OZEMPIC, WEGOVY, MOUNJARO

GLP-1 AGONISTS FOR WEIGHT LOSS

GLP-1 (Glucagon like peptide 1) drugs were developed for glucose control in patients with Type 2 Diabetes Mellitus (DM Type2). As they were tested it was incidentally noticed that patients were also experiencing dramatic weight loss. The most commonly used GLP-1 is Semaglutide which has brand names OZEMPIC and WEGOVY. Another, and possibly more potent, version of GLP-1 is Tirzepatide which has the brand name MOUNJARO.

How They Work

GLP-1 medications work be mimicking the action of Glucagon, a hormone we produce naturally. They stimulate insulin secretion by the pancreas to lower blood sugar.

They also slow gastric emptying and gastrointestinal motility so that it takes longer for food to move through the GI system. As a result, it increases the feelings of fullness and satiety. They also appear to have an indirect effect on the brain that inhibits appetite. The combination of the above actions makes them extremely effective for weight loss.

Benefits

When GLP-1 meds are used for weight loss there are many benefits, most of which are a result of weight loss, not the drug itself.

1- Decreased risk of cardiovascular disease (CVD), for instance blocked arteries, strokes, and heart attacks

2- Decreased overall inflammation

3- Improved immune function allowing better ability to fight infections and diseases

4- Marked improvement in sleep apnea

5- Decreased incidence of the many obesity related cancers: colon, rectal, pancreas, esophagus, breast, uterus, gall bladder, and liver, among others

Risks/Concerns

1- Many people experience side effects when starting these medications. The most common are nausea, vomiting, diarrhea, and constipation. Starting at low doses and increasing the dose slowly can help minimize these effects. Less frequent and more serious side effects are pancreatitis, gall bladder problems, kidney issues, and bowel obstruction.

2- Cost. These medications are about $1,000 or more per month. Most patients using them for DM Type2 are covered by insurance. When used for obesity (a Body Mass Index of 30 or higher in adults) many insurers will cover them if you have an obesity related issue such as high blood pressure or high cholesterol. Other patients usually pay out of pocket.

3- If you stop using the GLP-1 you will most likely regain the weight you lost. Most people will regain 2/3 of weight lost after one year, and nearly all of it after two years. There are exceptions to this, but not many. As a result, it is suggested that people use these drugs along with exercise and a healthy diet. People who do this tend to fare better when the drug is discontinued.

4- There is a possible association between thyroid cancer and these meds. Evidence shows there is an increased incidence of thyroid tumors in rodents, but in humans it is TBD. However, these meds should be avoided if you have a history of medullary thyroid carcinoma, or a family history of Multiple Endocrine Neoplasia Sybdrome.

5- There have been anecdotal reports of depression and suicidal ideation while using GLP-1 meds, but a clear association has not yet been shown.

6- Changes in Body Composition - When someone loses weight they not only lose fat mass, but also lean muscle mass. There is a possibility that lean muscle mass loss may be exaggerated when using these meds for weight loss versus other methods of weight loss. For this reason it is essential to follow a high protein diet and to engage in strength/resistance training while on these medications. Some physicians may also suggest using DEXA scans to monitor for possible muscle loss and osteopenia.

7- It is important to know that there are compound pharmacies in the US that are

manufacturing these medications. Currently, the GLP-1's from some of these pharmacies are not FDA approved. They can have added ingredients and are not made to be identical to the FDA approved version. Some of these places will sell their products on line without a preccription from a health care provider. It is important to know that your pharmacy is legitimate and licensed. These are serious medications, they should be properly formulated, FDA approved, and used under the supervision of a trained health care professional.

8- Because these meds are just now being more widely used, there is some uncertainty regarding the long term risks of using GLP-1 medications. To date, they seem to be fairly safe when used properly. However, new risks could possibly arise as these meds are used more widely and for a longer period of time. This is important to know as you weigh your relative risk vs. benefit when considering use of a GLP-1.

A final word- These medications are evolving, there will be changes in facts, thoughts, etc... It is important to check back every 6-12 months for updates.