GLP-1 agonists are the rage in the battle of the bulge. Approved for diabetes a few years ago doctors and patients noticed that these medications led to significant weight loss in the diabetics that used them. And currently two of them have now been approved for weight loss for nondiabetics that need to lose weight.
So what is a GLP-1 agonist and what does it do?
A Glucagon-Like Peptide-1 receptor agonist is a hormonal peptide medication that binds to the GLP-1 receptor and acts like GLP-1, an incretin, which upregulates insulin secretion and down regulates glucagon to help lower the glucose level in the blood BUT it also slows gastric emptying and signals the brain there is food in the stomach so stop eating. In other words it makes you feel fuller for longer after meals and reduces hunger and cravings between meals. Sounds like the perfect weight loss drug.
The GLP-1 weight loss medications?
Liraglutide and Semaglutide, branded as Saxenda and Wegovy, are injections that can be self-administered daily for Saxenda and weekly for Wegovy. They are currently also approved for diabetes under the brands Victoza and Ozempic but at different dosages than the weight loss drug.
How good are the results?
For Saxenda over the course of a year 62% lost at least 5% of their body weight compared to about 30% for placebo and about 32% lost at least 10% versus 8% for placebo. For Wegovy after one year of use 66% lost at least 10% of their body weight versus 10% for placebo and 48% lost at least 15% versus 3% for placebo. Both the medicated and the placebo groups were told to maintain a calorie restricted diet 500 calories below their estimated daily calorie expenditure and exercise at least 150 minutes per week.
Side effects?
The most common are gastrointestinal symptoms like nausea, diarrhea, constipation, heartburn and indigestion in about 10-20% of people but they were mild and resolved with subsequent injections. Other common side effects are headache, nasal congestion and injection site reactions. Overall only about 5-7% discontinue the medications due to side effects. So the GLP-1 agonists are generally well tolerated.
Price?
Outrageous. $1500 to $1800 per month and currently they are in limited supply and hard to get.
Bottom Line:
The hype about GLP-1 agonist medications leading to significant weight loss appears to be more fact than fiction. The results speak for themselves and are much better than older diet medications. Both are well-tolerated as well as have shown to also lower cholesterol, decrease blood pressure and improve glucose control. In fact, they may also help fatty liver disease for which there is currently no FDA approved medication. The main concern is that when people stop the medication they start regaining the weight back meaning they may need to stay on it to sustain the weight loss which is really nothing new for weight loss medications. The price is no small issue either.
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