by Margaret S Garrett - Published 6 months ago

GLP-1 Agonists for Weight Loss: Essential Guide

Type 2 diabetes is a prevalent and well-researched disease in modern times, leading to continuous development of new medications to address it.

One such medication is known as a glucagon-like peptide 1 (GLP-1) agonist. These medications have gained popularity due to their unexpected benefit: significant weight loss, despite initially being developed for type 2 diabetes treatment.

If you believe you might benefit from these medications, this information will provide a comprehensive overview of GLP-1 agonists for weight loss, including their mechanism of action, suitability, potential side effects, and more.

What are GLP-1 Agonists?

Hormones serve as the body's natural messengers, transmitting vital information to various organs to maintain normal bodily functions. Both insulin and GLP-1 peptide are naturally produced hormones.

The food we consume is broken down into simple sugars (like glucose) in the stomach.

Sugar enters the bloodstream and travels throughout the body. Insulin guides the sugar from the blood into cells for energy.

However, when insulin functions poorly, sugar remains in the blood, leading to type 2 diabetes.

This explains why people with diabetes have elevated blood sugar levels. Most diabetes medications, including GLP-1 agonists, aim to regulate blood sugar.

The body has a backup plan. When insulin weakens, as in people with diabetes, the GLP-1 hormone takes over.

Scientists, recognizing this clever strategy, created GLP-1 agonists to mimic the body's actions.

An agonist is a manufactured substance that mimics or enhances the actions of a naturally occurring substance like GLP-1 by activating its receptor.

How Do GLP-1s Work?

GLP-1, typically produced in the small intestine, acts as a four-fold messenger:

It signals the pancreas to increase insulin secretion for proper blood sugar control.
It instructs the pancreas to suppress hormones like glucagon, which can release glucose from storage into the bloodstream.
It signals the stomach to slow down digestion, preventing rapid sugar influx into the bloodstream before insulin can manage it.
It informs the brain about fullness, reducing hunger and increasing satiety, which helps prevent overeating and ensures food is fully digested before consuming more.

This last action has attracted public attention and has made GLP-1 agonists, semaglutide being the most prominent, popular even among individuals without diabetes.

GLP-1 agonists, available through this link: https://pubmed.ncbi.nlm.nih.gov/22236411/, can curb your appetite and make you feel full consistently. This could be particularly helpful if you struggle with portion control and want to lose weight.

However, does this mean GLP-1 drugs are a weight loss solution for everyone? Let's delve into the advantages and drawbacks of using these medications for weight management.

6 Key Factors to Consider When Using GLP-1 Drugs

The U.S. Food and Drug Administration (FDA) initially approved GLP-1 agonists for type 2 diabetes treatment in 2005. These medications are typically dispensed in liquid form, packaged with a needle and syringe.

Administration involves subcutaneous injection into the fatty tissue. The abdomen is the most common injection site, followed by the outer thighs, upper buttocks, and the back of the arms.

It's important to note that these medications are usually prescribed only when safer and more conventional weight loss strategies like diet and exercise have proven ineffective.

GLP-1 agonists are not miracle cures and need to be combined with dietary and lifestyle modifications for long-term effectiveness.

1. Identify Who Can and Cannot Take GLP-1s

To benefit from GLP-1 agonist drugs, your body mass index should be 30 or higher or 27 or higher with a health complication such as:

Prediabetes or type 2 diabetes
Cardiovascular disease
High blood pressure
High cholesterol
Non-alcoholic fatty liver disease
Obstructive sleep apnea
Polycystic ovarian syndrome

According to MyFitnessPal’s registered dietician, Stephanie Nelson, you should talk to your healthcare provider before starting this medication. This is because all medications come with potential risks and side effects. A good healthcare provider will help you weigh the risks of taking the medication versus not taking it.

They’ll also consider the health benefits you'll gain from taking the medication. These drugs are best suited for individuals who are at health risk due to their weight. For instance, if you have obesity, you’re at a higher risk of developing diabetes or heart disease.

If you are not at health risk, these drugs are not recommended because they may put you at unnecessary risk of side effects.

You have a personal or family history of thyroid cancer, as they increase the risk of thyroid cancer.
You’re pregnant, breastfeeding, or planning to get pregnant.
You have severe bowel disease.
You’re allergic/sensitive to semaglutide.
You have a past or active eating disorder.

Another factor to consider when choosing GLP-1s is how they affect your food consumption.

For example, GLP-1s impact food intake by reducing food cravings and subconsciously making you choose less salty, sugary, and fatty foods. This demonstrates the powerful influence of subconscious cues on eating behavior and the role of the brain in obesity.

However, this is a double-edged sword because you still need to be conscious and mindful of what you’re eating to ensure you’re consuming enough food. This is where tracking your food intake becomes important.

When using GLP-1 medications, it's essential to maintain a disciplined approach by making healthy food choices and keeping track of calorie intake to prevent malnutrition and achieve healthy weight loss.

2. Understand Available GLP-1 Medications and Their Effectiveness

Many GLP-1 medications are available in the U.S. market. However, only the following three are currently approved by the FDA for weight-loss use:

Type: Injectable
Frequency: Weekly
Starting dose: 0.25 to 1.7 mg for the initial 16 weeks
Maintenance dose: 2.4 mg
Efficacy findings:
1. Manufacturer-sponsored studies of 803 and 1,961 people: average body weight decrease of 7.9% and 14.9%, respectively, with smaller waistlines and lower overall cholesterol levels, systolic blood pressure, and triglycerides
2. Research review in 2021: weekly Wegovy dosage resulted in weight reduction effects in multiple studies

Manufacturer-sponsored studies of 803 and 1,961 people: average body weight decrease of 7.9% and 14.9%, respectively, with smaller waistlines and lower overall cholesterol levels, systolic blood pressure, and triglycerides
Research review in 2021: weekly Wegovy dosage resulted in weight reduction effects in multiple studies

2021 study of 169 people with obesity: 62.1% lost at least 5% of their body weight over 6 months and 17.2% lost at least 10% of their body weight
2021 manufacturer-sponsored study of 277 people: 9-lb weight loss over 7 months
2022 study comparing Wegovy and Saxenda in 338 people: Wegovy caused more weight after 68 weeks due to decreased hunger and food cravings

2021 study of 169 people with obesity: 62.1% lost at least 5% of their body weight over 6 months and 17.2% lost at least 10% of their body weight
2021 manufacturer-sponsored study of 277 people: 9-lb weight loss over 7 months
2022 study comparing Wegovy and Saxenda in 338 people: Wegovy caused more weight after 68 weeks due to decreased hunger and food cravings

Manufactured-sponsored SURMOUNT-3 trial: total mean weight loss of 26.6% over 84 weeks
Manufactured-sponsored SURMOUNT-4 trial: total mean weight loss of 26% over 88 weeks

Manufactured-sponsored SURMOUNT-3 trial: total mean weight loss of 26.6% over 84 weeks
Manufactured-sponsored SURMOUNT-4 trial: total mean weight loss of 26% over 88 weeks

3. Be Aware of Potential Side Effects

GLP-1 agonists come with a long list of potential adverse effects such as:

Digestive System: stomach discomfort, queasiness, throwing up, constipation, diarrhea, heartburn, indigestion, gas, bloating, burping, and acid reflux
Nervous System: head pain, feeling lightheaded, exhaustion, emotional swings, and thoughts of suicide or suicidal actions
Low blood sugar and diabetic retinopathy in individuals with diabetes
Allergic responses
Drug interactions
Heart rate fluctuations
Gall stones
Pancreatitis
Kidney problems
Elevated risk of thyroid cancer

According to cardiologist and MyFitnessPal scientific advisor Danielle Belardo, MD, many digestive side effects can be addressed by making dietary changes like consuming smaller meals, increasing fiber intake, and staying hydrated.

4. Determine Insurance Coverage for GLP-1 Medications

Insurance coverage for GLP-1 agonists such as semaglutide is determined by several factors, including the type of medication, plan, provider, and health condition.

GLP-1s are occasionally covered by insurance, but only when deemed medically necessary. For example, some providers cover them if used to manage type 2 diabetes.

Medicare does not cover these drugs for weight loss, but Medicaid does in some states.

Consult your provider before starting this drug. Some plans may require prior authorization, a documented diagnosis, specific health criteria, or a copayment.

Wegovy and Saxenda cost $1,349.02 per monthly package.

Zepbound costs approximately $1,059.87 per month.

Novo Nordisk and Eli Lilly, the manufacturers, offer savings programs for uninsured individuals.

You can potentially save about $500 per month for a four-week supply of Wegovy or Zepbound. According to the company, most people with commercial insurance for this drug pay less than $25 per month.

5. Explore Alternative Obesity Treatments

Here are some weight management strategies if GLP-1s aren't right for you:

Choose home-cooked meals over ultra-processed foods.
Make small, sustainable changes to your diet.
Increase your intake of protein and fiber.
Reduce high-sugar beverages and drink more plain water.
Ensure you get sufficient, high-quality sleep.
Increase your physical activity — whether it's through exercise, taking a walk, or doing chores.
In severe cases, consider other weight loss options like surgery or medications that cause weight loss (such as phentermine).
Consult with professionals such as a registered dietician, psychologist, endocrinologist, or physical therapist to receive personalized care tailored to your needs.

6. Consider the Maximum Treatment Duration for GLP-1s

Research indicates that people regain about two-thirds of their lost weight within a year after discontinuing GLP-1 supplements. Therefore, these medications might not be the best choice for long-term weight loss.

Obesity is categorized as a chronic condition. Drugs like GLP-1s suppress cravings, improve insulin sensitivity, and block obesity-promoting pathways in the body. However, these effects can be reversed when the drug is stopped.

GLP-1s can help treat obesity, but they can't completely cure it. So, you might need to take them long-term for ongoing weight management.

Conclusion: GLP-1s Are Not Suitable for Everyone

The best GLP-1 for you depends on your health, how well you tolerate drugs, your budget, and your insurance. Talk to your doctor before starting any new medication.

Diet and exercise are also crucial for successful weight loss. Start with simple changes like meal planning, calorie tracking, or creating an exercise plan.