What You Should Know About GLP-1 Agonists for Weight Loss

In the realm of weight management, the recent spotlight has begun to turn toward a class of medications known as glucagon-like peptide 1 (GLP-1) agonists. While traditionally these medications have been used to tackle diabetes and regulate blood sugar levels, in recent months they are now gaining massive popularity for their appetite-reducing and therefore weight-loss-promoting properties.

What Are GLP-1 Agonists?

GLP-1 agonists belong to a class of medications that were originally designed to treat type 2 diabetes and obesity. Main staples, Wegovy and Saxenda took the stage first as the only FDA-approved GLP-1 agonists for chronic weight management in individuals who are overweight or obese without diabetes. What followed was the popular Ozempic, which is where weight loss drugs began to rise in popularity. Intended to be used with diet and exercise, these drugs are designed for consistent and prolonged use to maintain efficacy, with the potential for weight gain to return upon discontinuation. All but one GLP-1 agonists are administered through subcutaneous injections, the exception being the semaglutide tablets (Rybelsus) - see below.

Types of GLPs

GLP-1 - Indicated for people with Type 2 Diabetes: GLP-1 receptor agents have been recommended as add-on therapy for patients who do not achieve A1C target after 3 months of metformin therapy, or as a replacement of metformin therapy. This usage is well suited for type 2 diabetes patients as it simulates the release of insulin and suppresses glucagon secretion only when blood glucose concentrations are elevated, thus resulting in a lower risk of hypoglycemia.

GLP-1 - Saxenda - indicated for people without Type 2 diabetes: This drug works much like those recommended for their type 2 diabetes counterparts and can serve as an adjunct to diet and exercise for obese or overweight adults. A higher dose than the ones used for treating type 2 diabetes, this medication also stimulates insulin release and inhibits glucagon secretion which slows gastric emptying and increases fullness upon eating. The benefits of this medication typically result in significant weight loss of 5% baseline body weight at one year, but weight gain may occur with discontinuation of the drug.

There are some notable side effects of the use of this medication: increased risk of acute gallbladder disease, acute pancreatitis, and severe hypoglycemia. In addition, GI symptoms are common and result in roughly 10% of patients discontinuing use.
Many doctors are in support of this medication for patients who are struggling with the disease of obesity, which is noted by a large BMI (Body Mass Index). This means that these medications are not for patients who are looking for cosmetic weight loss. These medications do have risks, and it is not worth losing a few pounds before a special event or vacation.

SGLT-2 inhibitors are another medication that is used to promote the renal excretion of glucose and thereby modestly lower elevated blood glucose levels in patients with type 2 diabetes. Additionally, these medications can be used for people with chronic kidney disease and or heart failure to help slow progression. These drugs work by preventing your kidneys from reabsorbing sugar that is created by your body, and the extra sugar levels leave through your urine.

How GLP-1 Agonists Work to Help with Weight Loss

These drugs mimic the action of a hormone called glucagon-like peptide 1. When blood sugar levels start to rise after someone eats, these drugs promote the body to produce more insulin which in turn helps lower blood sugar levels.

While it is not entirely clear yet why such drastic weight loss is achieved, doctors have attributed some of this to the curbing of hunger, as well as slowing the movement of food from the stomach into the small intestine while making you feel full faster and longer so you eat less.

List of GLP-1 agonists:

• Dulaglutide (Trulicity®)
• Exenatide (Byetta®)
• Exenatide extended-release (Bydureon®)
• Liraglutide (Victoza®)
• Lixisenatide (Adlyxin®)
• Semaglutide injection (Ozempic®)
• Semaglutide tablets (Rybelsus®)
• Dual GLP-1/GIP receptor agonist: Tirzepatide (Mounjaro®)

The difference in these GLP-1 agonists generally depends on patient traits and existing or potential comorbidities of the intended patient. 

• Semaglutide, for instance, is recommended for patients with Type 2 diabetes with established cardiovascular disease. 
• Dulaglutide, in contrast, is recommended for Type 2 diabetes patients with an increased risk of cardiovascular disease. 
• High-dose liraglutide is recommended for patients 12 years and older with a BMI of 30 or greater.

Your primary care physician in Saratoga will review your past history and health condition before making a decision on if and which GLP-1 agonists would be the most appropriate treatment for you.

GLP-1s Connection to Type 2 Diabetes Management

When blood sugar levels start to rise after someone eats, these drugs stimulate the body to produce more insulin. The extra insulin helps lower blood sugar levels. This, mixed with the slowing movement of the food entering the small intestine results in patients feeling full faster and longer, so they eat less.

Secondary to controlling blood sugar and boosting weight loss, GLP-1s seem to have other major health benefits like lowering the risk of heart disease, stroke, and kidney disease. Major health markers also improve like cholesterol and blood pressure, however, it is not clear whether this is due to the medication or the weight loss.

Should You Ask for a GLP-1 Prescription?

Are you struggling to manage your Diabetes 2 diagnosis? Simultaneously, have you tried everything to lose weight and still have little to no success? Are you hoping to see more benefits that come with lower blood sugar levels and weight loss? If you have answered yes to these questions, it may be worth discussing the use of GLP-1 medication with your primary care doctor.

A few words of caution here:

• GLP-1 is not recommended for pregnant women. If you’re able to become pregnant, you should use effective and reliable birth control while taking a GLP-1 agonist as they are not safe to take during pregnancy. If you become pregnant while taking the medication, see your healthcare provider immediately.
• If you have a personal or familial history of medullary thyroid cancer or multiple endocrine neoplasia GLP-1 drugs may not be recommended, as these drugs have been linked with thyroid tumors in rats. 
• People with a history of pancreatitis should also not be taking this medication.
• Finally, remember, GLP-1 agonists are not intended for individuals seeking modest weight loss. To qualify for a prescription, specific FDA guidelines must be met, including a BMI of at least 30 or a BMI of at least 27 with a weight-related condition such as high cholesterol, type 2 diabetes, or high blood pressure.

Things to Think About

While there are many notable positives while taking GLP-1 prescriptions, like with any medication there is a risk of side effects. Some of the more common side effects, like nausea, vomiting, and diarrhea, will improve while you continue to take the drug for a while. Other more serious risks are the potential for low blood sugar levels (hypoglycemia). However, this risk is small unless you are taking another drug known to lower blood sugar at the same time. Another disadvantage to these medications is that all but one must be taken by an injection.

Remember, medication is not simply a “cure-all” for weight management. Though GLP-1 agonists can be useful as a tool, they need to be included as part of a multifactorial plan that includes dietary changes, exercise, and weight loss.

Got More Questions?

We are here at Los Gatos Doc for your seasons of wellness including managing any chronic disease or weight loss desires. If you have more questions about these medications or others, call our office today: 408-502-6040.