GLP-1s for Weight Loss: Benefits and Considerations

How GLP-1s Work

GLP-1 receptor agonists (glucagon-like peptide-1 receptor agonists) work by mimicking the body's natural GLP-1 hormone, which is released in response to food intake. These medications slow gastric emptying, helping individuals feel fuller longer, reduce appetite by acting on the brain’s hunger centers, and improve insulin secretion while reducing glucagon production, leading to better blood sugar control. By modifying these processes, GLP-1s can lead to significant weight loss and metabolic improvements.

GLP-1 medications for weight loss

Starting GLP-1s: Low and Slow Approach

GLP-1s do not need to be maximized. While your stomach is emptying slower, cut your meal portion in half to prevent over-filling your stomach. We start low and then go slow. As an ER physician, I am very aware of the misery that women go through when they increase their dose and present with horrible nausea, vomiting, and abdominal pain. Additionally, I find the concept of micro-dosing GLP-1s very intriguing to help mitigate potential side effects. This approach may offer a way to balance the benefits of these medications while minimizing risks such as gastrointestinal distress and muscle loss. More research is needed to determine whether lower, carefully titrated doses could provide effective, sustainable weight loss with fewer adverse effects.

Alternative Medications for Weight Loss

Oftentimes, getting GLP-1s is difficult and expensive. Other options which may be easier to obtain are phentermine-topamax (a favorite of mine which I have used a fair amount over the years), naltrexone-buproprion (also quite safe and particularly beneficial for emotional eaters). Topamax is contraindicated in patients with a history of kidney stones.

Side Effects and Considerations

Constipation is often a side effect of GLP-1s and phentermine. Having a good bowel regimen is important.

Consulting an Obesity Specialist

I am not an obesity specialist, and I much prefer pursuing weight loss through non-pharmaceutical approaches. However, I have prescribed weight loss medications over the years and understand that, for some women, this may feel like a last resort. I want to be supportive in this journey. If weight management is a major concern for you, I encourage you to seek care with an obesity medicine specialist, as they have a broader range of tools available. That said, weight loss struggles are a common topic in my clinic, and I want you to feel safe bringing it up at your visit. I am not an obesity specialist. I encourage you to seek care with one if this is a big concern and struggle for you. I am happy to address this but do not have all the tools of an obesity medicine specialist. This is a common topic in my clinic, and I want you to feel safe bringing it up at your visit.

Final Thoughts on GLP-1s

GLP-1 agonists have demonstrated substantial weight loss benefits, but their long-term effects and risks must be carefully weighed. Potential complications, muscle loss, weight regain after discontinuation, and possible cardiac concerns all suggest that these medications should not be seen as a simple weight loss fix.

For those considering GLP-1s for weight loss, a comprehensive approach including strength training, proper nutrition (in particular adequate protein intake), and sustainable lifestyle changes is crucial. As with any medical intervention, the decision to use these medications should be made on an individual basis with careful consideration of long-term health outcomes.