Recently, new weight loss medications have come onto the market and gained significant interest. These medications are part of a class called GLP-1 agonists. GLP-1 agonists were initially created to help control blood sugar levels in diabetic patients. The drugs mimic changes in one of the several gut hormones that is affected in bariatric surgery, which helps produce weight loss after surgery. After seeing weight loss in patients prescribed these medications for diabetes, some medications have now been approved for use by the Food and Drug Administration for weight loss alone. These include:

• Semaglutide 

  • Ozempic / Rybelsus - for diabetes

  • Wegovy - for obesity

• Tirzepatide

  • Mounjaro - for diabetes

  • Zepbound - for obesity

• Liraglutide 

  • Victoza - for diabetes

  • Saxenda - for obesity

There are several other medications in this category as well that are not approved for prescription weight loss. These medications are administered through an injection into the tissue under the skin on a weekly or daily basis. Patients may see significant weight loss in addition to heart protective effects (i.e., fewer heart attacks, stroke, etc.) and reduced depression. The medications may also benefit patients with polycystic ovary syndrome (PCOS) and nonalcoholic fatty liver disease. As with any medication, there are several advantages and disadvantages to using these medications.

ADVANTAGES

• Significant weight loss: These medications can cause significant weight loss in patients taking them up to the highest dose. Some studies have reported weight loss of up to 15% of total body weight in 50% of patients taking the medication.

• Cardiac benefits: When used for obesity, these medications have shown decreased incidence of cardiac events (heart attacks, stroke, and cardiac death) in patients taking the medication for 1 year. 

• Diabetic control: Initially designed for management of diabetes, diabetic patients taking these can see better blood sugar control as well as better cardiac and kidney function.

• No surgery: Patients at very high risk for surgery may be good candidates for these medications. Some patients would like to try these before committing to surgery as well. Significant weight loss can be seen with health benefits such as the ones listed above. Although individual results vary, on average, surgery does provide greater weight loss compared to medications alone. 

• Weight loss before surgery: Patients with very high BMIs are considered high risk for any surgical procedure. These medications can be used to help with weight loss in the preoperative phase to make surgery safer and help patients get to a lower overall weight after surgery. 

• Improved weight loss after surgery: Patients who undergo bariatric surgery and regain weight or hit a plateau may benefit from starting these medications to achieve more weight loss after surgery.

DISADVANTAGES

• Cost: Currently, all of these medications are under patent by the manufacturers. These medications can be very expensive and require extended and potentially lifelong use. One study showed that of the people who stopped taking these drugs, cost was the main reason (almost 50%). Insurance companies may not cover the medications due to cost.

• Lack of Availability: Currently, due to high demand, many patients have difficulty finding the drug they are on with the right dosage at pharmacies. This can also be a concern, as some patients see weight regain after stopping or pausing the medication.

• Nausea: Nausea has been reported in up to 75% of patients taking these drugs. This is usually related to dose increases but may persist and cause patients to stop taking the dose or prevent them from taking a higher dose. 

• Delayed Gastric Emptying and Gastroparesis: Delayed gastric emptying slows the emptying of the stomach, and gastroparesis can occur, which is when the stomach muscle becomes paralyzed. Both of these can cause symptoms such as nausea, vomiting, bloating, and abdominal pain. Some patients have reported prolonged gastroparesis symptoms, even after stopping the medication. 

• Pancreatitis: Pancreatitis has been reported in patients on this type of medication. For this reason, patients with a history of pancreatitis or those at a high risk for pancreatitis are not able to take these medications. 

• Thyroid Cancer: Patients with a personal or family history of medullary thyroid cancer or a syndrome known as multiple endocrine neoplasia (type 2a or 2b) cannot take these medications.

• Gallstones: Similar to weight loss surgery, rapid weight loss can be a cause for gallstone formation, which can cause pain, discomfort, and potentially the need to remove the gallbladder. 

Overall, GLP-1 agonist medications are an exciting method for patients looking to lose weight, presenting potential for increased well-being and weight management. Although surgery typically results in greater weight loss overall (on average), the medications may be a useful option for weight loss before surgery, in patients who are struggling with weight regain after surgery, or patients with less weight to lose. Like any other treatment, there are risks and benefits associated, all of which should be discussed in depth with your healthcare provider before starting any medication or planning a course of action. Similar to surgery, these medications require adherence to a healthy diet and following an exercise regimen to sustain a healthy lifestyle.