What it is:
Weight loss can be challenging for many people, even following a well-balanced diet and exercise regimen. Because of this, some may look for other methods to support weight loss, such as medication. Glucagon-like peptide-1 (GLP-1) agonists are medications that have recently gained popularity for promoting weight loss. However, the published clinical studies are often sponsored by the drug manufacturer, introducing the possibility of a biased study.
Glucagon-like peptide-1 (GLP-1) is a naturally occurring hormone produced in the gut. It stimulates insulin secretion, which regulates hunger, and food intake, therefore keeping blood glucose levels in balance.
An "agonist" mimics the function of naturally occurring GLP-1. People with type 2 diabetes utilize this class of medication to support their natural levels of GLP-1 to stimulate insulin production and reach optimal blood sugar levels.
Ozempic is one of these GLP-1 agonist medications for type 2 diabetes that improves glycemic control and also may lead to weight loss. Wegovy was formed from the realization that the medication in Ozempic (semiglutide) was suppressing appetite and helping people lose weight. The specific semiglutide medication was then repackaged as Wegovy, a weight loss drug. On the market there are a few drug names you might have heard including semaglutide, tirzepatide, and liraglutide, but the brand names are Ozempic, Wegovy, Mounjaro, Saxenda, Rybelsus, and Victoza.
Purported claims:
Suppressing appetite
Delaying gastric emptying
Stimulating insulin secretion
Lowering or inhibition of glucagon secretion
What the science says:
Below our Apeiron Life Medical Director, Dev Mishra, has compiled a list of currently available medications, uses, and specificity of the item. Some on the list are specifically approved for weight loss. Others are not but may be prescribed by a physician "off label". We detail below Wegovy and Saxenda, which are approved for weight loss; Mounjaro, a medication receiving a massive promotion in social media and the press; and Rybelsus, the only GLP-1 agonist taken by mouth.
Current Studies
Wegovy
A 2021 research review found that taking 2.4 mg of Wegovy once per week led to reductions in weight across multiple studies and was more effective than a placebo.
In two studies of obese individuals, one with 803 participants and the other involving 1,961 participants, those taking 2.4 mg of Wegovy weekly experienced an average 7.9% or 14.9% decrease in body weight, respectively.
In comparison, those in the placebo group who received the same diet and exercise prescriptions, either gained weight or lost less weight than those taking Wegovy.
A 2022 study compared Wegovy with Saxenda. The study’s 338 participants were split into four groups: Wegovy (2.4 mg weekly), Saxenda (3 mg daily), and two placebo groups. All groups also made changes to their diet and exercise habits. After 68 weeks, the Wegovy group had an average weight loss of 15.8%, while the Saxenda group had an average weight loss of 6.4%. The authors suspected that Wegovy could better decrease food cravings and hunger, leading to less food intake.
Saxenda
A 2021 study in 169 people with obesity found that 62.1% lost at least 5% of their body weight over a 6-month period while taking Saxenda. 17.2% of participants taking Saxenda experienced at least a 10% reduction in body weight.
Another recent study showed that taking 3 mg of Saxenda per day resulted in an average weight loss of 9 pounds after 7 months, or about 4.2% of their baseline body weight.
Mounjaro
Potentially powerful effects at weight reduction, up to 22% weight loss.
This 2022 study looked at the effects of 5 mg, 10 mg, and 15 mg once-weekly tirzepatide (Mounjaro) in people with obesity or overweight and at least one weight-related condition.
After 72 weeks, the average amount of weight loss was 15% for those taking 5 mg per week, 19.5% for those taking 10 mg per week, and 20.9% for those taking 15 mg per week.
A 2022 study in 259 people had similar findings, reporting that taking tirzepatide for 26 weeks was effective at reducing body weight, improving blood sugar management, and altering levels of certain substances associated with type 2 diabetes and other metabolic conditions.
Rybelsus
Taken by mouth
According to a 2019 review of 11 clinical studies, Rybelsus was superior to several other medications for diabetes (including liraglutide) at improving HbA1c levels and reducing body weight.
Not specifically approved for weight loss
In those who take GLP-1 agonists, the principal mechanism of weight loss theory is a delay in stomach emptying, leading a person to feel fuller for longer. It may also help suppress the hormone Glucagon, preventing you from feeling hungry.
It also stimulates insulin release, allowing glucose uptake, which helps level out blood sugar. In diabetics or pre-diabetics, these medications will reliably reduce blood sugar. In a non-diabetic, there is unlikely to be any change in blood sugar level.
By preventing gastric emptying and suppressing appetite, a person is likely to lose weight due to lowering caloric intake. However, GLP-1 agonists must be in conjunction with lifestyle changes such as increased physical activity and healthy eating patterns. Two areas that can help with maintaining muscle mass during this weight-loss process are high protein levels and consistent strength training sessions.
One crucial term here is "weight loss", not fat loss specifically. This is an issue as studies have shown weight loss to include muscle. Loss of lean muscle mass is harmful, for it keeps us healthy, from increased metabolic rate to protecting our bones and joints.
Although GLP-1 agonists are a tool for initial weight loss, aggressive lifestyle changes must also occur to have the best chances of a healthy life. And an understanding that once you start a medical weight loss program with any of the above medications, nearly everyone who stops the medications will regain their lost body weight within a year ( Wilding, 2022/ Aronne, 2023).
One area to be aware of is that there is limited to no research regarding sustained weight loss with this drug in adults who are healthy or slightly overweight rather than those who have obesity or type 2 diabetes. As with other medications used to treat chronic diseases, using a weight loss drug is a treatment for life.
Our take:
Working with your Apeiron Life team to build healthy foundational habits is the best option for long-term weight loss, improved body composition, and overall good health. Most importantly, increasing protein intake and resistance training may mitigate muscle loss. Although the drugs presented may sound like a quick fix, you must implement a comprehensive muscle growth plan and lifestyle changes to have the highest chances of succeeding. These practices may be enough, rendering a lifetime of medical drugs unnecessary.
GLP-1 agonists are useful medical tools for those who have type 2 diabetes or obesity. However, as a quick-fix fad drug for otherwise healthy adults, it comes with a list of side effects and a lifetime commitment. Adverse side effects occurred in many patients early on, leading to discontinued treatment and regained weight.
We strongly recommend that any of these medications be prescribed and carefully monitored by your physician. Alternatively, we can refer you to nationally renowned medical weight loss specialist, Dr. Eden Miller, who can provide a virtual consultation, prescription, and regular monitoring.
Will this benefit you?
If you’re looking to lose fat, GLP-1 medications are not necessarily the best first step. Natural GLP-1 stimulators may also be helpful. Products such as berberine, green tea, curcumin, cinnamon, and resveratrol have shown promise in modulating GLP-1 expression and release.
Work with a medical professional who understands the possible side effects and consequences of these GLP-1 agonists. A high percentage of patients had discomfort and adverse symptoms. Adverse symptoms may include nausea, diarrhea, constipation, vomiting, fatigue, abdominal pain, injection site reactions, headache, hypoglycemia, dyspepsia, dizziness, increased lipase, pyrexia, kidney injury, and gastroenteritis.
Still curious to try it? If you do, here’s what to keep an eye on:
Be wary of the possibility of weight-cycling or yo-yo dieting if you don’t consume this drug for life. Going on and off the medication can be highly detrimental to your metabolic and general health with lasting consequences.
You are likely to experience side effects such as nausea, constipation, and other health issues by consuming this medication.
The drug also has an attached warning of an increased risk of thyroid cancer and intestinal blockage (2023).
References and additional reading:
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