GLP-1s have been billed as the most effective weight loss medications ever developed, often earning the label “miracle drugs.”

Initially approved by the Food and Drug Administration for treatment of Type 2 diabetes, they quickly gained attention when patients started losing significant weight.

But GLP-1s aren’t for everyone. Here’s what you need to know about these popular medications.

How do GLP-1s work?

The formal name for GLP-1 medications is glucagon-like peptide-1 receptor agonists, and they mimic the action of a naturally occurring hormone (GLP-1, of course) in the body.

There are two main types of GLP-1 medications, which are sold under brand names such as Rybelsus, Mounjaro, Ozempic, Saxenda, Wegovy, Zepbound and Foundayo. They work on many body systems, said Kevin G. Wietecha, D.O. of Aultman Medical Group Endocrinology in Canton.

“GLP-1s lower insulin levels by making the body use insulin more efficiently,” Wietecha said. “These medications also reduce sugar production from the liver. They cause the stomach to empty more slowly, helping people to feel full earlier. And in the brain, they help reduce people’s desire to eat.”

The resulting weight loss leads to additional health benefits. In some studies, people using GLP-1 medications have lost an average of 10% to 15% of their body weight over a year’s time, according to Harvard Health Publishing of Harvard Medical School.

Losing even 5% to 10% of body weight can improve metabolic health, lower blood pressure, lower the risk for developing weight-related chronic conditions, reduce the risk of heart attack and stroke and improve quality of life.

Why and how are GLP-1s prescribed?

GLP-1s are typically prescribed to help manage Type 2 diabetes and weight.

“Now available orally or by injection, these medications are used for diabetic care,” Dr. Wietecha said. “GLP-1s are also prescribed for weight management for patients who are obese or who are very overweight with other medical risk.”

Providers might also prescribe GLP-1 drugs to:

• Reduce the risk of worsening kidney disease and death in certain adults with Type 2 diabetes and kidney disease. Ozempic at 1 mg or greater dose has the FDA indication for this use.
• Treat noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) – a serious form of fatty liver disease, with semaglutide (Wegovy) having approval.
• Treat obstructive sleep apnea in adults with obesity. Obstructive sleep apnea is a condition where breathing is stopped for short times while sleeping, which Zepbound has the indication for.

Are there concerns about the use of GLP-1s?

These medications may not be appropriate for everyone, so it’s important to talk with your provider about the pros and cons.

For example, the question of how long people can use GLP-1s is still being researched and reviewed.

“For weight loss alone, we try to prescribe the lowest dose needed,” Dr. Wietecha said. “The medication is most effective when combined with a holistic approach to lifestyle changes. We usually stop the medication once the patient has achieved an ideal weight and has maintained lifestyle changes that will help them stay at a healthier weight.”

GLP-1s can have side effects. “Muscle wasting can be an issue because people lose both fat and lean body mass as their weight goes down,” Dr. Wietecha said. “Also, GLP-1 patients should be monitored for a rare thyroid disease.”

GLP-1s can cause nausea, vomiting, diarrhea or constipation. Rare side effects include stomach paralysis, inflammation of the pancreas or an obstruction in the small bowel.

More research needs to be done on the effects of long-term use, particularly for people who do not have Type 2 diabetes, Dr. Wietecha said.

Why are people talking about compounded GLP-1s?

GLP-1s became so popular so quickly that shortages developed. As a result, some people turned to compounded GLP-1s – customized versions made by a pharmacy.

The National Academy of Medicine cautions against the use of compounded GLP-1s. Compounded drugs have not been assessed by the U.S. Food and Drug Administration (FDA) for safety, effectiveness or quality.

“With compounded GLP-1s, proper supply lines are not followed,” Dr. Wietecha said. As a result, some compounded drugs may not have been stored properly, or they may be missing important ingredients.

“So many FDA-approved types of GLP-1s are now available that we don’t need to prescribe compounded drugs,” Dr. Wietecha said.

Should I talk to my provider about GLP-1s?

GLP-1s can be an effective treatment for people who really need them. If you have Type 2 diabetes or obesity or are overweight with other health conditions, your provider can help you decide whether GLP-1 medications are right for you.

Sources:
Harvard Health Publishing
National Academy of Medicine
The StayWell Company, LLC
U.S. Food and Drug Administration