Weight Loss in the GLP-1 Era: What We Know, Who to Follow, and What to Read

I am frequently asked what I think about “Ozempic” and if I would recommend it.

I am not a medical doctor, so I don’t recommend medications to people with chronic diseases. Obesity is a chronic disease; it is not a failure of willpower. One size doesn’t fit all when it comes to managing weight and health. If someone is prescribed a weight management drug and asks for nutrition advice, I am happy to support them on their journey.

Clearing Up Common Myths

Social media is full of confusion about these medications. The first myth is that all weight loss drugs are “Ozempic.”  That is like calling all facial tissues “Kleenex.”

Another myth is that taking medication is “cheating.”  We wouldn’t tell someone with high blood pressure they are cheating by taking their prescribed medication.

What are the Medications and How They Work

I tapped into expert, Nina Crowley, PhD, RDN, after hearing her insightful presentation in February.  GLP-1 is shorthand for glucagon-like peptide-1, a hormone made in the gut after eating. It helps regulate blood sugar, slows stomach emptying, and helps signal the brain that you are full.

 As a diabetes medication and a weight loss drug, GLP-1 receptor agonists is the correct term, but since that is a mouthful, you will hear the term GLP-1s for these drugs. (You will also hear them called “incretin-based therapies”). What they do is mimic the effects of natural GLP-1. (A quick but important side note: despite what you hear on social media, individual foods or supplements cannot substitute for the medications; there is no “natural Ozempic.”)

Injectable GLP-1, semaglutide or Wegovy, was the first GLP-1 specifically approved for weight loss in 2021. It was followed by tirzepatide (Zepbound) which targets both GLP-1 and another hormone, GIP, released by the small intestines, that works with GLP-1 agonists for greater weight loss and health benefits. Both drugs are injectables and many more drugs have since been approved, including oral pills. There are many more medications in the pipeline to help with weight loss and more importantly, improve health. “With more drugs, patients have more options and practitioners can better match a patient’s needs, preferences, and underlying health concerns with the appropriate medication,” says Dr. Crowley.

Shifting Expectations from Weight Loss to Health Benefits

While weight loss grabs the headlines, the most meaningful benefits are improvements in chronic disease risk. Research shows that these medications can:

• Reduce major cardiovascular events (such as heart attack or stroke)
• Lower the risk of chronic kidney disease
• Improve prediabetes
• Reduce symptoms of sleep apnea
• Reduce knee osteoarthritis pain
• Potentially, support treatment of substance abuse disorders

While some of these health benefits are related to weight loss, there is improvement in health outcomes even with modest weight loss. Healthful eating goes hand in hand with medications and here is a useful visual for a healthy eating pattern (courtesy of Dr. Crowley’s presentation).

Who I Follow to Stay Informed

If you want reliable, compassionate, science-based updates on obesity and weight management, I highly recommend ConscienHealth written by Ted Kyle (click here to learn more). Sound science and practical wisdom is how I describe ConscienHealth. I’ve been a fan of Ted for a long time, and I interviewed him six years ago for my blog to learn about his daily commentary. (Click here for the blog). His commentary covers treatment advances, research, and physical, social, and emotional dimensions of obesity. His compassion for those living with obesity is refreshing in a world where we are quick to judge people based on their size.

What I’m Reading: What Happens When Medications are Stopped

In their new book, Losing the Weight Loss Meds, Drs. Holly Wyatt and Jim Hill explain what happens when people stop taking GLP-1s. They are not suggesting people stop taking the medications, but the reality is that while the drugs work well “the benefits only last while people remain on them,” says Dr. Wyatt. People stop taking the medications for a variety of reasons, including cost, access, insurance coverage, and side effects, among others. As Dr. Wyatt says, “discontinuation is common; what follows in predictable.”  Weight regain is common, so people need a game plan to maintain weight loss and health improvements.

Their book offers a 10-week playbook to help from regaining weight when medications are stopped, but it is also a great guide for anyone who has lost weight and wants to keep it off. I highly recommend the book, written by two experts in weight loss and maintenance space. And Drs, Wyatt and Hill host a podcast, Weight Loss And….with Dr. Holly Wyatt and Dr. James Hill…follow along by clicking here.

What I’m Learning

Medications are a game changer for the treatment of obesity and the pace at which new medications are being studied and brought to market is dizzying. We need to do more for those who need these medications, including access and cost. Getting insurance to cover these drugs without delays and making patients jump through multiple hoops is sorely needed. And as a society we need to replace stigma with empathy for those living with obesity.

Key Takeaways

• Obesity is a chronic disease, not a matter of willpower.
• GLP-1 medications mimic hormones that help regulate blood sugar and appetite.
• No food or supplements can replace these medications.
• Health benefits extend far beyond weight loss.
• Stopping medication often leads to weight regain, so a long-term plan is needed.
• Consult with a Registered Dietitian Nutritionist to manage side-effects and support a long-term health plan.
• Major barriers remain to access and affordability.

I’m Chris Rosenbloom, PhD, RD (Registered Dietitian) and nutrition professor emerita (a fancy word for retired) at Georgia State University in Atlanta. I am also a 51-year member of The Academy of Nutrition and Dietetics. I love to read and write and share the fascinating world of nutrition with (older) adults. I co-authored Food & Fitness After 50 (with Bob Murray) and we are embarking on copy editing of the revised manuscript for a second edition (more to come on that). I am 75 years old and believe aging is a privilege, so I don’t whine about getting older.