There has been a tremendous amount of attention about a new “miracle weight loss” drug that is in the category of diabetic meds called GLP-1 agonists. This class of medication is known more colloquially by generic names such as Ozempic, Wegovy, Mounjaro, Trulicity, Victoza, Saxenda and Byetta.
These drugs have been all over the news and social media as well as new medical guidelines in recent months. As these medications become household names, we thought it may be helpful to break down the science of what we know; what we don’t know; and the benefits, side effects and long-term implications of their use.
First, it is important to note that this class of medication is not new and has been in use for more than a decade in the treatment of Type 2 Diabetes. At a basic level, GLP-1 agonists work by binding to the GLP-1 receptors in the body, stimulating insulin release from the pancreas, reducing glucose (sugar) release from the liver and thus lowering blood sugar levels. The initial medications in this class were used specifically for Type 2 Diabetes but often caused significant side effects of nausea and constipation, limiting their utility in many patients.
The unwelcome side effects of these medications are not actually side effects at all, rather manifestations of the intended mechanism of action of the medication. This class of medication leads to significant weight loss in many patients, in part due to their ability to slow the movement of food in the digestive tract, leading to higher levels of satiety earlier in a meal and lower levels of hunger throughout the day. This slowing of the GI tract, while helpful for weight loss and insulin resistance, also causes nausea in many people, as well as understandable constipation.
Renewed interest in this class of medication has recently exploded, due to statistically significant weight loss and the advent of the newer formulations like Ozempic, Wegovy and Mounjaro. Of note, Wegovy is the same medication as Ozempic, but with the indication of weight loss, not Type 2 Diabetes.
Adding to the excitement, these newer kids on the block (Ozempic, Wegovy and specifically Mounjaro) seem to have improved upon their formulation to minimize the unwanted side effects that plagued the previous versions. These newer medications boast data for improved weight loss over older formulations (up to 15% of initial body weight with Ozempic), which has sparked interest both from the public and the medical community, leading to further studies with the goal of broadening indications to include weight loss.
So the question we are faced with then, is who will benefit from these medications, and what precautions must we take when prescribing them?
As you can understand based on the mechanism of action, the people who stand to benefit the most from a GLP-1 agonist are those with clinically significant obesity and insulin resistance or Diabetes. Most people will lose weight while using these medications, but it must be understood that studies demonstrate most people gain back the majority of lost weight following discontinuation of the medication. These medications must be used in conjunction with other lifestyle changes to be successful in the long term, but patients also need to understand that to continue to reap the benefits of this treatment they may need to be willing to take these medications for the foreseeable future.
GLP-1 agonists represent a new and exciting frontier in the treatment of metabolic disease and obesity and have the potential to be helpful in the management and prevention of cardiovascular disease. However, the side effects, potential need for long-term use and lack of long-term, large-scale data require a pause to determine if this is the best course of action for each individual patient. These meds do not replace the benefit of better-known treatments for insulin resistance and the prevention of diabetes and arterial inflammation reduction. If you have heard of GLP-1 agonists and wonder if they may be a good option for you, a thorough and individualized conversation with your healthcare provider should provide clarity and insight as to the potential benefits for your individual situation.