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This article was updated 5/1/2024.
Glucagon-like-peptide-1 receptor agonist (GLP-1 RA) medications for diabetes and weight management have become very popular lately, due in part to celebrity endorsements and social media chatter.
Semaglutide (Ozempic), dulaglutide (Trulicity), and liraglutide (Victoza) were originally made to help people manage type 2 diabetes. In combination with diet and exercise, GLP-1 RAs medications may help people lose weight—more than 80% of patients with type 2 diabetes also have overweight or obesity, which means many patients could benefit from the dual effects.
But research has shown that GLP-1 RAs can also support weight loss in people who are obese or overweight without type 2 diabetes but who do have a related medical problem, such as high blood pressure or high cholesterol. This has led to a trend of people getting prescriptions to lose weight quickly, creating such high demand that patients who need the medications have had trouble getting them.
While GLP-1 RAs have the potential to help patients lose weight and live healthier lives, they can be expensive. And there can be side effects from treatment. The U.S. Food and Drug Administration announced in early 2024 that it is evaluating possible side effects including suicidal ideation and hair loss.
Patients should seek care from an endocrinologist who understands how GLP-1 RAs work for the most cost-effective and safe outcomes.
How GLP-1 RAs work.
Most GLP-1 RAs are injectable medications, which means the patient uses an injector pen pre-filled with the medication and needle to push the medicine through the skin and into their body. Semaglutide also comes in a pill form.
GLP-1 is a hormone that has multiple actions on blood sugar, mediated by the GLP-1 receptors. GLP-1 RAs bind to and activate the GLP-1 receptor. GLP-1 RAs increase insulin secretion in response to a rise in blood sugar after a meal, lowers glucagon secretion, and slows down stomach emptying. GLP-1 RAs also signal the fullness centers in your brain telling you to stop eating.
GLP-1 RAs help food move slower through the gastrointestinal tract, which means nutrients and sugars are absorbed more slowly. This allows the body to respond to glucose at a more regulated pace. As such, food doesn’t empty out of the stomach as quickly, so patients feel full after eating less.
For many patients seeking to control their weight or blood sugar, GLP-1 RAs can complement a healthy exercise and nutrition plan. Studies have shown that when these medications are combined with lifestyle changes, people with type 2 diabetes lost about 5-10% of their bodyweight and people who do not have diabetes lost from 6-17%.
Like any medication, GLP-1 RAs can cause side effects that should be carefully considered by doctor and patient before beginning a treatment regimen.
Possible side effects of GLP-1 RAs.
The most common side effects of GLP-1 RAs impact the gastrointestinal tract, typically when starting the medications or when the dosage increases. These can include:
- Abdominal pain
- Acid reflux
- Bloating
- Constipation
- Diarrhea
- Heartburn
- Nausea and vomiting
Reports to the FDA mention side effects such as hair loss, suicidal ideation, and aspiration (when food or liquids enter the airway or lungs by mistake). However, new research has shown that semaglutide is not linked to suicidal ideation. Not all GLP-1RA medications contain semaglutide, so more research is needed.
The FDA is actively looking into these reports, and patients should be sure to talk with their doctor about possible side effects before beginning a new medication.
Working with an endocrinologist can help minimize side effects, as they will help you find the most effective dosage. For most of my patients, the side effects fade after a few weeks. In clinical trials, fewer than 5% of patients stopped taking the medication because of these gastrointestinal effects.
Some patients have developed a side effect now known as “Ozempic face.” Quick weight loss can result in a face that appears gaunt with sagging skin in some patients. It is not uncommon to have excess skin after significant weight loss, regardless of how you lose the weight.
Studies have shown that people who have a history of pancreatitis should not take GLP-1 RAs because it may increase the risk of an attack. Research suggests an association between use of GLP-1 RAs and a rare type of thyroid cancer, so people with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 should avoid these drugs.
Some patients may need to take these medications indefinitely to maintain weight loss. Be sure to discuss the risks and benefits with your endocrinologist.
Losing weight is hard. We can help.
Society places a lot of importance on body image, and despite what you see on social media and TV, there is no elusive magic pill or injection that can achieve perfection.
The truth is, weight and blood sugar management can be difficult if you’ve lived with diabetes, overweight, or obesity for a long time. The body and brain become accustomed to functioning at a certain weight, which is part of why it’s so difficult to lose weight and keep it off. Your metabolic rate slows as you lose weight to try to conserve energy, making it even harder to shed pounds.
GLP-1 RAs are a newer weight management treatment, and many doctors are still learning how and when to prescribe them. It’s critical to work with a specialist who understands these medications so you get the correct dosage and minimal side effects as you work toward your goals.
In 2021, the global GLP-1 RA market was $16.53 billion, and it’s expected to exceed $24 billion by 2027. As these medications grow in popularity, remember that while they are difference-makers for many patients, they do not “cure” obesity. Lifestyle changes, and sometimes long-term medication use, are required to maintain a healthier weight and blood sugar. And these medications don’t work for everyone.
Before you start any weight loss or diabetes management plan, talk with an endocrinologist about all your options. A specialist can help you decide what’s right for you and help you get on the road to a healthier life.
