You’ve probably heard one of the above names in the past couple of months because EVERYONE is talking about them! But do you know how they work? They are said to be “miracle drugs” that are combating the world’s biggest ongoing epidemic - obesity. But what do they do and how do they work? Here’s the lowdown on everything you need to know about the new medicines that are making headlines all over the world in the weight loss space.
Most of the medications mentioned above were originally approved for people with type 2 diabetes. As they were rolled out in the market, a great “additional benefit” was discovered - they tend to make you lose weight! Being a multi-trillion-dollar industry, and one that is at the core of millions of people’s lives, the weight loss component of those medicines was studied by the manufacturers. To be effective for weight loss, the medicines needed to be administered at a higher dose than what was originally prescribed to help with diabetes. They are typically recommended for people with a body mass index (BMI) over 30, or individuals with a BMI over 27 with at least one weight-related condition, such as high blood pressure, heart disease, or obstructive sleep apnea. Here is how each of them works:
Manufactured by Danish pharmaceutical company Novo Nordisk, Wegovy is a brand name for semaglutide, a gut hormone called glucagon-like peptide receptor agonist, or GLP-1 analogue. It can lead to weight loss because it is designed to suppress appetite, therefore you eat less. Wegovy mimics the action of GLP-1 which is released after eating. It slows down the movement of food in your gut, essentially making you stay full for longer. It is also said to reduce cravings for certain foods, such as salty snacks or sweets.
The amount of weight you lose on Wegovy depends on your lifestyle and how long you are on the medication for. In a major study, the STEP 1 clinical trial, people on the maximum dose lost between 12 - 18% more of their body weight compared to those who were not on the medication. Crucially, both groups received advice to reduce their calorie intake, and increase their physical activity levels, which shows the importance of making those changes to get the best results out of any weight loss medication.
When considering Wegovy, any diabetic patient who is using insulin and has any diabetes-related eye disease needs to consult their doctor to make sure that this is the right medication for them.
Ozempic has taken the world by storm, to the point that the global supply of the medicine has reached record lows due to the huge demand on it. Used and endorsed by people from all walks of life, including some serious A-list celebrities, Ozempic has become a household name when talking about weight loss medications. Originally prescribed for type 2 Diabetes. Ozempic is also a semaglutide just like Wegovy, however, due to problems with supply and availability for actual diabetic patients, it is currently prescribed for Type 2 Diabetes only and is not the first drug of choice by doctors for weight loss purposes.
Mounjaro is the brand name for Tirzapetide and is manufactured by pharmaceutical company Eli Lilly. Tirzepatide is administered through once-weekly injections and works by activating both GLP-1 and GIP receptors to increase the level of incretins in the body. These incretin hormones increase the production of insulin in the body and decrease the glucose produced by the liver, lowering blood glucose.
Tirzepatide can have side effects. Common side effects of tirzepatide can include feeling sick, indigestion, constipation and diarrhea, while less common side effects including inflammation of the pancreas and gall bladder problems.
Saxenda, also manufactured by Danish Novo Nordisk is a different type of medicine under the Liraglutide family. It is administered as a once-daily injectable GLP-1 agonist, and was the first medication in its class to be approved for weight loss. It is a short-acting medicine that’s why it needs to be taken daily. It has also been shown to provide an average weight loss of about 8% from baseline body weight. Like the other weight loss medications, in order for Saxenda to give you the best results, it needs to be administered with clear changes to eating habits and increased physical activity.
Common side-effects:
Headache
Nausea - feeling sick
Diarrhea
Constipation
Abdominal pain
Skin reactions / rashes / bruising at injection site
GLP 1 analogue and Type 2 diabetes
If you have type 2 diabetes and are considering a GLP1 analogue medicine, your doctor will need to monitor the following:
Glycemic indices –Hb A1C is generally measured every three to six months to assess the control of blood sugar over the past period
Kidney function – In individuals with known kidney disease or those who experience gastrointestinal symptoms that increase risk for dehydration (vomiting, diarrhoea), serum creatinine should be monitored within four weeks of initiating therapy and two to three months after increasing the dose.
Retinal examination – For patients with a history of diabetic eye disease (retinopathy) it is advised slowly titrate the dose (to avoid rapid declines in A1C) .You doctor will perform retinal screening within six months to detect progression of eye disease.
Hypersensitivity reactions – Hypersensitivity reactions are uncommon. However, an alternative, non-GLP-1 receptor agonist glucose-lowering agent can be used in a person with a history of a hypersensitivity reaction to any GLP-1 receptor agonist.
So, can anyone start these medications?
GLP-1 receptor agonist-based therapies SHOULD NOT be used in patients with:
A personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B. Most experts would not prescribe any GLP-1-based therapy in this population.
A history of inflammation of the pancreas.
Until further data is available, we do not use GLP-1-based therapies in patients with type 1 diabetes specifically for glycemic management.
All GLP-1-based therapies slow gastric emptying therefore they should be used with caution in those patients with problems with delayed gastric emptying. Liraglutide, dulaglutide, and exenatide should be used with extreme caution in patients with kidney impairment.
Do I need to see a doctor before I start?
Yes, yes, yes! It is critical that the use of all the above medications is closely monitored by a trained physician in order to assure the safety of the patient. Prior to initiation of GLP-1-based therapy, speak to your doctor who will perform the following assessments:
Clinical history – Doctors will assess all patients for a personal or family history of medullary thyroid cancer or a disorder called multiple endocrine neoplasia types 2A or 2B. Doctors also ask about any prior diagnoses of gastroparesis or symptoms that suggest delayed gastric emptying.
Physical examination – Your doctor will perform a physical examination including assessment of thyroid size and the presence of any palpable nodules.
Retinal examination – If you have diabetes, your doctor will want to obtain a baseline retinal examination if not performed within the prior 12 months or in the presence of symptoms suggesting new or worsening eye disease.
Serum creatinine – Your doctor will want to measure serum creatinine to have an estimate of kidney functions if a recent value is not available or any suspicion exists for worsening or advanced kidney disease.
Lifestyle changes with GLP 1 meds:
Less caloric intake & increased physical activity
The main focus of your diet should be on eating whole foods such as fruits and vegetables which will provide essential vitamins and minerals while avoiding processed foods that are high in unhealthy fats and sugars. Eating smaller meals more frequently throughout the day can also help with blood sugar regulation while ensuring you don’t get too hungry between meals which may lead to overeating or snacking on unhealthy food choices.
Regular exercise can further boost your weight loss efforts as it helps burn off calories while building muscle which will help you reach a healthy body weight quickly and effectively. Plant-rich diets such as the Mediterranean diet or high protein diets are often recommended for those looking to lose weight while using glp-1 meds.
Like other weight loss medications, there is evidence of weight regain when people stop using them so it is important to continue making changes to your diet and physical activity levels to maintain the weight lost.
Hmm, now what?
Everyone’s weight loss journey is different and each person has a different threshold and risk tolerance to try new medications. The one thing that you MUST do is consult your physician on what is best for you and how to safely administer any of the above medications. Weight loss does not happen in a vacuum and when introducing any new substance into your body that alters some of it’s functions / chemistry, it is vital that it is done under medical supervision and following the correct protocols and checks. Another critical part of the whole journey is true, sustainable, and achievable lifestyle changes to your diet and exercise to give yourself the best (and long lasting) results.