The growing availability of injectable weight loss medications, called GLP-1 agonists, is bringing hope to the millions of Americans who struggle with their weight. But what exactly are these drugs and are they right for everyone? Sajani "Sunny" Shah, MD, bariatric surgeon at the Weight and Wellness Center at Tufts Medicine has the answers.
Q. We've all been hearing a lot about GLP-1 agonists, like Wegovy and Ozempic, over the past few years, but what are they and how do they work?
A. GLP-1 agonists are a class of medications, which include semaglutides like the medications you mentioned. They're made up of hormones that mimic the ones released in our body after we eat to signal that we're full. Given as a weekly injection, these drugs decrease your desire to eat and also slow down your GI tract so you feel fuller longer. These medications are also used to treat type 2 diabetes because they lower blood sugar and increase insulin production.
Q. Who is a good candidate for these medications?
A. First, these drugs aren't for someone looking to lose a few extra pounds. You need to have a Body Mass Index (BMI) of at least 27 along with another condition like diabetes or heart disease or a BMI of 30 or above with or without another condition. Second, it's important to understand that the vast majority of patients will need to take these medications for their entire lives to keep the weight off.
Q. Who should not take these medications?
A. It's important to note that anyone considering these medications should be partnering closely with their doctor and with a specialized weight loss team to understand any individual concerns. There are also a couple of conditions that make GLP-1s the wrong choice even if the patient meets the BMI criteria. Patients with a hereditary condition called multiple endocrine neoplasia (MEN) syndrome which affects the endocrine system and patients with a history of pancreatitis are not good candidates for these medications.
Q. So many of us are just hearing about these drugs, are they safe?
A. While these drugs might seem new because of high demand and media attention, they were approved for use in 2005 by the FDA and we have a lot of evidence that they're safe and effective.
Q. Are there side effects?
A. The most common side effects are nausea, constipation and fatigue. Some patients report vomiting and headache as well. For most patients, these typically lessen or disappear after a few weeks. We start all of our patients off on the lowest dose so we're better able to manage these side effects if they arise.
Q. What are the keys to being successful long-term using these medicines?
A. As I mentioned earlier, working with a supportive team is key to any weight loss success. At the Weight + Wellness Center, we always tell our patients that whether they choose medical or surgical weight loss, once they are a patient they are a patient of ours forever. Our dietitians, behavioral health providers and physician assistants are incredibly skilled at taking an individualized and personal approach. We work together to understand how patients are eating at home, what they like to eat and where there is an opportunity to make better choices. No matter what tools our patients choose, it will only work if it makes sense for their life.
