GLP-1 (glucagon-like peptide-1) receptor agonists are a class of medications originally developed to manage type 2 diabetes. In recent years, they have gained significant attention for promoting weight loss, especially for individuals struggling with obesity. Additional benefits related to the weight loss for these drugs include a lower risk of high blood pressure, heart disease, stroke, fatty liver disease, several cancers, and others
Patients and readers are always asking my thoughts on these drugs since I provide a holistic and integrative analysis that goes beyond the headlines by an often corrupt media. Do we prescribe these drugs at the Stengler Center? Yes. However, we prescribe them judiciously and with caution. There is a place for these medications for people struggling with Type 2 diabetes and obesity since these diseases skyrocket one’s risk for all the major chronic and serious diseases. For the person who has 10-20 pounds to lose due to diet and lifestyle factors, we do not recommend them. The reason I do not prescribe these drugs to anyone who wants them is due to two facts:
What Are GLP-1 Drugs?
GLP-1 is a hormone naturally produced in the gut that regulates blood sugar levels, appetite, and digestion. Most of these drugs are given by injection. It works by:
Synthetic GLP-1 receptor agonists mimic these effects, providing benefits beyond blood sugar control.
Popular GLP-1 Medications
Clinical Evidence
Numerous studies have demonstrated the efficacy of GLP-1 drugs for weight loss. On average, these medications result in a loss of 5% to 15% of body weight. The SURMOUNT-4 Randomized Clinical Trial demonstrated that a once-weekly injection of Tirzepatide in overweight or obese women resulted in a mean weight reduction of 20.9% of body weight over 36 weeks. From week 36 to 88, there was an additional 5.5% mean weight reduction, while those on placebo had an increase of 14%.
Potential Side Effects
The most common side effects of GLP-1 agonists are digestive-related and may include:
Nausea (the most common side effect)
Loss of appetite
Vomiting
Diarrhea
Additional potential side effects which are less common:
Dizziness
Increased heart rate
Infections
Headaches
Indigestion
Severe but rare side effects may include:
Pancreatitis
Medullary thyroid cancer (although this side effects was shown in rats and to date has not shown in human data)
Kidney injury
Worsening of diabetes-related retinopathy
Allergic reactions
Accessibility and Cost
One of the main challenges with GLP-1 drugs is their cost. Without insurance coverage, these medications can be prohibitively expensive, with monthly prices ranging from $800 to $1,500. Efforts are underway to improve affordability and expand access. Patients often have problems with insurance coverage and often prescribe through compounding pharmacies where the cost is significantly lower.
Conclusion
GLP-1 receptor agonists have become very popular in a world that is plagued by obesity and diabetes. This class of drugs can be effective for significant weight loss and diabetes improvement. Digestive side effects are common and long-term side effects still need to be confirmed. Patients should be aware that regaining weight is common for those who use and then discontinue these medications.
References
Abdullah bin Ahmed, I. (2024). A comprehensive review on weight gain following discontinuation of glucagon-like peptide-1 receptor agonists for obesity. Journal of Obesity, 2024, 1–8. https://doi.org/10.1155/2024/8056440
Aronne, L. J., Sattar, N., Horn, D. B., Bays, H. E., Wharton, S., Lin, W.-Y., Ahmad, N. N., Zhang, S., Liao, R., Bunck, M. C., Jouravskaya, I., Murphy, M. A., Fretes, J. O., Coronel, M. J., Gutnisky, L. L., Frechtel, G. D., Gelersztein, E., Aizenberg, D., Maldonado, N., … Nardandrea, J. P. (2024). Continued treatment with Tirzepatide for maintenance of weight reduction in adults with obesity. JAMA, 331(1), 38. https://doi.org/10.1001/jama.2023.24945
GLP-1 agonists. Cleveland Clinic. (2024, October 11). https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists
Koenig, D. (2024, November 26). Side effects of GLP-1 drugs: What doctors should know. Medscape. https://www.medscape.com/viewarticle/side-effects-glp-1-drugs-what-doctors-should-know-2024a1000l8r?ecd=mkm_ret_241228_mscpmrk_pcp_top-content_etid7124114&uac=130325DZ&impID=7124114
Rao, M., Shaunhessy, A., & Sokol, R. (n.d.). Prescribing GLP-1 Agonists for Weight Loss: Wrestling With Our Philosophical Angst. American Family Physician, 110(4).