Patients spent $2.2 billion on weight loss at U.S. medical aesthetics practices in 2025, according to Guidepoint Qsight. That was the same as 2024. For a category that had climbed almost without pause since 2021, flat is news for any owner deciding whether to add or keep a med spa weight-loss program built on GLP-1 drugs.

This guide is about money and rules. It says nothing about who should be prescribed what, at what dose or on what schedule; those are decisions for a licensed prescriber, and we are not clinicians.

Demand is large but no longer rising, patients in the category come back less often than toxin patients, and the compounded supply that grew up during the shortage years is now the part of the business regulators are writing letters about. A weight-loss line can still pay, but only on numbers that assume the cheap, loosely marketed version of it is gone.

Demand: big, and past its peak

Qsight's quarterly chart shows weight-loss spending at practices climbing from $53 million in the first quarter of 2021 to a high in the first quarter of 2025, then falling in each of the next three quarters to $493 million. The deck, presented at the Octane Aesthetics Forum on January 8, 2026, calls 2025 "a turning point for GLP-1." Multiply the last quarter by four and you get an annual pace of about $1.97 billion, roughly 10% under the 2025 total. (Our arithmetic, not a Qsight forecast.)

Retention is the other number. Qsight put year-over-year patient retention for the category it labels "Weight Loss Dietary Lifestyle" at 46%, against 57% for neurotoxin. (We covered how those rates are built in our piece on monthly numbers.)

And plenty of competitors are already in. A Washington University study of Missouri med spas found that 49 of the websites it reviewed, which it reports as 21.49%, offered GLP-1 agonists, and 122, which it reports as 53.07%, offered some form of medical weight loss. The spa list was compiled in September 2023. One state, one moment.

Supply: what changed, with dates

Compounded drugs are not FDA-approved. FDA's page on unapproved GLP-1 drugs, current as of October 1, 2026, says the agency does not review them for safety, effectiveness or quality before they are marketed.

A shortage listing opens a legal route to compounding. That route has closed. FDA determined the tirzepatide injection shortage resolved on December 19, 2024 and the semaglutide injection shortage resolved on February 21, 2025, and the last of the grace periods it gave compounders ended on May 22, 2025.

What's left depends on which kind of compounder your supplier is. In an April 1, 2026 reminder, FDA said a state-licensed pharmacy operating under section 503A of the Federal Food, Drug, and Cosmetic Act must compound for an individual patient on a prescription, and may not compound "regularly or in inordinate amounts" what the agency considers copies of a commercially available drug, unless the prescriber determines and documents a significant difference for an identified patient.

Outsourcing facilities, under section 503B, are in a tighter spot. They may compound from a bulk substance only if it is on FDA's 503B bulks list or the drug is on the shortage list. "Tirzepatide and semaglutide do not currently appear on the 503B bulks list or on FDA's drug shortage list," the same reminder says.

On April 30, 2026, FDA proposed to exclude semaglutide, tirzepatide and liraglutide from that list, saying it found no clinical need for outsourcing facilities to compound them from bulk. The comment period has closed. When we checked FDA.gov on October 8, 2026, the agency's 503B list page named none of the three on either side of the ledger, and we found no final determination (more on the proposal here). The proposal concerns 503B outsourcing facilities. It is not a ban on 503A pharmacy compounding.

One more item belongs in the file. FDA says it has received 990 adverse-event reports associated with compounded semaglutide and more than 730 associated with compounded tirzepatide as of May 31, 2026, while cautioning that it is not always possible to determine whether the drug caused the event.

Advertising: the claims that draw letters

FDA announced 30 warning letters to telehealth companies on March 3, 2026, and described the primary violations as claims implying sameness with FDA-approved products and branding that obscures who made the drug. Holland & Knight counts three rounds: more than 55 letters in September 2025, those 30, and 25 more dated June 8, 2026.

None of those letters went to a med spa, as far as the sources we read show. (The same firm reports a separate FDA warning letter to a Southlake, Texas med spa on April 1, 2026, under the Drug Supply Chain Security Act, over product sourcing.) Holland & Knight's view, in an August 5, 2026 alert, is that FDA's concerns "apply directly to any entity marketing compounded GLP-1 products."

The website evidence is older but pointed. A JAMA Health Forum study of 79 sites selling compounded GLP-1s through Google Shopping ads between July and September 2024 found that 29 (36.7%) said or implied the drugs were FDA approved and 39 (49.4%) reported no adverse effects, warnings or contraindications. Those were online sellers, not med spas. Still, if your web copy came from a vendor template written in 2024, read it against that list.

A worked example, with our assumptions

Every figure in this section is an assumption for illustration. We found no dated primary source for what practices pay for product in 2026, so the product cost below is a placeholder for the number on your own invoice. The only published price point we read is historical: the JAMA Health Forum study's median first-month price for compounded semaglutide online in mid-2024 was $231.

Say the program has 60 active patients paying $299 a month. That is $17,940 a month. Assume product at $110 per patient per month, licensed clinical time at $45 and supplies at $10. Contribution is $134 a patient, or $8,040 a month. Take off $2,000 a month for added insurance, legal review and software, and the line clears $6,040 a month, about $72,500 a year.

Now stress it. If the category's 46% retention held for this practice, 60 patients would become about 28 a year later, and it would take 32 new patients just to stand still. If the supplier loses its legal route and the program pauses, $17,940 of monthly revenue stops and the $2,000 doesn't. And if product cost rises by $60 because the lawful source is dearer, contribution falls to $74 a patient and annual profit drops to about $29,300.

That last case is the one to plan on.

What depends on your state

At least one state has written weight loss into its med spa rules. Maine is the example we read in full. Its joint rule of the Board of Licensure in Medicine, the State Board of Nursing and the Board of Osteopathic Licensure, Chapter 15, took effect July 14, 2026 and defines a "medical aesthetic business" to include medical weight loss treatment.

Under that rule, a static internet questionnaire does not count as a clinical interview and examination for issuing prescriptions. Being an owner or medical director is "insufficient to establish a valid licensee-patient relationship." Standing orders used for individualized assessment, diagnosis and treatment are considered unprofessional conduct and may result in disciplinary action. Licensees are responsible for knowing and meeting their obligations to use only authorized sterile compounding facilities and legally authorized distribution channels. For a program built on a remote prescriber and a questionnaire, each of those is a cost line.

Other states differ, and this is general information. Before adding or renewing the line, put three questions in writing: to your supplier, which section it compounds under and on what legal basis; to a health-care attorney in your state, what examination and delegation rules apply; and to your insurer, whether the policy covers it.

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