New Diabetic Blood Sugar Meds Induce Weight Loss – Are They the Cure for Obesity?

Unless you have been living off the grid you have probably heard of a diabetes medication that appears to cause significant weight loss. Maybe you read that some of your favorite celebrities have been using these to get super thin.  I know shocker right? Possibly you’ve seen the commercials for a blood sugar medicine for diabetics that also helps you lose weight.  Then of course there are the news reports that said medications are in limited supply for those that actually need them because people are using them for off label weight loss.  Ask Elon Musk, he twitted about it on that platform he owns adding to the shortage, yeah. So, what are these miracle drugs and do they really work? How can you get some and what are they called?

GLP-1

Here are the cliff notes, it gets technical and I won’t bore you with the details. These new miracle drugs (yes there is more than one) belong to a class of medications called Glucagon like Peptide-1 agonists or GLP-1 for short. You in fact already produce GLP-1 in your intestines. When you eat a meal GLP-1 is released in a biphasic fashion (twice) first within minutes and then again about an hour later.  GPL-1 signals your central nervous system that you are full, causes a release of insulin which in turn lowers your blood sugar levels to a more balanced state and slows digestion and motility so that you stay full longer. Remember this was in response to a meal.

When you inject the medication (I know, sorry, guess I could’ve led with that, it’s an injection) depending on the brand you administer once a day to once a week the medication gives you a similar response without eating a meal, you feel less hungry, you get full faster and you stay full longer. The causation for the weight loss is that you eat less. It is not a stimulant or metabolism booster. GLP-1s truly look like a good first step in curing obesity because with obesity there are always more steps. Never the less it’s a pretty good first step

Blood Sugar Meds

There are currently 9 GLP-1 medications on the market. Two have been approved for weight loss (Saxenda and Wegovy). Others are being used off label for weight loss though they are meant for Type 2 diabetics.  You might recognize these from commercials.

Trulicity (Dulaglutide) once weekly injection.

Bydureon bcise (Exenatide extend) once weekly injection.

Byetta (Exenatide) twice daily injection.

Ozempic (Semaglutide) once weekly injection.

Victoza Liraglutide) once daily injection.

Saxenda (Liraglutide) once daily injection. Approved for weight loss.

Adlyxin (Lixisenatide) once daily injection.

Mounjaro (Tirzepatide) once weekly injection.

Wegovy (Semaglutide) once daily injection, approved for weight loss.

Rybelsus Semaglutide) once daily oral.

Rybelsus is the only approved oral GLP-1 on the market. Saxenda is a stronger version of Victoza and both must be administered daily. Wegovy is a stronger version of Ozempic and approved for weight loss.

Use

There are slight variations in these medications which dictates which is most appropriate for the individual. With the exception of Rybelsus which is an oral pill, the others are administered using a single or multi dose injection pen. As noted above some are administered daily others are weekly.

In order for insurance coverage you must have comorbidities such as high blood sugar and obesity. Remember these medications are intended for type 2 diabetics and in the case of Wegovy and Saxenda obesity with an additional medical necessity. If you find a doctor who will prescribe it off label it can be very expensive. A monthly dose can range from $800- $1400 depending on the medicine and the dosage. Recently prices have gone up due to product scarcity. There are no generic versions so don’t fall for the scams. Note these drugs are intended for life long use they are not a cure. There are some online claims of people cycling on and off as weight gain and loss dictates, but there are no studies on efficacy or safety.

Results

One of the reasons for all the excitement is the effectiveness of this class of drugs on blood sugar modulation and of course weight loss. GLP-1 medications may finally solve obesity where everything else has mostly failed.  Diet and exercise doesn’t work completely for everyone, obesity is a disease, a complex disease. With GLP-1 the amount of weight loss is remarkable. Saxenda leads to an average weight loss of 5% of body weight in a year, Ozempic as much as 10%, Wegovy 15% and Mounjaro as much as 22%. Mounjaro is not currently approved for weight loss and is the only GLP-1/GIP dual action version. Continued use of these medications leads to continued weight loss. There are anecdotal reports of some people needing to cut the dose down because they lost too much weight. Exciting right?

Studies have found that beyond the blood sugar control and weight loss GLP-1 meds appear to increase or improve bone mass density, are cardio protective, and reduce pain and inflammation. On the negative side about 20-50% of weight loss was from lean body mass particularly skeletal muscle. To minimize this and improve shape and tone a resistance exercise program that challenges your muscles should be implemented.  This is imperative in those who have been sedentary or are losing significant weight.  Proper nutrition is also highly important.

What happens if you stop taking your GLP-1 does the weight come back? The answer is…a resounding yes. I know… excitement gone. In 3 studies it was found that 2/3 of weight came back at 52 weeks of discontinuation. Also, all health benefits (lower BP, less pain, etc.) went with it. Remember human metabolism is extremely complex with dozens of pathways and hormones that evolutionally try to put famine fat on us. When we try to change that it fights back harder. This is why GLP-1 drugs are a management tool rather than a cure.  Think of it this way, when you lose weight on a diet what happens when you stop…it comes back on right? Exercise is the same. Imagine if PE in school was all the exercise you would ever need. Good thing for me and my ilk that’s not the case.

There is another class of diabetic drugs with similar benefits called SGLT-2 inhibitors. These also control blood sugar and cause significant weight loss. Studies are underway with the idea of using these as an alternative or both together for even better results and possibly at lower doses. I for one am excited because a leaner population is a healthier population.

Side Effects

No medication is entirely without side effects, either are GLP-1 agonists. The most common negative effects reported are nausea, vomiting and diarrhea.  Constipation, bloating, headache and injection site redness or itching can also occur. Fun right? More serious events like allergic reaction, tachycardia, decrease urine flow and others are rare, but must be discussed with your doctor. To minimize symptoms patients are started on the lowest dose until symptoms subside. This can take a week or two in most cases before the dose is elevated. If one GLP-1 doesn’t work for you another brand might.

There are contraindications against using GLP-1 agonists if you have a history of pancreatitis, medullary thyroid cancer, IBD or are pregnant.

Other Potential Uses

GLP-1 agonists are being studied for treating atherosclerosis and hypertension, reducing neuro inflammatory pain, neurological impairments including Alzheimer’s, and reducing arthritic pain.

Outlook

Wegovy and Saxenda are already approved for weight loss several more are currently under consideration. As this happens more doctors will prescribe these medications for weight loss. As they become more readily available their price will begin to drop. Eli Lilly and Novo Nordisk are already building facilities to massively increase production of Ozempic, Wegovy, and Mounjaro.  With full FDA approval it’s my belief it’s only a matter of time before insurance companies and possibly Medicare cover the costs because the drop in obesity would net them tremendous savings from weight related illnesses such as heart disease, type 2 diabetes, stroke and certain cancers. According to Blue Cross/Blue Shield health care costs in the US exceed $3 trillion a year.  

Bottom Line

Like all medications there is a risk/reward choice to be made.. Knowing the benefits, risks and side effects should inform your decision as to whether GLP-1 agonists are right for you.

References:

Mayoclinic.com/diseases – GLP-1 agonists: Diabetes drugs and weight loss

www.ncbi.nlm.nih.gov/books/NBK551568/ - Glucagon-like Peptide-1 Receptor Agonists

www.ncbi.nlm.nih.gov/pmc/articles   Effects of GLP-1 on appetite and weight

www.ncbi.nlm.nih.gov/pmc/articles/PMC8464416/  Effects of GLP-1 on bone density

www.ncbi.nlm.nih.gov/ Review of effects of GLP-1 on…Lean body mass

Healthline.com – Semaglutide for weight loss: Why people regain weight after stopping

dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725 – Weight regain and metabolic effects after withdrawal of Semaglutide

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059595  Glp-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes

https://www.frontiersin.org/articles/10.3389/fendo.2021.721135/full  GLP-1 receptor agonists: beyond their pancreatic effects

journal-inflammation.biomedcentral.com GLP-1 agonist Liraglutide ameliorates inflammation/…/knee osteoarthritis

Forbes.com – Diabetes drug Mounjaro expected to be approved for weight loss