The GLP-1 Revolution

How easy would it be if you just didn't feel hungry?

Glucagon-like Glucagon-like peptide-1 (GLP-1) receptor agonists, initially developed for managing type 2 diabetes, have garnered attention for their effective role in promoting weight loss. These medications, including well-known names such as tirzepatide (Mounjaro, Zepbound) and semaglutide (Ozempic, Wegovy), are now acknowledged for their unique ability to aid in weight management, providing hope for those struggling with obesity.

So how do they work?

GLP-1 medications mimic the natural GLP-1 hormone. This hormone is released in the gut in response to food intake and has several physiological roles related to appetite and digestion. GLP-1 medications work by binding to GLP-1 receptors in the brain and gastrointestinal tract, particularly in regions that regulate appetite. This action promotes a feeling of satiety, helping individuals feel full faster and reducing overall food intake.

Moreover, these medications slow gastric emptying, which means they delay the time it takes for food to leave the stomach. This process further enhances the sensation of fullness and aids in appetite control. Through these actions, GLP-1 receptor agonists contribute to a reduction in caloric intake, thus leading to weight loss.

Where's the evidence?

Numerous clinical trials have demonstrated the efficacy of GLP-1 agonists in achieving weight loss. Studies have consistently shown that these medications can lead to significant weight reductions. For instance, trials with semaglutide have reported weight loss of approximately 15% of body weight over 68 weeks, significantly outperforming placebo groups. Studies on tirzepatide have shown even more dramatic weight loss of more than 20% of body weight.

Side effects & maintenance:

While GLP-1 medications are effective, individuals considering these treatments should be aware of potential side effects. Common side effects include nausea, vomiting, diarrhea, and constipation, which are generally mild to moderate and tend to diminish over time. Gallstones and their complications can occur in anyone, but they are more common in anyone experiencing rapid weight loss. Rare but more severe side effects, such as pancreatitis and kidney problems, may require hospitalization.

Additionally, GLP-1 medications may require long-term usage, particularly in patients who have always struggled with their weight. Once the medication is stopped, the struggle resumes. Patients whose weight gain was mostly situational (ie child-bearing, injury, medication-related weight gain, etc) are more likely to be able to maintain their goal weight without long-term usage, but each case is different. It’s probably no surprise that these treatments are most effective when combined with comprehensive lifestyle modifications, including diet and exercise, to sustain weight loss.

In most cases, we recommend stopping the medication once you have achieved your goal weight, but this is just the beginning of the next phase of your weight management.  We encourage patients to monitor their weight and eating habits and try to keep the weight off on their own. If they start to struggle, we encourage patients to reach back out so we can re-evaluate and discuss next steps. You’re not alone on this journey any more!