Over the past few years, Ozempic, Mounjaro, Zepbound, and similar GLP-1 Weight Loss medications have surged in popularity. We’ve seen increased interest in these medications in our practice as the use of these treatments has become more widespread.
There’s a lot to contemplate when considering medication for weight loss—including your medical history, disease risk, body weight and height, activity level, nutrition, personal goals, and more—but I’ll share my general thoughts on these medications.
First, it’s important to have a basic understanding of how these medicines work. The majority of them, most of which are injected weekly, belong to a class of medicines called GLP-1, or glucagon-like peptide-1 receptor agonists. They were initially aimed at treating patients with type 2 diabetes, but some are now developed specifically to treat obesity.
Some of these GLP-1s have the same main component but different brand names. Some are FDA-approved for managing type 2 diabetes (even though they aid with weight loss), and some, such as the brand Zepbound by Eli Lilly, are now specifically approved for weight loss. When used for weight management, they are recommended for those with a body mass index (BMI) of 30 and higher or a BMI of 27 and higher in individuals with a weight-related health condition, such as high blood pressure.
Two of the most popular GLP-1s on the market today are semaglutide (sold as Ozempic, Wegovy, and Rybelsus) and the latest, tirzepatide (sold as Mounjaro and Zepbound). There are a few others, but these are the most commonly talked about and prescribed today, so we’ll focus on them.
Regardless of the name, GLP-1s imitate natural hormones in the body and impact several metabolic functions. Perhaps their most important effect is that they slow down the emptying of the stomach. This leads to patients feeling satiated and full for longer. This is likely the biggest factor in inducing weight loss. In addition, these medicines stimulate the pancreas to produce insulin, allowing the body to convert ingested food into energy and reduce the amount of glucose in the bloodstream. Simultaneously, they inhibit the release of glucagon, which also helps manage blood sugar levels. In broad terms, GLP-1s help manage blood sugar levels and help you feel full longer, with smaller portion sizes.
Clinical Studies for Weight-Loss
When reviewing different trials and studies for weight-loss results with GLP-1s, it’s important to note that some studies focus on individuals with type 2 diabetes, while others are now targeting those with obesity. We must also take into account the dosage and how long patients were on them.
While no clinical trials directly compare the medications, these two recent studies provide insights into common results.
A study published in The New England Journal of Medicine in February 2021 focusing on the use of semaglutide (sold as Ozempic, Wegovy, and Rybelsus) for weight loss showed that people lost an average of 6.9 kg (or about 15.2 pounds) of body weight at the end of 40 weeks.
Tirzepatide studies have shown even more promising results. It is the first of these medications to interact with two hormones in the body, which is why researchers believe it manages blood sugar levels better than previous medicines and helps people lose more weight. In a study also published in The New England Journal of Medicine a few months later in June 2021, those taking 5mg lost about 7.8kg (about 17lbs), those with 10mg lost 10.3kg (about 22.7lbs), and those on 15mg lost 12.4kg (about 27lbs). All results were at the culmination of 40 weeks.
Side Effects, Risks and Considerations
While these medications are effective, there are some additional factors to consider prior to commencing treatment.
Side Effects
Although these medications are generally well tolerated, they can lead to uncomfortable side effects. When first starting treatment, some patients experience stomach cramping or nausea, while others can also have vomiting or diarrhea. To avoid or minimize these effects, the medications are started at a low dose and then ramped up slowly over a few months. Generally, we’ve seen these side effects fade over time.
Risks
One of the risks that has been discovered with GLP-1 agonists is an increased risk of thyroid cancer, specifically medullary thyroid carcinoma. This type of cancer is fairly rare, but it’s important to consider, especially if you have a risk for or a family history of thyroid cancer.
Since these medications are still fairly new, we don’t know all the possible long-term effects or risks. We continue to follow the medical literature for updates.
Cost
Another consideration is cost. These medicines can be expensive and sometimes challenging to get covered by insurance. Some insurance companies cover some medications for the treatment of type 2 diabetes, but not all of them.
When a medicine is used off-label (for example, if your doctor prescribes a diabetes medication like Ozempic for weight loss), insurance will most likely not cover it. Even some FDA-approved medications for weight loss, like Wegovy and Zepbound, have had limited coverage. Some insurances, for example, may require that a patient first complete a six-month supervised weight-loss program prior to insurance approval for a weight-loss-specific GLP-1 medication.
Availability
Due to the surge in demand, some GLP-1s have been in short supply over the past several months, as you may have seen reported in the news. Pharmaceutical companies are trying to meet the demand, but at times, patients have had some difficulty obtaining them.
At our clinic, we have worked with patients to find a pharmacy that has it in stock, or in some instances have had to adjust the dose or change between similar medicines. Our staff is in close contact with our patients and local pharmacies to do our best to try to avoid any lapses in treatment.
Lifestyle Changes
As with any weight-loss treatment, GLP-1s work best when incorporated into a healthy lifestyle. This includes attention to diet and portion sizes and incorporating exercise and movement into your daily routine. These changes will also assist with long-term success, as they will help you maintain the weight loss once you stop taking the medication.
Most research to date shows that when patients stop the medication, they gain at least some of the weight back. However, our hope is that patients may build healthy habits while on the treatment, which will help them maintain the weight loss when they stop treatment.
Body Composition
While patients can lose weight with GLP-1s, they can lose some muscle mass as well as fat. This effect is seen with any form of weight loss. The best way to maintain muscle mass is with adequate protein intake and exercise that includes resistance training.
Long-Term Use
One common question patients have is how long can someone take a GLP-1 medication. For the treatment of diabetes, these medications can be used long-term if they are needed for control of the diabetes and are well tolerated. Many researchers also feel that obesity is a chronic condition and that long-term treatment is recommended.
In studies where people have been treated with GLP-1 medicines and then had the medication stopped, partial weight is often regained in the ensuing months. In practice, we weigh the risks and benefits of every medical treatment that we consider and adjust our recommendations based on the latest research and the individual’s specific situation. Research on GLP-1 medications is still evolving, and we expect to have much more information in the next few years.
Final Thoughts
GLP-1 medications are an important tool in managing diabetes and obesity. They do come with some risks and side effects, which are mostly mild and transient, but there are also significant benefits in risk reductions associated with lower blood sugars and weight loss. Even with new medication options, a person’s lifestyle, which should include a healthy diet and regular activity and movement, remains a crucial part of health and wellness. It is important to review your specific health goals and considerations with your physician.
As always, we at Peninsula Doctor team are here to answer any of your more specific questions about these medications and discuss whether GLP-1s may be a worthwhile option for you.
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