What’s New with Medications for Weight Management

by Dr. Brie Woodruff

Over the past few years, glucagon-like peptide receptor agonists (GLP-1 RA) have gained attention as a promising tool for weight management. Originally developed to manage type 2 diabetes, these medications have shown considerable effectiveness in not only helping to manage type 2 diabetes but have been shown to promote weight loss. More recently, combination GLP-1 RA and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists have also become available and show promising results for weight loss.

Both GLP-1 RAs (common name: semaglutide) and GLP-1 RA/GIP RAs (common name: tirzepatide) have been shown to be effective medications when combined with lifestyle modifications to aid in weight loss.

So, you may be wondering, what are the risk and benefits of taking these medications and could it be right for you?

Benefits may include:

  1. Effective Weight Reduction: Clinical studies have demonstrated that GLP-1 receptor agonists can lead to significant weight loss. Studies have demonstrated 15-17% weight loss with the use of semaglutide and up to 22.5% weight loss with tirzepatide.

  2. Improved Glycemic Control: For those with type 2 diabetes, these medications offer the dual benefit of managing blood glucose levels while also supporting weight loss. By improving insulin sensitivity and reducing blood sugar levels, these drugs can help mitigate some of the complications associated with diabetes, such as cardiovascular issues.

  3. Reduced Appetite and Caloric Intake: These medications help to slow how quickly food leaves your stomach and increase the ability to feel satisfied with food intake. This can lead to reduced calorie intake which is crucial for weight loss. Many patients report feeling less hungry and more satisfied with smaller meals.

  4. Cardiovascular (Heart) Benefits: Semaglutide has been associated with cardiovascular benefits. Studies suggest that these medications may reduce the risk of major adverse cardiovascular events, such as heart attack and stroke, particularly in patients with type 2 diabetes or with pre-existing cardiovascular disease.

Risks and Considerations

  1. Gastrointestinal Side Effects: Common side effects of GLP-1 receptor agonists include nausea, vomiting, diarrhea, and constipation. These symptoms are often temporary but can be bothersome and may lead some individuals to discontinue the medication.

  2. Pancreatitis Risk: There have been reports of acute pancreatitis in patients using GLP-1 receptor agonists. Although the risk is relatively low, it is a serious condition that requires immediate medical attention. Patients with a history of pancreatitis or other pancreatic disorders should discuss this risk with their healthcare provider before starting the medication.

  3. Thyroid Concerns: Animal studies have shown a potential link between GLP-1 receptor agonists and thyroid cancer. While there is no conclusive evidence in humans, caution is advised, particularly for individuals with a history of thyroid disease or those at high risk for thyroid cancer.

  4. Cost and Accessibility: GLP-1 receptor agonists can be expensive, and insurance coverage may vary. This cost can be a significant barrier for some patients.

  5. Individual Variation: As with any medication, individual responses to GLP-1 receptor agonists can vary. While some people may experience substantial weight loss and benefit from the medication, others may not see the same results or may experience side effects that outweigh the benefits.

  6. Injectable Medication: These medications are injected subcutaneously, which can be a barrier to those with needle phobias.

  7. Lifetime Intervention: A common question many patients ask is “do I have to stay on these medications forever?”. Discontinuation of medication, even with continued lifestyle modifications is associated with weight regain. In studies with semaglutide, patients regained two-thirds of weight loss within a year of stopping the medication and also showed reductions on cardioprotective benefits.

Conclusion

These new medications represent a valuable option for weight management, especially for individuals with type 2 diabetes or those struggling to achieve weight loss through conventional methods. They offer significant benefits, including effective weight reduction, improved blood sugar control, and potential cardiovascular advantages. However, the risks, including gastrointestinal issues, potential pancreatitis, thyroid concerns, lifetime commitment and cost, must be carefully weighed.

With careful management and monitoring, these medications can be an effective component of a comprehensive weight loss strategy. As with any treatment, it's essential for individuals to have a thorough discussion with their healthcare provider to determine whether GLP-1 receptor agonists are an appropriate choice based on their specific health profile and goals. We encourage you to schedule an appointment with one of our providers to discuss in more detail if you are interested in learning more about if this treatment is right for you.

Want to learn more about these medications and if they are the right fit for you specifically? Schedule a visit with myself or one of the other Neighborhood Naturopathic and Primary Care providers here!

See you in clinic,

Dr. Brie Woodruff

References:

Melson E, Ashraf U, Papamargaritis D, Davies MJ. What is the pipeline for future medications for obesity? Int J Obes (Lond). 2024 Feb 1. doi: 10.1038/s41366-024-01473-y. Epub ahead of print. PMID: 38302593.

Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, Lingvay I, McGowan BM, Oral TK, Rosenstock J, Wadden TA, Wharton S, Yokote K, Kushner RF; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. doi: 10.1111/dom.14725. Epub 2022 May 19. PMID: 35441470; PMCID: PMC9542252.

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