The use of Glucagon-like peptide-1 receptor agonist medications (GLP-1 medications) has surged in popularity for treating obesity. This article explores the rise of GLP-1 medications, provides key counseling points for patients, addresses concerns related to side effects and pregnancy, discusses the role of pharmacy in device training and proper usage, emphasizes obesity as a chronic disease requiring long-term therapy, and highlights the importance of having an evidence-based resource for pharmacists and patients.
The Meteoric Rise of GLP-1 Medications for Weight Management
It's nearly impossible to avoid hearing about GLP-1 medications in today's media landscape. The social media buzz around these drugs has contributed to a significant increase in prescriptions, with a 2,082% rise from 2019 to 2022. GLP-1 medications, including semaglutide, liraglutide, dulaglutide, and tirzepatide, were initially approved for treating type 2 diabetes. They work by reducing glucose release after meals and suppressing appetite, making them a safer option compared to older drugs that merely increased insulin production and caused weight gain.
Weight Loss as a Primary Indication
GLP-1 medications were designed to help with weight loss, or at least avoid causing weight gain. Clinicians noticed the weight management benefits of GLP-1s when addressing metabolic syndrome in patients with diabetes and treating those with cardiovascular disease and conditions worsened by overweight and obesity.
Today, many GLP-1s are approved for weight loss, which has practically become their main purpose. Injectable semaglutide is also indicated for cardiac risk reduction, and it is expected that other GLP-1 medications will soon gain approval for cardiac indications as well. The increased awareness of these weight-loss benefits has led to a surge in the popularity of GLP-1s. Recent data indicates that a significant percentage of adults have taken a GLP-1 medication at some point. In the past five years, the number of patients with diabetes taking GLP-1 medications has risen to 43%, and the number of patients diagnosed as overweight or having obesity taking the drugs has risen to 22%. In the past year, the percentage of adults who have heard “a little” about these drugs has risen from 70% to 82%, while the number who have heard “a lot” about them has increased from 19% to 32%.
Given the strong patient and media focus on these medications, it is crucial for healthcare providers, pharmacists, and care management teams to have the necessary resources and tools to guide patients safely through weight-loss treatment planning and address critical questions about GLP-1s, especially if they are not specialists in the field.
Read also: Facial Toner with Hyaluronic Acid
Key Patient Counseling Points for GLP-1 Medications
GLP-1s are often considered specialty drugs due to their self-injectable nature, use for chronic conditions, and high cost, especially for patients without full insurance coverage. For healthcare professionals who are starting to prescribe GLP-1 medications for weight-loss treatments, it's important to have a deeper understanding of these drugs beyond the basic labeling information, including how to manage both perceived and actual side effects and how to navigate drug shortages.
It is recommended that professionals utilize an evidence-based and current clinical decision support solution to familiarize themselves with recommendations regarding GLP-1 weight-loss indications and therapeutic uses. Reviewing patient education materials is also helpful for sharing information with patients and plan members. While there's a lot to discuss about these drugs, focusing on the most important points can prevent overwhelming the patient:
- Help patients understand what they should feel if the drug is working correctly, as opposed to what constitutes a harmful side effect.
- Ensure patients are comfortable with injections.
- Emphasize that overweight and obesity are chronic conditions. GLP-1 medications are not a quick fix and may require long-term therapy.
- Stress that along with medication therapy, lifestyle changes such as reducing calories and increasing physical activity are necessary.
- Inform patients about potential drug shortages and insurance coverage fluctuations. Discuss developing an alternative treatment plan in case they cannot obtain their medication.
Side Effects vs. Correct Effects: Helping Patients Understand GLP-1s
Clinicians and care managers should have an open conversation with patients about what they might experience while taking GLP-1 medications. Many patients report feeling less hungry, feeling full more quickly, or experiencing a sensation of fullness after eating. These are signs that the drug is working as intended.
It's important for patients to understand that the initial rapid weight loss may slow down and eventually plateau. The drug will then assist in maintaining weight rather than continuing to lose it, which does not mean the drug is no longer effective. Patients should also be aware of potentially harmful side effects. While some may experience mild side effects like upset stomach or nausea that subside within a few weeks, severe vomiting or abdominal pain could indicate pancreatitis and require immediate medical attention.
Because GLP-1 medications lower blood sugar, there are concerns about patients' sugar levels dropping too low. However, this is rare when the medication is used alone. Patients with diabetes may need less of their other diabetes medications and may see improvements in blood pressure. Low blood sugar is more of a concern for patients with pre-diabetes or those taking other diabetes medications that increase the risk of hypoglycemia.
Read also: Is Clinical Works Vitamin C Serum worth the hype? Find out here.
Concerns Related to GLP-1 Medications and Pregnancy
Providers often encourage weight loss to help with infertility in overweight or obese individuals. While GLP-1 drugs have not been shown to improve fertility directly, they can aid in weight loss, which can address this comorbidity. However, if a patient using a GLP-1 plans to become pregnant or becomes pregnant, they must stop the medication immediately. Weight loss medications are not recommended during pregnancy, according to the American College of Obstetricians and Gynecologists and other groups. Furthermore, GLP-1 medications have not been adequately studied in pregnant women or for their effects on fetuses.
The Role of Pharmacy: Device Training and Proper Usage of GLP-1 Medications
Before a patient leaves the pharmacy with their GLP-1 medication, it is essential to ensure they are completely comfortable with how to administer it.
Device Training
GLP-1 medications are injectables delivered through specific devices that may differ from what patients are used to, even if they have experience with insulin or other injections. Providing thorough device training is crucial, especially given the high cost of the medication. Incorrect injection not only prevents therapeutic benefits but also wastes medication. Device training is necessary when a patient switches between different GLP-1 brands, as the devices vary.
Pharmacists and care professionals should emphasize that GLP-1s must be titrated and cannot be started at the highest dose immediately. Patients need to understand how and when to increase their doses. They also need to know how to manage missed doses, as most GLP-1 medications are administered once weekly. It is helpful to explain what to do if a dose is missed, as doubling the next dose is not an option.
Obesity as a Chronic Disease with Long-Term Therapy
A significant downside of weight-loss medications is that weight often returns once the patient stops taking them, regardless of other mitigating efforts. While traditional diet and lifestyle interventions can lead to further weight loss, data shows that discontinuing GLP-1 medications often results in patients regaining much of the lost weight, even with a healthy diet and lifestyle.
Read also: Clinical Trials & Weight Loss
It is crucial for providers and care managers to educate patients that obesity and overweight are chronic diseases, not simply the result of personal choices. Because there is an underlying disease process, patients must understand that they are committing to long-term medication use. While some individuals may eventually no longer need medication therapy, GLP-1 medications are generally a long-term commitment, similar to other chronic medications.
Drug Shortages and Coverage Fluctuations: Be Prepared and Have a Backup Plan
Shortages of GLP-1 medications are common due to increasing demand. Additionally, insurance coverage for GLP-1s is subject to change. The medications have become highly sought after, leading to potential risks. Patients might encounter health spas and clinics advertising GLP-1 availability, but these establishments are often not certified to dispense medications and lack proper pharmacy oversight. This has led to the emergence of fraudulent medications claiming to be semaglutide but are actually diluted or counterfeit versions.
Patients seeking weight loss may be tempted to obtain these drugs from unaccredited sources if their regular supply becomes unavailable. Pharmacists, providers, and care managers must educate patients about the dangers of obtaining these drugs outside of accredited dispensing pharmacies. It is wise to help patients develop a strategy for managing barriers to medication access, such as shortages or high costs. A prolonged interruption in medication can reverse weight-loss progress, requiring patients to restart and titrate back up to the full dose when they can obtain new medication.
Pharmacists can assist patients in navigating insurance coverage for different GLP-1 medications and facilitate potential switches with their prescribers. Professionals can also research and locate manufacturers' vouchers and coupons to help patients obtain drugs at a discounted rate outside of insurance or explore assistance programs for underinsured patients who meet certain qualifications.
The Importance of Having an Evidence-Based Resource for Pharmacists and Patients
When working with GLP-1 medications, providers must stay informed about shortages and potential therapeutic substitutions. They also need resources to answer questions about titrating doses, transitioning patients onto therapies, monitoring for side effects, and identifying potentially harmful fraudulent drugs.
A trusted, evidence-based resource that provides the latest best practices and recommendations, along with quick links to patient education articles, is essential for professionals navigating the complexities of GLP-1 medications. Clinical decision support suites have enhanced their content related to GLP-1s, diabetes, and obesity to support clinical decision-making and patient counseling.
The Role of Obesity Management Drugs
Obesity and its associated health issues have long been a major challenge for healthcare systems globally. Current treatment options include lifestyle changes, medication, or bariatric surgery aimed at creating a negative energy balance. Although medications for obesity have been available for many years, healthcare providers have often hesitated to prescribe them due to worries about potential side effects and the need for long-term use. It is important to recognize that side effects are a common possibility with any medication, and drugs are prescribed when their benefits outweigh the risks. Not treating obesity effectively also poses risks that need to be considered. Similarly, a chronic disease like obesity requires chronic treatment, including medications, if necessary, much like lifelong treatment for diabetes.
Historically, obesity pharmacotherapy has faced setbacks due to the side effect profiles of medications. However, recent advances in understanding the gut-brain axis and weight regulation mechanisms have led to new, transformative therapies. These developments are reflected in research that explores the practical use of current and emerging drugs, considerations for their increased adoption, and future directions for research and clinical practice.
Practical Applications in Special Populations
The practical applications of obesity management drugs extend to special populations like older adults and children, who face unique challenges in obesity management. In geriatric populations, growing evidence supports the safety and effectiveness of intentional weight loss with obesity management drugs. These drugs reduce cardiometabolic risks while addressing concerns about muscle and bone mass preservation, making them a viable option for older adults whose health has already been affected by age-related decline. These drugs are not only effective in facilitating weight loss but also hold promise for preserving muscle mass, an essential factor for metabolic health and long-term weight maintenance. Emerging evidence suggests these drugs positively influence body composition, making them an important tool in individualized treatment plans, especially in older individuals.
For pediatric populations, obesity management drugs fill the treatment gap between lifestyle modifications (traditionally the cornerstone of treatment for children with obesity) and bariatric surgery (which is often not accessible or desired by families). Recent clinical trials have demonstrated the safety and efficacy of these medications in children and adolescents, which resulted in official recommendations by the American Academy of Pediatrics to enable healthcare providers to offer pharmacotherapy as part of a comprehensive obesity management strategy. Together, these studies underscore the expanding role of obesity management drugs across the lifespan, emphasizing their versatility and potential for improving health outcomes.
Challenges and Considerations for Adoption
While the benefits of obesity management drugs are clear, their adoption comes with several challenges to be considered. More available and widespread information with strong endorsement from healthcare providers is essential. Factors influencing patients’ decisions to pursue pharmacotherapy include the efficacy, side effects, cost, and support from healthcare providers. The safety of obesity management drugs is frequently discussed within the medical profession and also between patients and healthcare providers. Comprehensive reviews of the safety profiles of gut-hormone receptor agonists affirm their favorable balance between efficacy and safety. However, continuous surveillance is crucial to identify potential long-term risks, particularly as these drugs are used in broader populations with multiple chronic diseases.
Addressing patient perspectives through patient-centered approaches can enhance adherence and optimize outcomes. The use of GLP-1 receptor agonists in addressing weight regain after bariatric surgery represents an opportunity to sustain weight loss in this population. As bariatric surgery remains the option for many patients with obesity, pharmacotherapy could serve as a valuable adjunct, mitigating metabolic adaptations and improving long-term outcomes. Behavioral changes associated with or recommended alongside obesity management drugs are another important consideration for the treatment adoption by patients. GLP-1 analogs not only reduce appetite but also influence food ingestive behaviors in the weight loss phase. However, these changes are self-reported and not studied during the weight maintenance phase. More objective and long-term data will provide significant advantages for the adoption of obesity management drugs. Even though lifestyle changes are recommended with all obesity management drugs and have the potential to augment their efficacy while addressing broader health concerns, there are no trials to demonstrate the additive benefits of combining these approaches.
Future Directions and Innovations
The future of obesity management drugs is marked by exciting opportunities and development. The promising pipeline of next-generation drugs includes dual and triple hormone receptor agonists that approach the weight loss efficacy of bariatric surgery. These innovations, such as cagrisema (GLP-1/amylin RA) and retatrutide (GLP-1/GIP/glucagon RA), represent a significant leap forward in treatment options for patients with obesity. Looking ahead, continued research into the mechanisms, safety, and cost-effectiveness of these drugs in various populations with multiple health conditions will be essential. As the field advances, the integration of obesity management drugs and other treatment modalities will remain a priority, ensuring that care is both comprehensive and personalized. The advent of next-generation obesity pharmacotherapy is a transformative moment in healthcare, offering hope for millions living with obesity. The studies in this special edition reflect the complexity and potential of this new era, emphasizing the need for collaborative efforts among clinicians, researchers, and patients.
Premier Physicians Weight Loss Program
Choosing a program for weight loss requires much more than showing up for an appointment. Led by board-certified obesity medicine specialists, the Premier Physicians Weight Loss Program helps guide you toward both visible results and continued accountability. Premier Physicians has been recognized as “Top Doctors” in Obesity Medicine by peers in Health Care Quarterly for nine consecutive years. Their Founder and Chief Medical Officer (CMO), an American Board of Obesity Medicine-certified specialist, brings nearly 20 years of expertise to the program.