The game-changer in Obesity and Diabetes treatment: What you need to know about GLP-1 medications

In recent years, a new class of medications has revolutionized the way we treat obesity, diabetes, and even heart and kidney disease. You may have heard the names—Ozempic, Wegovy, Mounjaro—making headlines as celebrities and everyday people alike tout their dramatic weight loss results. But these drugs, known as glucagon-like peptide-1 (GLP-1) receptor agonists, do more than just trim waistlines.

Originally developed to help people with type 2 diabetes, GLP-1 medications have been found to offer powerful benefits for weight loss, heart health, and even organ protection. But they also come with side effects and unanswered questions about long-term use. Are they the miracle solution they appear to be? Here’s what you need to know.

How Do GLP-1 Medications Work?

The secret behind these drugs lies in a hormone called glucagon-like peptide-1 (GLP-1), which our bodies naturally produce after eating. This hormone helps regulate blood sugar, slows digestion, and signals to the brain that we’re full. GLP-1 medications mimic this effect, leading to reduced hunger, lower blood sugar, and in many cases, significant weight loss.

Some of the most well-known GLP-1 medications include:

1. Ozempic (semaglutide) – Approved for type 2 diabetes but widely prescribed for weight loss. It is injected under the skin weekly. 

2. Wegovy (semaglutide) – Specifically approved for obesity treatment. It is injected under the skin weekly.

3. Mounjaro (tirzepatide) – Targets an additional hormone (GIP), making it even more effective. It is injected under the skin weekly.

4. Zepbound (tirzepatide) – Approved for weight loss and injected under the skin weekly. 5. Saxenda (liraglutide) – An older version is taken as a daily injection. 

6. Semaglutide has an oral formulation as well, dosed daily and marketed as Rybelsus. 

The Benefits: Why So Many People Are Taking GLP-1 Medications

1. Significant Weight Loss: For people struggling with obesity, GLP-1 medications have changed the game. Clinical trials show that people taking Wegovy or Mounjaro can lose 15-20% of their body weight—results that were once only possible through bariatric surgery (Wilding et al., 2021).

2. Better Blood Sugar Control for Diabetes GLP-1 medications have long been used to help people with type 2 diabetes lower their blood sugar and A1C levels. Unlike some older diabetes medications, they don’t cause dangerous low blood sugar episodes. They also promote weight loss, which further improves insulin sensitivity (American Diabetes Association, 2023).

3. Protection Against Heart Disease: Large clinical trials have shown that GLP-1 medications can reduce the risk of heart attack, stroke, and heart-related death, particularly in people with diabetes (Marso et al., 2016).

4. Liver and Kidney Health Emerging research suggests that GLP-1 medications may help reduce fat buildup in the liver, making them a potential treatment for Metabolic dysfunction-associated steatotic liver disease (MASLD) (Newsome et al., 2021). They also appear to slow the progression of kidney disease in people with diabetes, which could help prevent the need for dialysis (Mann et al., 2017).

The Risks: What You Should Know Before Taking GLP-1 Medications 

1. Nausea and Digestive Issues

The most common complaint? Nausea, vomiting, diarrhea, and constipation. Some people find these symptoms improve over time, while others struggle with ongoing discomfort (Davies et al., 2015).

2. Rapid weight loss—whether from medication, surgery, or diet—can increase the risk of gallstones and gallbladder inflammation (Sumithran et al., 2016).

3. Some studies suggest a possible link between GLP-1 medications and pancreatitis, although the risk is still debated. There are also concerns about thyroid cancer, but so far, the evidence is mostly from animal studies (Drucker, 2021). Because of these risks, GLP-1 medications aren’t recommended for people with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (MEN2) (U.S. Food & Drug Administration, 2023).

4. Cost and Accessibility: One of the biggest barriers to these drugs is price. Without insurance, Wegovy and Mounjaro can cost over $1,000 per month. Many insurance plans still don’t cover them for obesity, despite the proven health benefits (IQVIA Institute, 2023). But manufacturers offer discount cards to offset the cost. 

5. In rare cases, these medications may trigger a severe allergic reaction that requires immediate medical attention. 

6. One new study suggests there may be a connection between semaglutide use and increased risk for a blinding eye disease called non-arteritic anterior ischemic optic neuropathy (NAION). But experts say there isn't enough data yet to suggest patients should be concerned or should stop taking their medications. People who have diabetes are already at risk for NAION, whether they use semaglutide or not.

"It is premature to conclude that the association is a causal association. More research is necessary to test the hypothesis. Until then, patients should be aware of this information and, in consultation with their care team, make a careful, informed choice based on their individual risk profile," said neuro-ophthalmologist Andrew Lee, MD.

If patients are already taking semaglutide and have not experienced any symptoms, they should continue to do so as instructed and discuss any questions or concerns with their primary care physician. People interested in starting to take semaglutide for blood sugar control or for weight loss should ask their physician if this medication is right for them.

Are GLP-1 Medications Right for You?

GLP-1 medications might be a good option if you:

* Have obesity (BMI ≥ 30) or overweight (BMI ≥ 27) with related health conditions.

* Have type 2 diabetes and need better blood sugar control.

* Are at high risk for heart disease and could benefit from added protection.

However, you may need to explore other options if you:

* Have a history of pancreatitis or medullary thyroid cancer.

* Struggle with severe nausea or digestive issues.

* Can’t access the medication due to cost or insurance limitations.

Perioperative Considerations: What to Know Before Surgery

Patients taking GLP-1 medications should be aware of important precautions before undergoing surgery. Because these drugs slow gastric emptying, they can increase the risk of aspiration during anesthesia, a potentially serious complication (Elgendy et al., 2023).

Recommendations for Surgery Patients

* Medication Hold: Some experts recommend stopping GLP-1 medications before surgery—typically at least a week prior for weekly injections and 24-48 hours before for daily formulations (American Society of Anesthesiologists, 2023).

* Gastric Emptying Concerns: Patients on GLP-1 medications may have delayed stomach emptying, increasing the risk of regurgitation and aspiration during intubation. Surgeons and anesthesiologists may recommend adjusting preoperative fasting guidelines.

* Glucose Management: If GLP-1 medications are stopped before surgery, patients with diabetes may require alternative blood sugar control strategies.

Patients should inform their surgical team if they are taking a GLP-1 medication and follow their doctor’s instructions on when to pause and resume treatment.

Consumer protection advice:

GLP1 medication is in high demand with finite supply. Patients should have a discussion with their provider if they are going to consider using compound pharmacies or other sources of non-brand Tirzepatide or Semaglutide, choose wisely and proceed with caution.

The Future of GLP-1 Treatments

Scientists are already working on next-generation GLP-1 drugs that last longer, work more effectively, and have fewer side effects. Some researchers are even exploring whether these drugs could help prevent conditions like Alzheimer’s disease (Hölscher, 2020).

For now, GLP-1 medications are changing lives—but they’re not a one-size-fits-all solution. If you’re considering trying one, talk to your doctor about the benefits, risks, and what to expect.

As GLP-1 medications like Ozempic, Wegovy, and Mounjaro redefine the frontiers of obesity, diabetes, and chronic disease management, their meteoric rise underscores both their potential benefits and the risks associated with these medications. They have demonstrated their effectiveness in combating obesity, stabilizing blood sugar, and offers a shield against heart and kidney disease —benefits once unimaginable without invasive weight loss surgery. Yet, the shadow of side effects, uncertain long-term risks, and exorbitant costs tempers the hype, leaving patients and providers to navigate a complex calculus of reward versus risk. With next-generation drugs on the horizon and research probing new frontiers like Alzheimer’s prevention, osteoarthritis, and even longevity, GLP-1 therapies are poised to evolve further—but for now, they remain a powerful, imperfect tool, demanding careful consideration and candid conversations with a doctor before taking the plunge.

References

* American Diabetes Association. (2023). Standards of Medical Care in Diabetes—2023. Diabetes Care, 46(1), S1–S266.

* American Society of Anesthesiologists. (2023). Preoperative management of patients on GLP-1 receptor agonists.

* Davies, M. J., Bergenstal, R., Bode, B., et al. (2015). Efficacy of liraglutide for weight loss. The Lancet, 387(10027), 1096-1106.

* Drucker, D. J. (2021). Mechanisms of Action and Therapeutic Applications of GLP-1. Cell Metabolism, 34(2), 255-272.

* Elgendy, A. Y., et al. (2023). Anesthetic considerations for patients taking GLP-1 receptor agonists. Anesthesia & Analgesia, 137(5), 951-963.

* Hölscher, C. (2020). GLP-1 and neurodegenerative diseases. Nature Reviews Neuroscience, 21(10), 615-632.