Drugs like Wegovy and Zepbound, known as GLP-1 medications and typically prescribed for obesity, have shown impressive results in weight loss. However, a new joint advisory from four major medical groups highlights potential risks, including muscle loss, weight regain, and high long-term costs if proper nutrition and lifestyle support are not integrated into the treatment plan.
Understanding GLP-1 Medications
GLP-1 medications, such as semaglutide and liraglutide, have gained significant attention for their effectiveness in promoting weight loss. Ozempic is medicine for adults with type 2 diabetes, Wegovy is prescribed for long-term weight loss in adults and children. Both contain the active ingredient semaglutide. These drugs work by mimicking a hormone that regulates appetite and blood sugar levels, leading to reduced food intake and weight loss. While these medications can be highly effective, experts emphasize that they are not a magic bullet and should be used in conjunction with comprehensive lifestyle changes.
The Advisory: A Call for Holistic Approach
The advisory, contributed to by experts from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society, underscores the importance of a holistic approach to weight loss. The report noted that only about half of users continue taking their GLP-1 medication after one year and only about 15% remain on treatment after two years. Many people stop taking GLP-1 medications due to side effects, cost or disappointing results -- and when they do, they often regain weight, making long-term success depend on consistent use and a healthy diet, the report stated.
Dr. Dariush Mozaffarian, a cardiologist, director of the Food is Medicine Institute at Tufts University, and the report's lead author, emphasized the need for comprehensive lifestyle changes to achieve success on GLP-1s. "The FDA says these drugs are approved for use as an adjunct to lifestyle therapy," he said. "In fact, they are prescribed the other way around with lifestyle therapy being the adjunct if being thought about at all. Doctors are not following either society guidelines or FDA guidelines if they are prescribing [GLP-1s] without lifestyle therapy."
Potential Risks and Side Effects
The advisory highlights several potential risks associated with GLP-1 medications, including:
Read also: Discover the Calibrate approach
- Muscle Loss: Weight loss can lead to muscle loss, especially in older adults.
- Weight Regain: Many people regain weight once they stop taking GLP-1 medications, making long-term success dependent on consistent use and a healthy diet.
- Gastrointestinal Issues: Nausea is a common side effect of GLP-1 medications, which may trigger cravings for sugary, high-calorie comfort foods.
- Nutrient Deficiencies: Lower food intake while on GLP-1s can make it harder to get all the nutrients the body needs.
- Bone Density: The report also underscored the importance of maintaining muscle mass and bone density while losing weight.
Recommendations for Clinicians and Patients
The report aims to guide both clinicians and patients on nutrition and lifestyle changes to improve long-term outcomes while taking a GLP-1. Before starting GLP-1 medications, the report recommended that patients work with their doctors to set goals that focus on overall health, not just weight loss. It's also important to check for any stomach or bone issues that could lead to side effects like nausea, vomiting, or muscle and bone loss, the report stated.
The advisory offers several recommendations for mitigating these risks and maximizing the benefits of GLP-1 medications:
- Comprehensive Lifestyle Changes: Commit to a healthy diet, regular exercise, and other healthy lifestyle habits.
- Medical Nutrition Therapy: Work with registered dietitians to develop a personalized nutrition plan.
- Gradual Dose Increase: Start GLP-1 medications at the lowest dose and slowly increase as needed.
- Mindful Eating: Eat small, frequent meals and focus on minimally processed, nutrient-rich foods.
- Strength Training: Do a full body strength training routine at least three times a week.
- Cardio Exercise: Get 150 minutes of moderate cardio each week.
- Supplementation: Consider taking supplements like vitamin D, calcium, and multivitamins, while increasing protein intake by 50-100% from foods such as fish, eggs, nuts and seeds.
The Role of Registered Dietitians
"Registered dietitians can play really key roles in comprehensive obesity care by providing medical nutrition therapy to support GLP-1 therapy," said Emily A. Callahan, registered dietitian nutritionist and director of policy strategy for the Food is Medicine Institute. "The evidence space is growing that shows when registered dietitians deliver medical nutrition therapy, it has been associated with improvements in body weight, waist circumference, blood pressure and glycemic control."
Cautions for Specific Diets
The report called for exercising special caution for anyone following an intermittent fasting diet or a low-carbohydrate "keto diet" that limits foods like breads, pastas and fruit to put the body into a state called ketosis, where it burns fat for fuel instead of carbs. These individuals might be especially vulnerable to gastrointestinal side effects, the report said.
The Broader Context: Obesity and Diabetes Treatments
The market for obesity and diabetes treatments remains scorching hot, funneling billions in sales to Eli Lilly and spawning a bidding war over another drugmaker. Under the pending agreements, a month's supply of the drug would cost roughly $149.
Read also: Real People, Real Weight Loss
Emerging Research and Potential Benefits
Scientists have been studying other possible health benefits of GLP-1s besides diabetes management and weight loss for this class of medication, which includes drugs like Ozempic and Wegovy, in the wake of their booming popularity.
- Heart Health: ABC News' Dr. Tara Narula breaks down new research on how GLP-1 medications, commonly used for weight loss and diabetes, may also benefit heart health. A new study reveals the obesity drug Wegovy, from maker Novo Nordisk, may help protect the heart more than competing drug Zepbound from Eli Lilly.
- Addiction: ABC News' Dr. Tara Narula breaks down new findings suggesting that popular diabetes and weight loss medications may also help reduce alcohol and drug cravings. Popular obesity and diabetes drugs called GLP-1 medications may have added benefits, with a new study finding they helped heavy drinkers cut alcohol consumption by nearly 70%.
- Cancer Risk: ABC News’ Dr. Darien Sutton breaks down a new report on GLP-1 weight loss medications and their potential for reducing cancer risk. A new study suggests a link between GLP-1s and lower cancer risk.
- Fatty Liver Disease: The active ingredient in the popular weight loss drug Wegovy may help treat a type of fatty liver disease, according to a new study published Wednesday.
The Rise of Counterfeit Weight Loss Drugs
A black market of fake and illicit versions of drugs used for weight loss, like Ozempic and Mounjaro, is growing and alarming authorities. Experts say it could put people's health at severe risk. ABC News' Juju Chang investigates the digital market for counterfeit weight-loss medications, as well as the warning signs to watch for.
Accessibility and Affordability
Novo Nordisk is teaming up with GoodRx to offer Wegovey and Ozempic for a flat price of $499 a month. Wegovy will be available for a reduced price via telehealth companies Hims, Ro and LifeMD will soon start selling Wegovy at a reduced price of $499 per month.
The Impact on Obesity Rates
Gallup reported a "meaningful decrease" in the adult obesity rate, which coincided with an increased uptake of injectable weight loss drugs. The Gallup report, which relied on self-reported data, showed the obesity rate fell to 37% this year after hitting a record high of nearly 40% three years ago. That’s progress after years of rising obesity rates. And that accounts for an estimated 7.6 million fewer obese Americans, Gallup said.
Dr. Todd Worley, a bariatric surgeon at Houston Methodist, called the decline in the obesity rate significant. He said there’s never one factor in weight loss, but he said the weight loss injectables have no doubt “had a huge impact.”
Read also: Discovering Healthy Food