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When I was in medical practice, patients asked me for weight loss drugs. There were a few that varied in effectiveness, side effects, and risks. In general, none were effective in significant long-term weight loss.
I also had numerous patients with type 2 diabetes who needed medication to achieve optimal blood sugar levels, but did not want or need insulin. Again, there were several, but most patients needed at least two drugs to lower the glucose to the target level.
Then came the GLP-1 drugs.
GLP-1 medications (glucagon-like peptide-1 receptor agonists) are FDA-approved drugs used to manage type 2 diabetes and chronic weight loss. Popular brands include Wegovy, Ozempic, Mounjaro, and Zepbound, which are generally meant for adults with high BMI (body mass index) or weight-related conditions.
(Body Mass Index (BMI) is a screening tool that calculates a person’s body fat percentage based on their height and weight. It is calculated by dividing weight in kilograms (kg) by height in meters squared.)
How GLP-1 Drugs Work
- Appetite Regulation: They mimic the GLP-1 hormone, signaling to the brain that you are full, reducing hunger and calorie intake.
- Blood Sugar Control: They stimulate insulin release after meals and prevent the liver from producing too much glucose.
- Slower Digestion: They delay gastric emptying, keeping food in the stomach
However, they are not perfect and have risks.
- Possible side effects -nausea, vomiting, diarrhea, constipation, and abdominal pain, which often improve over time.
- Potential for thyroid C-cell tumors (based on animal studies), pancreatitis, kidney issues, and severe gallbladder issues.
- Rapid weight loss can cause “GLP-1 face” (loss of facial fat leading to a sagging/wrinkled appearance)
- costs over
$1000 per month, and insurance coverage varies
- FDA has warned about risks associated with unapproved, compounded versions of these medications.
Taking a GLP-1? Doctors Say Not To Forget About Movement and Mental Health
Severe ankle pain drove Jelon Smart to start taking a weight-loss injection a year and a half ago.
Smart was 285 pounds and worked as a caterer in Savannah, Georgia. After she’d been standing on her feet for long hours, her ankles would be “as swollen as a football,” she said. She was walking with a limp.
An orthopedic doctor diagnosed her with Achilles tendinitis and recommended losing weight to mitigate the symptoms. Smart began taking the brand-name GLP-1 Ozempic.
The appetite suppression resulted in her shedding pounds quickly, at first.
“I lost 30 pounds initially without changing anything,” said Smart, 48. But then she found herself unable to shed additional pounds.
GLP-1 Drugs- Weight Loss Made Easy
GLP-1s have quickly become one of the most popular types of weight loss drug in America. Nearly 1 in 5 people have taken them at some point, according to research from KFF, a health information nonprofit that includes KFF Health News.
But doctors say it takes more than a regular shot for patients to achieve their weight goals in the long run.
Here’s what to know.
The Old-School Rules of Diet and Exercise
Regular exercise, smart food choices, plenty of sleep — those basic, healthy lifestyle choices are not only going to help you lose weight on a weight loss drug but also help you keep it off, said Dafina Allen, an obesity medicine physician who runs a clinic in Saginaw, Michigan.
For example, some people find that they eat less on a GLP-1, “but they’re not improving their health because they’re not exercising. They’re not improving the quality of the food they’re eating,” Allen said.
The path to weight loss is also guided by hormones, metabolism, and genetics.
After her weight loss on Ozempic plateaued, Smart realized she needed to start moving her body, too. “I’m in the gym now six days a week,” she said. “I went from 285 to 175” pounds. The swelling and pain in her ankle went away as well.
Mental Health Matters Too
The mind and body are deeply connected. Food and body image can be especially emotional, Allen said. “I can tell you about the patients that I helped lose 50 pounds, that I helped lose 100 pounds, and they still look in the mirror and are not happy.”
The key is seeking help for mental health along the way, said Gerald Onuoha, who practices internal medicine in Nashville, Tennessee. “Making sure that you’re talking to people about your problems, whether it’s a family member or a licensed professional, I think goes a long way,” he said.
Work With a Doctor To Closely Monitor Your Dosage
Onuoha said people can run into serious problems if they increase their GLP-1 dosage too quickly or don’t follow the recommended schedule. He’s seen patients come to the hospital with pancreatitis, gallstones, or acute kidney injury.
“I always ask patients who are on GLP-1s: How long have they been on them?” he said. “Are they adhering to the directions? Because those things determine whether or not you’re going to have those complications.”
Part of the issue, Allen said, is that GLP-1s are relatively easy to access — and often much cheaper — through online pharmacies or websites, but those providers may not educate patients about their dosage or side effects.
“So they might just go online, find a random company that will ship it to their house, where they don’t even know what dose of the medication they’re taking, or even if the medicine is safe for them as the patient with the medical conditions they have,” she said.
People and Policy-Who Pays for GLP-1s?
GLP-1 drugs can be costly, and most insurance programs — public or private — don’t cover the medications for weight loss.
Medicaid, the government program that covers 69 million Americans, covers GLP-1s for medically accepted conditions like diabetes, but only about a dozen state Medicaid programs cover GLP-1s for obesity treatment, according to KFF.
For older Americans with Medicare, the federal government is planning to allow temporary coverage of GLP-1s for weight loss starting in July.
Katherine Ruppelt at Nashville Public Radio contributed to this report.
HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and KFF Health News.KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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The photos in this post are for illustration only and were not in the original article.
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