What are GLP-1 Medications? 9 Common Questions
Allyson S. Hughes, PhD; Natalie Keirns, PhD; Carly M. Goldstein, PhD
GLP-1 medications entered the U.S. pharmaceutical market in 2005. Very recently, GLP-1’s exploded in popularity as a type 2 diabetes drug designed to help the pancreas produce insulin. Even more recently, other benefits were discovered for this drug, specifically appetite satiation, which leads to weight loss.
The “success” of these drugs as a means of weight management has been lauded by celebrities on social media and prominent ad programming. Since the introduction of GLP-1s, roughly 12% of U.S. adults have tried medications in this group, as have roughly 43% of adults with diabetes. Although these drugs can be beneficial for short-term weight loss, behavioral medicine and lifestyle changes are not often paired with the prescription, so long-term weight loss is not guaranteed.
Some Common Questions about GLP-1 Medications
How do GLP-1 medications work?
Their primary function is to assist the pancreas in producing insulin. GLP-1 stands for “Glucagen Like Peptide”. Glucagen is a hormone that is naturally produced in the human gut. GLP-1s help produce more of this hormone, impact hunger signaling and impact motility (slowing down gastric emptying). This can lead to feeling “full” for longer periods of time, making it easier to manage food intake.
Are GLP-1 safe for someone like me?
These medications are not recommended for people who have been diagnosed with pancreatitis or type 1 diabetes, are under 18 years of age, or are pregnant or breastfeeding. They’re also not recommended for use by those with diabetic retinopathy, or have experienced problems with the pancreas or kidneys, a family history of medullary thyroid carcinoma (MTC), or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
It’s best to discuss your specific needs with your medical provider. They’ll be able to help you make the best decision for you.
What are the benefits of GLP-1 medications? What is the short- and long-term effectiveness of these medications?
The short-term and long-term benefits of GLP-1 medications include improved blood glucose, weight loss, and improvement in blood pressure. This may impact overall longevity and well-being. However, without integration with behavioral medicine and lifestyle changes, these benefits will likely end when patients stop taking GLP-1 medications.
What are the most common side effects of GLP-1 medications?
The most common side effects include nausea, vomiting, diarrhea, stomach pain, low appetite (which the drug is meant to cause), fatigue, and dizziness. There is also a risk of low blood sugar, which is more likely if you take other medications to manage blood sugar.
More serious side effects are less common but include pancreatitis, gastroparesis, problems with your gallbladder, and bowel obstructions. Consult your provider about managing side effects. Some may be managed by lowering your dose or behavioral modifications (e.g., eating smaller meals more frequently), but others can require immediate medical attention.
What are the consequences of not taking this medication? What alternatives exist to GLP-1 medications?
This depends on why GLP-1 medications were recommended to you in the first place. If you were advised to take one of these medications but choose not to, you may continue to have the same health status with regards to your diabetes, weight, or liver function.
If you were advised to consider this medication for blood sugar management, there may be other medications that may help you manage your A1c. If you do not already have one, talk to your endocrinologist about a continuous glucose monitor, as this technology may help you maintain tighter blood sugar management.
If you were advised to consider this medication to lose weight, you may choose to make behavioral modifications, like changes to your dietary intake or increases in physical activity, to try to lose weight. You can also consider other medications or bariatric surgery. You can also evaluate your current medication regimen with your prescribers to ensure that you are not taking any medications that are likely to cause weight gain, particularly if an alternative that works for you is available.
You may also decide to not pursue weight loss at this time: having a larger body and even being advised to lose weight does not mean that you must opt to lose weight.
If you were advised to consider GLP-1 medications for management of a liver condition, which is an off-label use but is becoming more common, you might also consider reducing alcohol and staying up-to-date on your vaccines: these can reduce the severity of some liver conditions or prevent likelihood of worsening due to infections. More and more medications are being released to treat these common conditions, so know that if you decide to not take one of these medications right now, the landscape may be very different in 6-12 months.
Do I still need to exercise or eat in a particular way when I am GLP-1 medications for weight loss?
Because these medications often lower appetite and/or increase feelings of fullness, it’s important to engage in healthy eating to ensure your body is receiving adequate nutrition with lower overall food intake. Additionally, adhering to recommendations for healthy eating and physical activity can help maintain weight loss even after stopping the medication and promote overall good health.
The current dietary guidelines for Americans recommend a dietary pattern consisting primarily of nutrient-dense foods (like fruits and vegetables, whole grains, lean proteins, and low-fat dairy products) and limiting added sugar, sodium, and saturated fat. The current physical activity guidelines for American adults recommend engaging in 150 minutes of moderate intensity physical activity per week. Last, some evidence suggests that eating smaller, more frequent meals high in protein and fiber and low in fat can help manage gastrointestinal side effects.
How long do people take GLP-1 medication for? What can I expect if I stop taking it?
Clinical studies of GLP-1s have investigated their effects after taking the medications for up to 4 years. Official recommendations do not include a timeline for discontinuing these medications. They can be taken indefinitely.
In practice, American adults take GLP-1s for an average of 6 months. Gastrointestinal side effects and high out of pocket costs have been associated with discontinuation, while being older and having diabetes are associated with longer-term maintenance of these medications. If/when these medications are stopped, observed health improvements (e.g., lowered blood glucose) are often not maintained and significant weight regain is common - especially in the absence of behavioral changes to promote health and support weight loss maintenance.
How much do GLP-1 medications cost?
GLP-1s can be quite costly. The list price for these medications before insurance is ~$900-1400/month. Insurance may only cover part - or none - of this cost. Approximately 20% of insured adults pay for GLP-1s fully out of pocket, while the cost of these medications is fully covered by insurance for ~25% of adults. Talk to your doctor and your insurance provider to determine your out-of-pocket costs for these medications.
When considering taking a medication that is regularly making headlines, it can be difficult to tease apart the scientific realities from the common narrative. The choice of whether to take a GLP-1 is a very personal one. Everyone’s likelihood of risks and benefits is highly individualized, but these medications can touch on very personal issues, like weight status, weight stigma, body image, chronic illness management, and future disease risk, which must be carefully considered and handled with compassion plus a focus on currently available scientific evidence.
Be mindful that regardless of your choice, behavior is usually a key ingredient for successful weight management. Consider all the facts before beginning any medication, and continuously reevaluate if your current path is working for you, whatever that may be.
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