the most common side effects: usually mild to moderate, and they settled with time. PMID 33567185
- Jastreboff AM et al. (2022). N Engl J MedTirzepatide Once Weekly for the Treatment of Obesity
2,539 adults over 72 weeks. This is the trial that shows the stomach and bowel side effects cluster in the dose-escalation period rather than lasting the whole program, which is why week 1 asks you to diary your dose changes. PMID 35658024
- Look M et al. (2025). Diabetes Obes MetabBody composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight
160 people scanned at the start and at 72 weeks. About three quarters of the weight lost was fat and a quarter was lean tissue, and that split was the same on the medication as on placebo: what changes is how much, not the proportion. PMID 39996356
- Karakasis P et al. (2025). MetabolismEffect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: Systematic review and network meta-analysis
22 trials pooled. Lean tissue accounted for roughly a quarter of the weight lost, which is the number behind everything this pathway does about protein and strength work. PMID 39719170
- Friedrichsen M et al. (2021). Diabetes Obes MetabThe effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity
At a test meal, people on the medication ate about 35 percent less. Your protein and vitamin needs do not fall by a third alongside it, and that gap is the whole reason week 2 exists. PMID 33269530
- Morton RW et al. (2018). Br J Sports MedA systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults
49 studies. More protein alongside strength training built more muscle and more strength, with no further gain above about 1.6 g per kg a day. That is the ceiling on the target this pathway gives you. PMID 28698222
- Villareal DT et al. (2017). N Engl J MedAerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults
160 older adults losing weight. Everyone lost about 9 percent, but the groups doing resistance work lost the least lean tissue and the least bone, and the combined group improved function most. PMID 28514618
- Lundgren JR et al. (2021). N Engl J MedHealthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined
195 adults over a year. Supervised exercise added to the medication roughly doubled the drop in body fat compared with either alone: the best evidence there is that training on top of the drug changes what you keep. PMID 33951361
- He L et al. (2022). JAMA Intern MedAssociation of Glucagon-Like Peptide-1 Receptor Agonist Use With Risk of Gallbladder and Biliary Diseases: A Systematic Review and Meta-analysis of Randomized Clinical Trials
76 trials and 103,371 people. Gallbladder problems were more common on these medications, and more so again in the weight-loss trials, which is why upper right abdominal pain is on the same-day list rather than the wait-and-see one. PMID 35344001
- Gleason PP et al. (2024). J Manag Care Spec PharmReal-world persistence and adherence to glucagon-like peptide-1 receptor agonists among obese commercially insured adults without diabetes
Of 4,066 people who started outside a trial, 46.3 percent were still taking it at six months and 32.3 percent at a year. Weeks 1 to 12 are where that gets decided, which is why your coach contacts are weighted into them. PMID 38717042
- Aronne LJ et al. (2024). JAMAContinued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial
People who stopped the medication regained substantially, and diet and activity support carried on in both groups without preventing it. It is why this pathway promises habits, strength and early detection, and does not promise a weight. PMID 38078870
- Lincoff AM et al. (2023). N Engl J MedSemaglutide and Cardiovascular Outcomes in Obesity without Diabetes
17,604 people with existing heart disease followed for over three years. Serious heart events fell from 8.0 to 6.5 percent, and 16.6 percent stopped for side effects: the honest long-horizon figure on both benefit and tolerability. PMID 37952131
Why this pathway runs 24 weeks
Twenty-four weeks is the window the dose-response trials measure, and this pathway front-loads inside it: three coach contacts per module through week 12, then two. The reason is specific to this medication rather than borrowed. Fewer than half of people who start one outside a trial are still taking it at six months, and about a third at a year, and weeks 1 to 12 are where that decision gets made while side effects are at their peak and the benefits are still arriving. The step-down lands on a module boundary, not in the middle of one.
Where the length came from: No playbook. Length was set from the dose-response evidence and from Cindy Cathcart's signed answer A2 (August 2026).
Length and cadence are set from the evidence on how much coaching contact actually changes anything. Below roughly one session a month, programs stop reliably beating no program at all; above about sixteen to twenty-four sessions in the first six months, more sessions stop adding. That is why sessions here are front-loaded and then step down, rather than spread evenly.
- Bauman V et al. (2019). BMJ Open Diabetes Res CareEffect of dose of behavioral weight loss treatment on glycemic control in adults with prediabetes
Randomized 287 adults with obesity and prediabetes to 8, 16 or 24 coaching sessions over six months. More sessions meant more weight lost, and the curve flattened between 16 and 24. PMID 31245006
- Perri MG et al. (2014). Obesity (Silver Spring)Comparative effectiveness of three doses of weight-loss counseling: two-year findings from the rural LITE trial
Randomized 612 adults to 16, 32 or 48 sessions over two years. The 16-session arm was barely better than education alone; 32 and 48 were the same as each other. PMID 25376396
- Ely EK et al. (2017). Diabetes CareA National Effort to Prevent Type 2 Diabetes: Participant-Level Evaluation of CDC's National Diabetes Prevention Program
Followed 14,747 people through the CDC's National Diabetes Prevention Program. Every additional session attended was worth another 0.3 percent of body weight. PMID 28500215
- Wadden TA et al. (2020). Am PsycholLifestyle modification approaches for the treatment of obesity in adults
The review behind the obesity guideline standard: six months of 14 or more counseling sessions for an active phase, then at least monthly for the year that follows. PMID 32052997
- Cannon MJ et al. (2020). Diabetes CareRetention Among Participants in the National Diabetes Prevention Program Lifestyle Change Program, 2012-2017
Tracked 41,203 people through a year-long program. People dropped out fastest at exactly the point where sessions went from weekly to monthly, which is why our step-downs land on a module boundary and get their own check-in. PMID 32616617
- Hartmann-Boyce J et al. (2021). BMJAssociation between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis
Pooled 249 trials and 59,081 people. Weight comes back after a program ends, but the gap against people who never did one was still there five years later. PMID 34404631
- Wadden TA et al. (2019). Obesity (Silver Spring)A Protocol to Deliver Intensive Behavioral Therapy (IBT) for Obesity in Primary Care Settings: The MODEL-IBT Program
The protocol that turned the 14-session standard into a real schedule: 14 visits in the first 24 weeks, then monthly. It is the front-load-then-step-down shape this pathway uses. PMID 31544345