Obesity vs Weight Management: The When, What, Why and How of GLP-1s

GLP-1s, a class of peptide-based weight loss medications, are all the rage right now. Eli Lilly recently got FDA approval for its GLP-1 weight loss drug, Zepbound, celebrities like Oprah and Elon Musk have come forward to share their positive experiences losing weight with the GLP-1 Ozempic, and there’s a rapidly growing community on TikTok is documenting their weight loss journeys with GLP-1s.

“They are remarkably effective,” said Dr. B.J. Ho, a leading osteopathic physician and board- certified obstetrician and gynecologist based in Phoenix, Arizona. “I see this as being an option for those that maybe want to try an option before weight loss surgery.”

However, while GLP-1s are a powerful class of drug that can definitely lead to weight loss results, they are not intended to be used in every weight loss scenario and are frequently prescribed off-label. Here’s how to determine if GLP-1 weight loss treatment is right for you and how to seek it safely.

GLP-1s and Weight Loss

Glucagon-like peptide 1 receptor agonists, or GLP-1s, are a special class of drug used to control blood sugar in those with type 2 diabetes, and in some cases, obesity.

GLP-1 drugs mimic the body’s natural GLP-1 hormone, released by the body’s gastrointestinal tract to stimulate the pancreas to release of insulin, which helps facilitate the movement of glucose, or sugar, out of the bloodstream and into your cells, where it is broken down into energy. Likewise, GLP-1s delay stomach emptying, helping sustain that full feeling after a meal.

The way GLP-1 drugs control blood sugar and manage hunger has helped many people, like Christy O’Neal, a sales director and mother in Oklahoma, lose weight. Since losing her thyroid to thyroid cancer at the young age of 19, O’Neal has struggled with obesity, even living a healthy lifestyle.

“I had my thyroid removed at 20 and losing weight has been an issue ever since,” she said. “I was just so discouraged because I eat extremely healthy, I’m pretty active, but nothing was happening.”

When her endocrinologist suggested semaglutide for weight loss, Christy pursued treatment at EVEXIAS on a friend’s recommendation. In a handful of months, O’Neal has lost close to 50 pounds and kept it off.

At the same time, Dr. Ho explains that GLP-1s aren’t the ideal weight loss tool for everyone. While Dr. Ho believes GLP-1s are effective for weight loss, he asserts that these drugs are most appropriately used in patients who are obese, especially if there is a limited supply.

“I believe that people that do have a BMI over 30 with a component of an abdominal circumference or central obesity aspect, to be the most deserving of this therapy, especially if we have to “ration” what’s available. They’re the people most at risk,” said Dr. Ho.

Where GLP-1s Can Go Wrong

Likewise, many patients using GLP-1s for weight loss are doing so off-label and with unnecessary risk.

While GLP-1s like Wegovy and Zepbound have been approved for use in patients with obesity, Ozempic is only officially approved for the treatment of diabetes. And yet, in 2022, a clinical trial showed Ozempic to reduce weight, sparking a TikTok trend of Ozempic users sharing their incredible weight loss.

This trend led to a rise in scammy social media profiles selling poor quality GLP-1s at lower price and an uptick in off-label prescriptions of the drug for people trying to lose ten to twenty pounds. As a result of the increased demand, diabetics experienced a shortage of drugs they need and many people were self-administering and exposing themselves to unnecessary health risks.

It was in the midst of this social media craze that O’Neal first learned about GLP-1s from a neighbor who’d obtained a GLP-1 prescription over email. That concerned O’Neal.

“She had a lot of success with it, and I was interested, but not interested in sacrificing my health to do so,” said O’Neal.

So, O’Neal sought out Nicole Taylor, NP, an EVEXIAS Health Solutions trained provider and a leading practitioner, who she knew would be able to offer her a safer treatment plan and help her tame any side effects.

GLP-1 Patients commonly experience gastrointestinal side effects such as nausea, vomiting, diarrhea, and constipation that are best managed when working with a provider. Likewise, having a provider to help you work through emotional and behavioral patterns concurrent with treatment also helps to make the results more long-lasting, experts say.

“The evidence is clear that GLP-1 medications without comprehensive behavioral support puts patients at risk for weight regain once the medication is stopped. A prescription alone does not change habits, but adding sustained support from a behavior change program can,” Dr. Carolyn Bradner Jasik, Omada’s Chief Medical Officer, told Omada Health.

After running her labs to determine if she was a good candidate for GLP-1s for weight loss, Taylor prescribed O’Neal semaglutide, the generic form of Wegovy. Taylor also guided O’Neal through the entire process, instructing her to eat 100 grams of protein, drink plenty of water, and to use GLP-1s as part of a multifaceted approach to holistic health, and not a weight loss bandaid.

“The whole way through they’re telling you, ‘Now keep in mind, you want to make sure you’re trying to step into a healthy lifestyle with this, because if not, when you get off of it, many people gain weight,’” said O’Neal.

Are GLP-1s Right For You?

Similar to Taylor’s approach, Dr. Ho says having a full 360-degree understanding of the patient is essential before prescribing GLP-1s for weight loss. After all, other factors like hormonal imbalance, commonly cause stubborn weight gain.

“Unfortunately, with menopause and aging, hormones shift and there can be many changes in body composition. A common issue is certainly central weight gain and weight gain in general, and women will often significantly describe an inability to maintain muscle mass, an increase aches and pains. Couple that all with your normal menopause symptoms, which usually have a huge impact on sleep and rest, and it’s a terrible recipe for undesired weight gain,” he said.

With this in mind, getting your labs done and working with your provider to gain an understanding of your hormone levels and thyroid function are a sound course of action to take before hopping onto a GLP-1 for weight loss. For patients like Shane Strong who chose to try EvexiPEL, hormone optimization, not GLP-1s, was the ticket.

“I was not massively overweight, but I had gained some weight over the years. As you get older, you start maintaining the weight you gain. I tried exercise and diets and nothing ever really sustained. And so I chose to get on hormone optimization therapy, I gradually lost about 50 pounds,” he said.

If your hormones are normal and you decide GLP-1s are the right course of action for you, beware of scams and impure products, and remember there are clinics and providers out there who take pains to offer this therapy ethically and safely.

“Anytime a diet fad comes out, you know, people come out of the woodwork. They’re like, let’s sell as much as we can,” said O’Neal. “It’s very important to get yourself and your health in the hands of a place that you can trust.”

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