Weight management.
Insulin, leptin, GLP-1 — the workup before the protocol.
Almost always metabolic and hormonal, not just caloric. Insulin resistance, sex hormones, thyroid, cortisol, sleep architecture — all testable. GLP-1 weight loss therapy is sometimes part of the answer, but not before the workup.
Services we use to treat weight management.
GLP-1 weight loss therapyWhen the workup points therePeptide therapyTargeted metabolic + recovery supportCustom supplementsInsulin, micronutrients, thyroid supportReady to investigate the root cause?
Thirty minutes with Dr. Scribner. No exam, no charge — just a conversation about what’s actually going on.
Book free consultation →Weight that won’t move.
Hormonal. Metabolic. Sometimes both. Almost never just caloric.If the same intake and exercise that maintained your weight at 30 is adding pounds at 45, you’re not failing. Your hormones, insulin sensitivity, thyroid, cortisol, and sleep architecture have shifted. The workup names which shift. The protocol — sometimes including GLP-1 weight loss therapy — addresses it.
of US adults have at least one marker of metabolic dysfunction. Most don’t know.
The 5 drivers — and what we test for each.
Midlife weight gain is rarely one thing. The workup runs all five categories at once, and the protocol pulls the levers that the labs name.
Insulin & metabolic
Insulin resistance precedes diabetes by 10–15 years and is the dominant driver of midlife weight gain. Often invisible on standard labs and crosses to brain fog.
Sex hormones
Estrogen shifts redistribute fat toward visceral storage in women; declining testosterone reduces lean mass in men. Both alter resting metabolic rate. Often the dominant driver in perimenopause and menopause.
Thyroid
Subclinical hypothyroidism drives weight gain at “normal” TSH values. The full panel matters — TSH alone misses 30%+ of clinically relevant cases.
Cortisol & stress
Chronic cortisol elevation drives visceral fat storage and insulin resistance independently of diet. Frequently overlooked in metabolic workups.
Sleep architecture
Poor sleep degrades insulin sensitivity by ~30% within a week. Untreated apnea drives weight gain and resists every other intervention.
“They tested insulin resistance and thyroid before they ever mentioned diet. That was the conversation that finally made sense.”
Weight management, as practiced here.
Workup first. Hormones and metabolism second. GLP-1 third — when it’s the right tool.The first visit — sixty minutes on history and pattern.
When the weight started. What's been tried. Cycle and hormonal context. Sleep, stress, alcohol, medications. The clinical picture usually points to two or three of the five drivers before labs are drawn.
The comprehensive metabolic panel.
All five driver categories tested at once. Lipase included as a baseline before any GLP-1 conversation (pancreatitis safety). DEXA scan referral for accurate body composition baseline — visceral fat matters more than total weight.
Hormonal optimization where indicated.
For women in perimenopause or menopause, hormone replacement therapy often produces meaningful changes in body composition independent of weight. For men with clinically low testosterone, testosterone replacement therapy restores lean mass and resting metabolic rate. Both are evidence-supported levers most weight-loss programs ignore.
GLP-1 weight loss therapy when appropriate.
Semaglutide or tirzepatide, compounded through Empower Pharmacy (with added B vitamins as a clinical bonus). Lipase confirmed pre-treatment. Started at conservative dose, titrated based on response and tolerance, monitored monthly. Not a subscription drip — clinical care with a real downstream plan. See GLP-1 weight loss therapy for prescribing detail.
The adjacent work — because GLP-1 is half the protocol at best.
Strength training to preserve and build lean mass (critical on GLP-1, where sarcopenia is the central risk). Protein targeting (1g/lb lean body mass, often higher than patients have been eating). Zone 2 cardio. Sleep optimization. Glycemic stability. The work that determines whether the weight loss is durable after the GLP-1 dose changes — and the work that makes this longevity medicine, not just weight loss.
Practiced in a building older than the prescription pad.
Sycamore Square — the 1890 Mason Block — on the National Register of Historic Places (#77001363), in Bellingham’s Fairhaven Historic District. Medicine practiced over an hour, in a room older than the modern healthcare system. The setting is the signal.
Two blocks from the Fairhaven waterfront. Patients from Whatcom County, Skagit County, San Juan Islands, and lower-mainland British Columbia.
Bellingham, WA 98225
(360) 498-7529
A doctor who tested insulin resistance
and thyroid before he ever
mentioned diet.
Weight management, answered.
The questions most patients arrive with — written long because that’s what AI search engines cite.
Find what’s actually driving it.
Thirty minutes with Dr. Scribner. No exam. No charge. A conversation about what the workup would reveal and whether the practice is the right fit.
Book free consultation →Or call (360) 498-7529 · 1200 Harris Ave Suite 308, Bellingham WA 98225