Weight loss medications such as Wegovy and Zepbound have garnered an enormous amount of attention recently for their ability to help some users lose significant amounts of weight relatively easily. But what are GLP-1s, how do weight loss medications work, and are they right for you?
If you’re considering a GLP-1 inhibitor, it’s essential to discuss your options with a health care provider.
[READ Can Microdosing Weight Loss Drugs Like Ozempic Help You Lose Weight?]
What to Ask About Weight Loss Drugs
GLP-1 medications for weight loss can be expensive, so you may want to call your health insurance company to find out what it covers before you see your doctor.
Be sure to ask your doctor the following 13 questions before beginning one of these medications so you’ll know what to expect.
1. What are GLP-1 medications?
Glucagon-like peptide-1, or GLP-1, is “a hormone that’s secreted by the intestinal tract,” explains Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California.
Also known as incretin mimetics, these GLP-1 receptor agonist medications mimic the effects of the GLP-1 hormone, and “stimulate insulin secretion, which lowers blood sugar levels,” Ali adds.
There are several drugs in this class:
— Semaglutide. Sold under the brand names Ozempic, Wegovy and Rybelsus, this medication has become the most recognizable of this class of drugs.
— Liraglutide. This medication is sold under the names Saxenda and Victoza and is used to treat Type 2 diabetes and obesity.
— Dulaglutide. Also known as Trulicity, this injectable medication is used to treat Type 2 diabetes.
— Exenatide. Sold as Byetta or Bydureon, this injectable medication is used to treat Type 2 diabetes.
— Lixisenatide. This once-daily injection medication is sold as Adlyxin and used to treat Type 2 diabetes.
Additionally, tirzepatide — marketed as Mounjaro or Zepbound — is a dual GIP and GLP-1 receptor agonist, meaning that it activates both GLP-1 receptors and glucose-dependent insulinotropic polypeptide, or GIP, which is a hormone produced in the gut that also regulates blood sugar levels and helps with weight management.
Initially developed to treat diabetes and prediabetes, GLP-1 medications can also trigger weight loss. Though it was initially considered an unintended side effect, for many people with prediabetes or diabetes, losing weight is now recognized as a key benefit, as weight loss can improve your body’s sensitivity to insulin and reduce symptoms of these conditions.
Noting that significant weight loss was possible for some patients, drug manufacturers developed more potent formulations of some of these medications that have since been approved to treat obesity. For example, tirzepatide is approved for obesity treatment under the brand name Zepbound, while semaglutide, the medication approved explicitly to treat obesity, is branded as Wegovy.
[READ: Semaglutide vs. Weight Loss Surgery: Which Is Better?]
2. How do GLP-1 medications work?
GLP-1 medications work in two main ways. First, they slow down the gut so you feel fuller longer, says Dr. Muhammad Ghanem, a bariatric and minimally invasive surgeon with the Orlando Health Weight Loss and Bariatric Surgery Institute in Florida.
Secondly, these medications work on receptors in the brain to inhibit hunger. The combination of these effects leads people to eat less and lose weight.
3. What’s special about these weight loss medications?
Up until recently, when an individual sought help with losing weight, they were usually advised to strive for a simple calorie deficit by exercising more and eating less. In some cases, the patient might have been offered bariatric surgery to physically change the size of the stomach and reduce feelings of hunger.
There have also been other weight loss medications prior to the arrival of GLP-1 medications, but these drugs often came packaged with dangerous side effects or the rapid regain of any weight lost once the medicine was discontinued.
Bariatric surgery has also been an option for many years, but some people balk at the invasive nature of the procedure or are unable to have it due to other health concerns.
But the arrival of these next-generation obesity medications has provided new insights into obesity and how best to manage it, Ghanem says.
That’s because GLP-1 medications have proven that there’s more to weight loss than a simple calorie deficit; hormones also play a significant role.
As more people use these medications and researchers have time to study them, there may be new revelations and developments that continue to alter how we understand and treat weight problems.
“GLP-1s are the tip of the iceberg and we’re just starting to tackle this disease,” Ghanem says.
[READ: What to Eat — and Avoid — on GLP-1 Weight Loss Medications]
4. How much weight should I expect to lose?
Weight loss estimates vary from person to person, but studies have shown that people taking GLP-1 medications can expect to lose about 10% to 15% of their body weight, Ghanem says.
However, “not everyone responds the same,” Ghanem cautions, so your results may vary.
5. How long do weight loss drugs take to work?
Most people will begin losing weight within the first 6 weeks of taking a GLP-1 medication. Typically, your doctor will start you at a very low dose and gradually increase it over the course of a few months. This means that you may not notice much effect initially. But as the dose increases, so should its effects.
Most people can expect to see that 10% to 15% weight loss over about 12 to 18 months, Ali says.
6. Do I have to make other changes to lose weight?
In a word, yes. While GLP-1 medications have revolutionized weight loss, they work best when combined with sensible lifestyle changes, including eating a balanced, healthy, lower-calorie diet and moving more. Many experts recommend increasing protein intake in combination with strength training to help minimize muscle loss.
How best to do that also varies from person to person, but Ghanem points to dietary and activity guidelines from the American Heart Association as a good starting point. These guidelines recommend getting at least 150 minutes of moderate intensity activity or 75 minutes of vigorous exercise each week and eating a balanced diet that limits processed foods, alcohol and sodium. The Mediterranean diet is a perennial favorite of doctors and dietitians everywhere.
[Read: What Happens When You Stop Taking Weight Loss Drugs?]
7. What are the challenges associated with GLP-1 medications?
There are two significant challenges associated with these medications:
— Access. GLP-1 medications cost $1,300 a month or more if you’re paying out of pocket, and many health insurance policies don’t cover them.
— Side effects. From indigestion to bowel obstructions, there can be a range of side effects associated with weight management medications.
8. What are the side effects of GLP-1 medications?
For some users, GLP-1 medications can bring uncomfortable or unpleasant side effects, including:
— Nausea
— Vomiting
— Diarrhea
— Gas and bloating
— Dizziness
— Fatigue
— Abdominal cramping
“Some side effects can linger, but most of the time they end up going away in a certain period of time,” Ghanem says. However, “the only real way to resolve the side effects is to stop taking the medication.”
Some users may also experience muscle loss as part of their overall weight loss.
[READ: Mounjaro for Weight Loss: What Is Mounjaro and How Does it Work?]
9. Who is not a candidate for GLP-1?
Not everyone can take a GLP-1. People with certain health conditions should not take these medications, including:
— A history of pancreatitis
— Severe gastrointestinal issues, including gastroparesis
— Kidney or liver problems
— During pregnancy or while breastfeeding
— A history of or high risk for certain types of thyroid cancer
— Diabetes-related eye problems
You also must meet certain criteria to get a prescription:
— Have a body mass index of 30 or above
— Have a body mass index of between 27 and 30 with a qualifying medical condition such as diabetes
10. If I stop taking the medication, will the weight come back?
Most doctors say yes, you’re highly likely to regain the weight you’ve lost if you stop taking a GLP-1.
“Almost all the studies show that as soon as you stop the medication you’ll gain the weight back,” Ghanem says. This is because these medications can’t cure the underlying cause of obesity; they simply control some of the symptoms, including overeating and cravings.
Stopping a GLP-1 medication means your body will return to its normal hunger levels, and you may experience a resurgence of cravings along with a renewed drive to eat more. This can lead to weight gain.
However, if you’ve made substantial lifestyle changes in combination with taking the medication, you may be able to maintain weight loss indefinitely after stopping the medication. In one study, participants regained two-thirds of their prior weight loss after stopping a weekly injection of semaglutide.
It’s also worth noting that because these medications are relatively new, researchers are still investigating their potential long-term impacts. Though they are generally thought to be safe for continuous use over an indefinite period of time — and some studies have found they can reduce patients’ risk for some cardiovascular issues and other chronic conditions — other studies have suggested that gastrointestinal complications can arise from their use.
[READ Foods That Mimic the Effects of Ozempic and Other GLP-1 Drugs]
11. Who can prescribe me a GLP-1 medication?
While most any prescriber can write you a prescription for a GLP-1 medication, you’re best served if you work with an obesity medicine specialist when using one of these medications.
12. Is one GLP-1 weight loss drug better than the other?
There are three GLP-1 medications currently approved specifically for weight loss: Saxenda, Wegovy and Zepbound. They work in very similar ways, though some studies have found that Zepbound can lead to a greater percentage of weight loss for some patients.
The proper medication for you will depend on your unique physiology. Some patients respond to one and not another or have fewer side effects with one over another, Ghanem says. It’s not clear why this is the case, so you may need to try a few options to see which works best.
13. What other drugs are used for weight loss management?
There are a variety of weight loss medications on the market that help with weight loss, and some of them have been available for a longer period than GLP-1 medications. Some examples include:
— Orlistat (Xenical or Alli)
— Phentermine-topiramate (Qsymia)
— Naltrexone-bupropion (Contrave)
— Setmelanotide (Imcivree)
They all work differently from GLP-1 medications, and though they typically lead to less weight loss than newer GLP-1 medications, they may be a good option for some people.
There are other options beyond weight loss drugs. You can also undergo bariatric surgery. There are several types of bariatric surgery, but they all involve a structural alteration to part of the digestive system to restrict food intake or absorption, which can lead to weight loss and improvements in obesity-related health problems.
Ghanem says bariatric surgery can lead to greater weight loss than GLP-1 medications, on the order of about 30% of your body weight. He argues that it’s also more sustainable than taking an expensive medication for the rest of your life, but you’ll need to work through those specifics for yourself.
In all cases, he recommends “making sure you’re talking to a specialist and that they’re giving you the spectrum of available options as a patient.”
After You Start a GLP-1 Medication
Tracking your dosing, how you feel after each dose and side effects can be very helpful for you and your doctor after you start a GLP-1 medication.
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13 Questions to Ask Your Doctor Before Starting a GLP-1 Weight Loss Drug originally appeared on usnews.com
