What you Need to Know about Weight Loss Drugs (GLP-1s)
What’s the deal with these “weight loss drugs” and should I be asking my doctor about them? GLP-1s like Wygovy and Ozempic are getting a lot of media attention, and you deserve to know more about them.
The first thing I want to say about this is that I understand how tempting this might sound. We live in a culture preoccupied (obsessed) with bodies and trying to make them as small as possible. So no, I don’t have any judgment if you have been tempted by the promise of weight loss without the deliberate deprivation that comes along with a diet. I don’t question the allure of finding a way to lose weight quickly if you have always felt pressure in some form to shrink your body. And as always, I support body autonomy. Ultimately, you are the only person who gets to make this decision and I will respect your choice. I see it as my job to be here for you and support you, while also giving you some things to consider if you are contemplating starting a GLP-1.
What is GLP-1?
GLP (Glucagon-like-Peptide)-1 is a hormone that helps to regulate blood sugar. It works by indicating to the pancreas the need for insulin, which then helps sugar to be moved from the bloodstream and into our cells. This process is what gives us energy.
A GLP-1 agonist or drug, such as Ozempic, Wygovy, etc. work by replicating the effect of the GLP-1 hormone. These drugs were initially created for people with type 2 diabetes to help manage their blood sugar when their body does not naturally create enough insulin, or effective insulin. These drugs also impact the hypothalamus and suppress appetite, causing most people who take these medications to report experiencing decreased appetite and “head noise” (a normal hunger signal) around food.
Of note: While the idea of experiencing decreased “head noise” around food can come with many bonuses, including allowing people to feel less anxious and more in control around food, and more focused in other realms of their lives, the body still requires nourishment to exist and function properly. Under-nourishment, no matter the cause, is dangerous to a person’s health.
What’s the difference between taking a GLP-1 for diabetes management and weight loss?
The dose. For diabetes management, and for most medications, the goal is to find the lowest dose that gives the benefits the patient is seeking. Because weight loss is not the intended use of this drug, and it is something that was seen with increasing doses, people on GLP-1s for weight loss are often prescribed large doses. While mathematically this makes sense, scientifically, there is less long term research to comment on the effects of a high dose for a long period of time. As of now, the longest research study on a GLP-1 at a higher dose intended for weight loss is two years.
Side Effects
GI Distress
Nausea, vomiting, diarrhea, constipation, gas (burping and flatulence)
Dizziness and headaches
Fatigue
Pancreatitis (inflamed pancreas)
Gallbladder disease or gallstones
Gastroparesis (slowed gastric emptying)
Ileus
When digestion slows and solid waste does not exit the body, a bowel obstruction can occur. This can require hospitalization and it is potentially fatal.
Black Box Warning
This warning from the FDA indicates that there is evidence for high risk outcomes by taking a drug. This is the most serious warning that the FDA uses. The box warning for GLP-1s indicates risk for development of thyroid C-Cell tumors.
Does it work?
The answer here is complicated. Short-term, weight loss is possible and is frequently seen with the use of these drugs. Research has found that within two years of starting the medication, people experience weight regain. In this study that looks at weight trends following 68 weeks of injections of GLP-1s intended for weight loss without co-occurring diabetes, participants gained two-thirds of the weight they had lost back. This indicates the need to be on the drug consistently in order to continue to see weight loss, while simultaneously indicating that the weight loss is impermanent even while taking the medication.
Something to Sit On
The studies being released about these medications are funded by the pharmaceutical companies that produce the drugs being discussed. Similarly, much of the media coverage that has focused on getting insurance to cover these drugs is funded by Novo Nordisk and Eli Lilly, the pharmaceutical companies behind these drugs.
I know society does not say this, so let me remind you: you are a human and you require energy. This is not a weakness, this is not a problem. We must eat to get energy. So if this medication causes a suppressed appetite that makes it hard for you to eat at all, this is dangerous. This is not “winning.” Bodies were not built to run on empty.
Our bodies are incredible and they adapt to keep us alive, though just because we survive something, it does mean it was safe for our bodies. I will support you and your choices, and I will never support becoming malnourished.
If you are considering a GLP-1 for weight loss, I recommend you speak with your providers, and add a dietitian to your team. Your body is worthy of respect, and no matter what you choose to do, your body deserves to be cared for.
Sources:
https://pubmed.ncbi.nlm.nih.gov/35441470/
https://rethinkingwellness.substack.com/p/the-hidden-risks-of-weight-loss-drugs
*Disclaimer: Some of these resources use the term ob*sity. Proceed with caution.
