By Robert Duhaney, MD
If you’ve been paying attention to the latest trends in healthcare and weight management, you’ve probably heard a lot about GLP-1 medications. Drugs like semaglutide (marketed as Ozempic, Wegovy) and tirzepatide (Mounjaro and Zepbound) are making waves in both the medical community and pop culture. But what’s behind all the buzz? As a primary care physician who works closely with patients on weight management and overall health, I think it’s time to break it all down: what GLP-1s are, how they work, and why they’re creating so much excitement.
What Are GLP-1 Medications?
GLP-1 stands for glucagon-like peptide-1, a hormone naturally produced in the gut. This hormone plays a key role in regulating blood sugar levels, appetite, and digestion. GLP-1 receptor agonists (technically called GLP1-RAs) are medications that mimic the effects of this hormone. While these drugs were initially developed to treat type 2 diabetes nearly 20 years ago (exenatide, trade name Byetta), researchers quickly noticed a significant side benefit: patients lost weight. Now, some GLP-1 medications are FDA-approved specifically for weight management, and they’re changing the way we think about obesity and its treatment.
How Do They Work?
GLP-1 medications work through several mechanisms:
Appetite Suppression: These drugs slow the emptying of the stomach, making you feel fuller for longer. They also act on areas of the brain that regulate hunger, reducing cravings and the urge to overeat.
Improved Insulin Sensitivity: For patients with diabetes or prediabetes, GLP-1s improve how the body uses insulin, helping to stabilize blood sugar levels.
Reduced Caloric Intake: By curbing hunger and promoting a sense of fullness, these medications naturally lead to reduced calorie consumption, which supports weight loss.
Why the Excitement?
The enthusiasm around GLP-1s comes from their effectiveness and the broader implications for how we approach weight and health. Here are a few reasons they’re getting so much attention:
Significant Weight Loss: In clinical trials, patients on GLP-1 medications often lose 10-15% of their body weight or more, results that were previously difficult to achieve without surgery.
Health Benefits Beyond Weight: Losing weight with GLP-1s can lead to improvements in other health markers, such as lower blood pressure, better cholesterol levels, and reduced risk of heart disease. These drugs also show promise in managing conditions like fatty liver disease, obstructive sleep apnea, and even alcohol dependency.
A New Perspective on Obesity: GLP-1s underscore the idea that obesity is a complex, multifactorial disease, not simply a matter of willpower. They validate what many of us in primary care have been saying for years: weight management often requires medical interventions, just like any other chronic condition.
Accessibility of Non-Surgical Options: For patients who aren’t candidates for bariatric surgery or prefer a less invasive approach, GLP-1s offer a viable, evidence-based alternative.
The Patient Experience
In my practice, I’ve seen GLP-1 medications make a profound difference in patients’ lives. Patients who have struggled with weight for years—despite dieting, exercising, and doing "all the right things"—are finally seeing results. And it’s not just about the number on the scale. Many report feeling more energetic, sleeping better, and experiencing an overall improvement in quality of life.
The Caveats
Of course, no medication is perfect. Here are a few things to keep in mind:
Side Effects: Common side effects include nausea, vomiting, diarrhea and/or constipation especially when first starting the medication. These symptoms often subside over time.
Cost: GLP-1 medications can be expensive, and insurance coverage varies widely. For many patients, the out-of-pocket cost is a significant barrier.
Long-Term Commitment: For sustained benefits, GLP-1s typically need to be taken long-term. Stopping the medication often leads to weight regain, highlighting the need for ongoing treatment and lifestyle support.
Loss of muslce mass. With GLP1s you can lose fat and muscle, so it's recommended to maintain adequate protein intake and engage in weight bearing exercises to mitigate any lean muscle loss.
Not for Everyone: These medications are not appropriate for patients with certain medical conditions, such as a gastric motility problems, a history of medullary thyroid cancer, or history of pancreatitis. Also, while there are reports that GLP1s are improving women's fertility (likely by reducing insulin resistance and regulating menstural cycles), tirzepatide can make birth control less effective. Also, during pregnancy you need to gain a healthy amount of weight so these meds are recommended to be stopped 2 months prior to trying to conceive.
Where Do We Go From Here?
The rise of GLP-1 medications is an exciting development in the fight against obesity and its associated health risks. I remember when all we had was phentermine and the ill-proven HCG injections. Other meds came along like Alli, Contrave, Qsymia, and even the predecessor to Ozempic/Wegovy called Victoza/Saxenda which had relatively small but variable amounts of weight loss....but a lot of unwanted side effects. And...the weight loss simply could not be sustained for most patients. Nevertheless, these newer generation GLP1s are not a magic bullet. Weight management remains a holistic process that involves nutrition, physical activity, mental health, and social support - not just medication assistance. For patients with BMIs of 40 or more, bariatric surgery may in fact be the better option - perhaps with a low to medium maintenance dose of GLP1s post procedure to help keep the weight off.
As a physician who has treated patients for weight for almost 17 years and have had personal challenges in my family as well as myself with weight, I’m truly encouraged by the progress we’re making in understanding and treating obesity. Finally we are starting to move away from the wagged finger in the face of patients to "Do better - just walk more and eat less" as we as health providers just got back from our burger and fry lunch ourselves. Or worse, we would send patients to the dietician (who has a BMI of 19) to have them counsel the patient on healthy eating - they themselves having virtually no concept of the struggle to lose weight.
Weight is multifactorial and complex. GLP-1s represent a step forward, but they’re just one tool in a much larger toolbox. My hope is that as these medications become more widely available and affordable, more patients will have the opportunity to benefit from them. I feel we as primary care providers have a unique opportunity to be part of this renewed discussion about weight, nutrition, and health with our patients. Online platforms like Hims, Ro, and Calibrate are stepping in to fill the void where traditional primary care has come up short. Even med spas are getting in on the action. This is where either inappropriate patient selection or lack of instructions on "generic" versions have led to adverse side effects - like patients accidently drawing up too much medicine from a vial triggering massive GI upset, vomiting and an ER visit.
With proper use and guidance by trained medical professionals, these meds can in fact be safely compounded by an accredited compound pharmacy under FDA provisions. But...even better - getting an affordable FDA-approved brand version of these GLP1s in the hands of appropriate patients is what is really needed.
So if you’re curious about whether a GLP-1 medication might be right for you, talk to your medical provider or find one who is willing to have a respectful conversation about weight. Together, you and your medical team can create a personalized plan to help you achieve your health goals—because everyone deserves to look and feel their best!
For more on the topic, check out this great article on GLP1s by Dr. Jared Dashevsky here.
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