What's the Latest About Injectable GLP1s?

By Robert Duhaney, MD

If you’ve been following the latest developments in healthcare and weight management, you’ve likely heard about GLP-1 medications. Drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are generating significant buzz in both the medical community and popular culture. But what’s behind the excitement? As a primary care physician specializing in weight management and overall health, I want to break down what GLP-1 medications are, how they work, and why they’re making such an impact.

What Are GLP-1 Medications?

GLP-1 stands for glucagon-like peptide-1, a hormone naturally produced in the gut. It plays a crucial role in regulating blood sugar levels, appetite, and digestion. GLP-1 receptor agonists (GLP-1 RAs) mimic this hormone’s effects. Originally developed nearly 20 years ago to treat type 2 diabetes (exenatide, trade name Byetta), researchers quickly noticed an unexpected benefit—significant weight loss. Today, some GLP-1 medications are FDA-approved specifically for weight management, revolutionizing obesity treatment.

How Do They Work?

GLP-1 medications promote weight loss through multiple mechanisms:

Appetite Suppression: They slow stomach emptying, increase satiety, and act on hunger centers in the brain.
Improved Insulin Sensitivity: They enhance the body’s insulin response, stabilizing blood sugar levels.
Reduced Caloric Intake: By naturally curbing appetite, they help patients consume fewer calories and sustain weight loss.

Why the Excitement?

GLP-1 medications are receiving widespread attention for several key reasons:

Significant Weight Loss: Clinical trials show patients often lose 10-15% of their body weight or more—results that were previously difficult to achieve without surgery.
Health Benefits Beyond Weight Loss: Improvements in blood pressure, cholesterol, fatty liver disease, and even conditions like obstructive sleep apnea and alcohol dependence.
A New Perspective on Obesity: Reinforcing that obesity is a complex medical condition requiring evidence-based treatments.
A Non-Surgical Option: Providing an effective alternative for those who are not candidates for bariatric surgery.

The Patient Experience

In my practice, I’ve seen GLP-1 medications transform lives. Patients who have struggled for years—despite diet and exercise or other less effective, more side-effect laden weightloss medications—are finally seeing meaningful results. Beyond weight loss, many report increased energy, better sleep, and an improved quality of life.

Important Considerations

Like any medication, GLP-1s have potential drawbacks:

Side Effects: Common issues include nausea, vomiting, diarrhea, and constipation, especially when starting the medication.
Cost: These drugs can be expensive, with insurance coverage varying widely. See my blog post on Compounding Pharmacies.
Long-Term Commitment: Discontinuing the medication often leads to weight regain.
Muscle Loss: Maintaining protein intake and incorporating strength training is important.
Not for Everyone: Contraindications include gastric motility disorders, a history of medullary thyroid cancer, or pancreatitis. Additionally, tirzepatide may reduce the effectiveness of birth control, and these medications should be stopped two months before trying to conceive.

The Future of Weight Management

GLP-1 medications mark a major advancement in obesity treatment. Gone are the days of ineffective weight loss solutions like phentermine or HCG injections. While not a magic bullet, these drugs—when combined with proper nutrition, exercise, and behavioral support—offer a game-changing approach to sustainable weight management.

As a primary care physician, I’m encouraged by the shift away from outdated advice like “just eat less and exercise more.” Weight regulation is complex, involving genetics, hormones, metabolism, and lifestyle factors. It’s time to approach obesity with empathy, science, and the most effective tools available—including GLP-1s when appropriate.

Summary of Dr. Peter Attia’s Current Take on GLP-1s

Key Takeaways:

Most Benefits Stem from Weight Loss: Improvements in sleep apnea, immune function, and heart health are largely due to weight reduction.
Potential Brain & Dementia Protection: Lower dementia risk in diabetic patients; ongoing studies in non-diabetics.
Cancer, Kidney & Heart Benefits: Reduced risk of obesity-related cancers and heart disease; possible kidney protection.
Fertility Effects: May improve hormonal balance; women should review contraception options.
Addiction Treatment Potential: Early research suggests reduced cravings for alcohol and nicotine.
Thyroid Cancer Concerns: No clear human evidence of risk despite early animal studies.
Mental Health Considerations: No strong link to depression, though rapid weight loss can impact emotions.
Eye Health & NAION Risk: Recent studies suggest a possible link to non-arteritic anterior ischemic optic neuropathy (NAION). Patients should be monitored for visual changes.

The Bottom Line

GLP-1 receptor agonists are powerful tools for weight loss and metabolic health, but their primary benefits come from weight reduction rather than a direct drug effect. Long-term safety is still under study, and these medications should be used under medical supervision. While online platforms and med spas offer easy access, patients need proper guidance to avoid misuse and complications.

For those considering GLP-1 medications, a discussion with a knowledgeable healthcare provider is essential. Together, you can develop a sustainable, personalized health plan—because everyone deserves to feel their best!