Successful weight loss takes a long-term commitment — build a healthy lifestyle you can stick with These medications can increase fertility — but the risk of taking them while pregnant isn’t well known That means questions remain on how your body may react to a smaller dose than what your healthcare provider prescribed. “That’s usually a conversation patients have with their doctors, who know a lot about these medications and how they work.” Which is the Best GLP-1 Provider Overall? This is why many healthcare providers discuss long-term treatment plans or transition strategies when starting these medications. Most people regain some weight after discontinuing GLP-1 medications. The most noticeable weight loss tends to happen in months 2 and 3 as your dose increases and your body fully adapts. Plus, simply having people who understand the unique challenges of these weight loss treatments makes a huge difference. In the SURMOUNT-1 trial, a 72-week clinical study of over 2,500 adults with obesity, Mounjaro delivered impressive, sustained weight loss. Be prepared to discuss your past attempts at weight loss, your current eating and exercise habits, and your complete medical history.Thus, the onset of action was very much delayed, and a steady state was not reached until 8–10 weeks of treatment 17,18.Such interventions can vary in many key components, including the frequencies of visits; individual or group settings; in-person, telehealth, or digital delivery; targets for food composition, calorie intake, physical activity, and other lifestyle habits; use of meal replacements; mechanisms for self-monitoring, feedback, and peer support; efforts to maximize adherence; and overall duration.Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for the management of type 2 diabetes, have gained prominence in managing obesity, offering clinically meaningful weight loss of 15–20% in many clinical trials.1 The approval of liraglutide, semaglutide, and tirzepatide for chronic weight management has significantly expanded their use.You’ll also continue to have regular follow-ups with a healthcare team to help you manage their dosage and any side effects they experience.The basic characteristics of participants in treatment and placebo/control groups were similar, such as baseline age and diabetes duration, with a weighted means of 57.9 ± 2.6 kg and 8.7 ± 2.4 years, respectively.GLP-1 Semaglutide can be a game-changer in managing weight.Even though obesity leads to an intensified probability of illness and impairment, negatively impacting life expectancy and quality, weight reduction is correlated with a moderate enhancement in cardiometabolic indicators . To address these concerns and sustain the progress made, many healthcare providers recommend transitioning to a maintenance dose rather than discontinuing treatment altogether. This advice is based on robust clinical studies indicating that abruptly stopping treatment often leads to weight regain. These medications mimic the incretin hormones that the body usually produces to stimulate insulin secretion in response to meals, thereby helping regulate blood sugar levels. Regarding hospitalization for heart failure (E), hazard ratios did not vary with HbA1c reduction. A significant reduction in hospitalizations for heart failure was restricted to SGLT-2 inhibitors and independent from reductions in HbA1c (Figure 8F). Remarkably, these additional data points were positioned along the same regression lines, and the relationship between the reduction in HbA1c and MACE (Figure 8A) or stroke (Figure 8C) remained significant. In particular, they identified a relationship between the mean reduction in HbA1c in individual trials and the corresponding hazard ratio for stroke . For CV outcome studies of GLP-1 RAs, a relationship that links the magnitude of the HbA1c reduction achieved (versus placebo) to the hazard ratio for major adverse CV events was suggested by Caruso et al. . Adverse events leading to discontinuation of the study product occurred in 5 (3%) out of 199 participants in the semaglutide 2.4 mg group, 3 (3%) out of 100 participants in the semaglutide 1.7 mg group, and 1 (1%) out of 101 participants in the placebo group . In the STEP-6 trial, mild to moderate gastrointestinal disturbances were reported by 118 (59%) out of 199 participants in the semaglutide 2.4 mg group, 64 (64%) out of 100 participants in the semaglutide 1.7 mg group, and 30 (30%) out of 101 participants in the placebo group. However, due to gastrointestinal issues, a higher number of study participants in the semaglutide group (59 4.5% vs. 5 0.8%) withdrew from the study. In the meantime, monitor health improvements (like blood sugar or blood pressure), which may improve before weight does. Clinical studies show significant weight loss usually appears after several weeks. Clinics typically start GLP-1s at a very low dose (e.g. 2.5 mg weekly for tirzepatide) and step up every 4 weeks. Below listed Tirzepatide benefits are supported by clinical studies and guidelines from organizations such as the American Diabetes Association. A subcutaneous Tirzepatide injection has been shown to be safe and effective in clinical studies. Tirzepatide has undergone extensive testing, including animal reproduction studies and clinical trials, and has shown to be safe and effective. That’s right, this drug may have the power to not only control your diabetes but also help you shed unwanted pounds. What if there was a solution that could help you manage your diabetes without the hassle? If someone is switching due to side effects from semaglutide, their doctor may recommend waiting two to four weeks before starting tirzepatide."What surprised me most was how quickly my relationship with food began to change," she says of the medication's effects.While the tips above may be helpful, weight loss is personal.For example, it’s not known yet if microdosing can actually result in the same level of weight loss as standard doses.For example, StatPearls recommends increasing tirzepatide by 2.5 mg no more than once every month.For vomiting or diarrhea, make rehydration a priority (consider electrolyte drinks) and ask your doctor about temporary dose adjustments if needed.Both medications are approved by the FDA for treating type 2 diabetes and/or for chronic weight management.The choice between these medications depends on several personal factors, your medical history, weight management goals, how well you tolerate different treatments, and what fits best with your lifestyle. Small portions and mindful eating prevent overeating complications that can occur with semaglutide. Avoiding high-fat, sugary, and processed foods helps your GLP-1 medication work effectively. The GLP-1 diet focuses on foods that work with your medication rather than against it. The study showed, along with weight loss, that the drug also improved the quality of life and well-being of participants, as cardiovascular risks such as high blood pressure were also being managed. Semaglutide is available in oral and subcutaneous injection forms, and FDA-approved doses of semaglutide for chronic weight management are 1.7 mg or 2.4 mg weekly. While these medications are sometimes prescribed in isolation, some clinical studies have reported better outcomes upon combining them with lifestyle changes. Past research also suggests that long-term use of such medications may result in more severe side effects such as hypoglycemia (low blood sugar), pancreatitis, and C-cell hyperplasia, a potential precursor to medullary thyroid carcinoma 7, 11. There are several alternative treatments available that can help you maintain your progress and support your overall well-being. Regular monitoring and consultations with healthcare providers are essential to tailor the tapering plan effectively. Instead, consult with your healthcare provider to discuss a safe and gradual discontinuation plan that supports your long-term health goals. Remember, it’s important to tailor your discontinuation strategy to your individual needs, so be sure to consult with your healthcare provider for personalized guidance. Be sure to talk to your healthcare professional about the best protocol for you. GLP-1s reduce energy intake by 16-9% compared with placebo, related to changes in cravings, hunger, and fullness.56,147,148 Multiple studies demonstrate beneficial effects on food cravings and disordered eating. If significant diarrhea occurs, fiber capsules or powders provide bulk to the stool, and anti-diarrheal medications can provide acute relief. Foods high in protein or fat can further slow gastric emptying, which can promote weight reduction and metabolism but also worsen constipation, potentially requiring temporary limitation of these foods.141 If dietary strategies are insufficient, other therapies include daily magnesium supplementation, titrated to keep bowel movements regular. GI side effects are generally more likely to occur during GLP-1 initiation or dose escalation. Individuals should be assessed for risk of sarcopenia and osteopenia, seen in individuals who are older, sedentary, chronically ill, malnourished, or with type 2 diabetes. 1. GLP-RAs Control Body Weight/Energy Intake by Stimulating Different Regions and Pathways of the Brain Pathways Based on the overall evidence around nutrition and obesity including potential impacts on metabolism, the microbiome, thermogenesis, and epigenetics, the authors of this Advisory recommend eating more minimally processed, nutrient-dense foods and fewer starch and sugar rich ultraprocessed foods for optimizing weight reduction while using GLP-1s (Table 6). The adverse effects of weight reduction on muscle and bone mass—particularly among individuals with insufficient physical activity or protein intake or at older ages63,158—have highlighted the interrelated priorities to preserve muscle mass, muscle quality, bone mass, and physical function. Dietary recommendations should be adjusted based on the rate of weight reduction, nutrient status, individual tolerance, and treatment response. GLP-1 RAs have shown important cardioprotective benefits beyond their role in weight loss. The high cost and limited access to these medications raise critical policy and equity challenges. Beyond obesity and type 2 diabetes, the therapeutic potential of GLP-1 RAs extends to a range of conditions such as cardiovascular disease, liver disease, neurodegenerative disease, and substance abuse disorders. This review examines their expanding role, evaluating efficacy compared to alternative treatments, emerging indications, ongoing challenges, and future directions. You’re not just losing weight—you’re gaining energy, confidence, and control over your health. Clinical trials should be designed to compare low-dose regimens of GLP-1 treatments to standard full-dose therapies, particularly in the context of managing chronic conditions such as diabetes and obesity. The main concern with microdosing GLP-1 medications is that microdosing therapy may not be effective at helping you achieve significant weight loss and complete blood sugar control. In the context of GLP-1 drugs, this means taking doses significantly lower than those used for diabetes or obesity treatment. At week 28, a numerically, but not significantly, greater reduction in energy intake during ad libitum lunch was observed with tirzepatide versus semaglutide (∼64 kcal difference). Actions of tirzepatide to modulate adipose lipid storage through actions at GIP receptors have been described in preclinical and clinical studies (7) and may contribute to such differential actions of tirzepatide. Nevertheless, the absolute changes in total and fat mass were greater with tirzepatide, suggesting that the added efficacy of tirzepatide may be achieved by utilizing body fat more effectively than semaglutide. The 3 mg daily dose provides sustained weight reductions of approximately 4 to 6 kg more than the placebo in overweight and obese patients with and without T 2 DM. There may also be a risk of acute gallbladder disease with liraglutide, but gallstones may also be related to acute weight loss. If the 3 mg dose cannot be tolerated, treatment should be discontinued, although some weight loss would still be expected. Furthermore, liraglutide has shown significant improvements in insulin action, cardiovascular disease (CVD) risk, weight reduction (including waist circumference), and reproductive function, including increased pregnancy rates in overweight or obese PCOS women . Exercise and liraglutide therapy together promoted healthy weight loss maintenance more than either therapy alone . Managing your weight while taking GLP-1 medications can feel overwhelming when you don’t know which foods work best with your treatment. “At Restore Hyper Wellness, our approach to weight loss medications is unparalleled. It is not a traditional healthcare avenue for patients to seek treatment outside the established clinical guidelines of Weight Management. The decision to use a weight loss medication is a personal decision that requires shared decision-making between you and your clinical provider. Why are GLP-1 medications so effective for weight loss? It is important to note that the use of exenatide twice daily and lixisenatide should be avoided in patients with decreased kidney function (estimated glomerular filtration rate eGFR, 30 mL/min/1.73 m2, as these agents are excreted by the kidneys, and exposure may be increased in patients with decreased function.26 At maximal doses, it reduced HbA1c by −0.78%.13 Once daily lixisenatide, structurally similar to exenatide and administered by subcutaneous injection, was later approved and found to reduce HbA1c by 0.8–0.9%.14 Exenatide twice daily is commercially available in Europe and the US, while lixisenatide is available only outside of the US. Exenatide administered by twice-daily subcutaneous injection was the first GLP-1 RA in clinical use. Conversely, reducing the expression of the proglucagon gene, responsible for encoding GLP-1, specifically in the nucleus tractus solitarius (NTS), results in heightened appetite and weight gain in rats.11 In humans, the administration of GLP-1RAs reduces appetite, decreases energy intake, and increases satiety. These studies demonstrate that administering the GLP-1 receptor antagonist exendin (9–39) directly into the brain increases food consumption in satiated rats. Semaglutide is another compound with a structure generally similar to liraglutide (GLP-1 with a free fatty acid side chain) but with a much longer half-life, apparently mediated by even tighter coupling to albumin. After subcutaneous injection, they reach effective circulating concentrations relatively early, thus beginning to lower plasma glucose soon after initiating such treatment. Thus, the onset of action was very much delayed, and a steady state was not reached until 8–10 weeks of treatment 17,18. Liraglutide, approved in 2009, was designed to provide a nearly unchanged amino acid sequence compared to mammalian GLP-1. For example, the National Weight Control Registry has identified several nutrition-related correlates of weight maintenance,277,278 including eating at regular times daily; eating regular breakfast; eating more minimally processed foods higher in nutrients, fiber, and/or protein; avoiding sugary drinks, highly processed foods, and snack foods; and permitting flexibility with food choices and occasional portion-controlled treats rather than severe restriction. Weight maintenance is one top goal—preserving health gains as much as and for as long as possible. Approaches to address and support the ability of individuals to achieve long-term success with their overall weight management program are a critical area for future implementation research. Importantly, adherence with dietary and other lifestyle changes is also challenging for many people. Once your weight stabilizes and your body adjusts, people can see their hair return to its normal growth cycle. When your body goes through significant changes, whether from meaningful weight loss, eating fewer calories, or variations in nutrition, it can shift more hair follicles into a resting phase. While the trials did not evaluate the specific cause of shedding, the pattern aligns with what is typically seen when the body undergoes meaningful weight loss. The answer is “yes.” As with any weight-loss program, lifestyle changes are necessary for long-term weight management. This is legal and there is usually evidence of how the medication can successfully treat the other condition. Dr. Eisenberg contributed to the conception and design of the study, provided clinical expertise, and critically revised the manuscript for important intellectual content. Tsoukas, Yu, and Peters provided clinical expertise and critically revised the manuscript for important intellectual content. This open-label, parallel-group study was conducted in 122 sites across 13 countries between 1 April and 15 November 2019, with 1947 participants assessed for eligibility and 1444 randomized to treatment . Serious adverse events were reported in 15 out of 133 participants (11%) in the semaglutide group and 6 out of 67 participants (9%) in the placebo group . Five participants (4%) in the semaglutide group and no participants in the placebo group had cholelithiasis. In adolescents, the incidence of gastrointestinal adverse events was higher with semaglutide than with placebo (62% vs. 42%). GLP-1 microdosing is an emerging concept with promising potential, particularly for individuals who struggle with medication side effects. Given the potential benefits of GLP-1 receptor agonists in managing metabolic disorders, it is crucial to explore how microdosing might influence metabolic pathways and patient outcomes. However, animal studies suggest that low-dose GLP-1 activation can still help balance and manage blood glucose levels without triggering full-scale gastrointestinal side effects. Switching from semaglutide to tirzepatide comes with financial and insurance-related factors that need careful planning. When switching, the body may react differently to tirzepatide. Both semaglutide and tirzepatide are injected under the skin (subcutaneous injection), usually in the abdomen, thigh, or upper arm. Glucagon‐like peptide‐1 (GLP‐1) receptor agonists (RAs) are an example of a drug class with proven or potential benefits across a range of prevalent age‐related conditions and complications (Müller et al., 2019). To sustain and reinforce this positive trend and help ensure a prolonged healthspan for more people across the world, novel pharmacotherapeutics and optimal use of existing options are arguably needed. In sum, GLP‐1 RAs are positioned as one of the pharmacotherapeutic options that can contribute to addressing the high unmet medical need characterising several prevalent aging‐related diseases, potentially helping more people enjoy a prolonged healthy lifespan. As far as I can tell, Willow is completely unique in their prescribing to people who are not overweight. My only suggestion is that you follow a strategic strength training program and a macro-based diet (high in protein) to ensure you’re preserving your muscle while losing body weight. Help to manage side effects There may be things you can do to mitigate some of these risks. If you are taking or considering a GLP-1, discuss these risks with your doctor. While GLP-1 drugs are generally considered safe, they do come with potential risks. "While gastrointestinal side effects like nausea and constipation are common, they are usually temporary and manageable," she notes. Other less common but possible side effects include headaches, increased heart rate, dizziness, and fatigue. The phase III studies that have compared GLP-1 RA agents head-to-head have demonstrated that all GLP-1 RA agents are effective therapeutic options at reducing A1C.Both semaglutide and tirzepatide can cause stomach-related side effects, such as nausea, vomiting, diarrhea, and constipation.However, if the side effects are severe or persistent, it's important to contact your provider.The results showed that liraglutide provided significantly better glycemic control than exenatide twice daily and was better tolerated .By building this habit, you set yourself up for smoother treatment and long-term success.During the transition period, side effects may occur.Studies suggest that tirzepatide may lead to greater weight loss than semaglutide due to its dual action on GLP-1 and GIP receptors, but individual results vary.This results in a reduction of monocyte accumulation in the vascular wall, as shown for example with exenatide . She Lost 30 Pounds With GLP-1 Microdosing: "My Body Just Thrived" Periodic check-ins can help detect any potential weight regain early and allow for timely interventions. Even after successfully tapering off, regular follow-up with your healthcare provider is essential. Ensure that any underlying health conditions, such as hormonal imbalances, thyroid issues, or metabolic disorders, are well-managed. Our pharmacy is also certified to provide sterile compounding, so you don’t need to worry about contaminated medication. Changes in hormones can also cause you to gain belly fat, and research has found that extra abdominal weight can lead to increased inflammation, which affects metabolism. But these drugs can come with some side effects, which include nausea, vomiting, diarrhea, bloating, and indigestion. It also helps quiet food cravings and what people call food noise, those constant thoughts about food (what to eat, when to eat, how much to eat) that can throw off your day, and take up way too much mental space. Keep reading to find out more about microdosing GLP-1s, how they can help with menopause-related weight gain, and what to know about trying it yourself. Wegovy and Saxenda are also approved for the treatment of children aged 12 and older; the precise BMI cutoffs for children differ by age. Once per week, users attach a needle to their pen, prick themselves in the torso or another fleshy area, and press a button on the pen to administer their medication. Find out what the research says about who's at higher risk of developing it and how to slim down with lifestyle changes. WebMD does not provide medical advice, diagnosis or treatment. We’ve got to use all of it together to help you be the most metabolically healthy person you can be. “I don’t recommend people who have a history of an eating disorder take GLP-1 drugs unless they absolutely need treatment,” says Sue Decotiis, MD, triple board-certified physician in New York City.Dr. Meghan Garcia-Webb, a Boston-based physician board-certified in Internal Medicine, Lifestyle Medicine, and Obesity Medicine, has guided hundreds of patients through their GLP-1 weight loss journeys.There were no significant differences in hospitalization rates for non-fatal myocardial infarction, non-fatal stroke, and heart failure between the liraglutide and placebo groups .In a phase 2 clinical trial among Chinese patients, mazdutide reduced HbA1c by −1.41% to −1.67% in a dose dependent manner compared to +0.03% for placebo.31 Survotutide was studied in once and twice weekly administration by subcutaneous injection in a phase II trial, and was shown to significantly reduce HbA1c compared to placebo (Table 1).32In this demographic, obesity is defined as a BMI at or above the 95th percentile, while overweight is defined as a BMI in the 85th to 94th percentile.BIA allows for repeated measures at low cost, for instance, when weight reduction trajectories are high and muscle loss is more likely.Another report found an average weight loss of 6%-17% across a few different studies.By checking coverage in advance, exploring savings programs, and working with healthcare providers, patients can reduce financial stress and focus on their health goals.Several factors should be considered, including how long you have been on semaglutide, your response to the medication, and whether you are experiencing side effects. Always consult a healthcare provider to ensure a program fits your health profile. Platforms differentiate themselves with pricing, medication choices, and extras like behavioral guidance. This includes medication, supplies, and diet tips. If your provider determines treatment is right for you, it’s then sent to a pharmacy which will then be filled and delivered to you. A provider will send your treatment recommendation to your patient portal. Because our study did not include patients using structured weight loss interventions, our findings may better reflect the expected range of weight loss in the real world.20 However, this means that our weight loss results may be more modest than what can be expected in patients who are fully adherent to GLP-1 agonist therapy. Prior studies have examined real-world weight change among patients with type 2 diabetes initiating a GLP-1 agonist in other settings. GLP-1 drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro. Zepbound) regulate blood sugar, slow stomach emptying, and reduce appetite. Social media influencers have increasingly become early adopters of experimental health trends, often promoting treatments before scientific research has confirmed their safety or effectiveness. Weight loss surgery, or bariatric surgery, is also an option for some people with a need to lose weight. A combination of cardio exercises and strength training is often the best exercise strategy for weight loss. It may go without saying, but the old-fashioned way — diet and exercise — remains a preferred weight loss method. GLP-1 receptor agonists in the treatment of type 2 diabetes - state-of-the-art. With tirzepatide, there is now one GIP/GLP-1 receptor dual agonist with a promising development that may find a prominent place in the treatment algorithm for the therapy of T2D and possibly also for obesity. In conclusion, the modifiable risk factors obesity, diabetes, and hypertension increase the risk of COVID-19–related mortality in young and middle-aged patients to the level of risk observed in advanced age. Data from the European LEOSS registry as well as other data show an additive effect of obesity, diabetes, and hypertension on the risk of mortality, which is higher in young and middle-aged patients (18–55 years). Here are the foundational rules I teach my Semaglutide patients during their first visit.Although GLP-1 drugs can trigger certain side effects like nausea, bloating, and constipation, berberine appears to cause those same issues.A common misconception is that you can take GLP-1s for a few months, lose the weight, and then stop without consequence.Some people may need medication, they may need weight loss surgery, they may need diet and exercise.If you are uninsured, underinsured, or if the medication is not covered by your insurance, your provider may assist you in finding a prescription discount card or an alternative medication that is more cost effective.The biggest price difference comes down to whether a program uses compounded GLP-1 medications or FDA-approved brand-name drugs.If you’re working out but not losing weight, consider switching up your routine and trying a new type of exercise.Life happens, and you might occasionally have missed doses or need to pause treatment. This was the reality for many individuals before discovering the transformative potential of GLP-1 medications. Personal triumphs showcase the profound impact of semaglutide on individuals' lives, highlighting its potential to revolutionize the treatment landscape. This medication, known for its efficacy in controlling blood sugar levels, offers a beacon of hope for those struggling with obesity and related complications. So far, no trials have been published that compare different dual- or triple-receptor agonists with each other. The efficacy regarding lowering glycemia and body weight is stronger than that of GLP-1RAs while the safety profile and the incidence of adverse events seem comparable. Until then, GLP-1RA with cardiovascular benefits remains the recommended substance class for obese patients with T2D and pre-existing atherosclerotic vascular disease or patients with a very high risk for this condition (17). Cardiovascular data on endpoints like MACE-3 or MACE-4 are presently not available yet, but an early meta-analysis demonstrated at least cardiovascular safety in patients with T2D treated with tirzepatide (78, 79). The best time to take your GLP-1 injection depends on what feels right for your body and your schedule. Ultimately, the best time for your GLP-1 injection is what works for your body and lifestyle. Whether you take your GLP-1 injection in the morning or at night depends on your schedule, side effects, and personal preference. Or would nighttime be better to sleep through potential side effects? This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. In the third study, SURPASS-3, researchers evaluated the efficacy and safety of tirzepatide compared to titrated insulin degludec in people with T2DM who had inadequate control of metformin with or without SGLT2 inhibitors. The second study, SURPASS-2, compared the efficacy and safety of once-weekly tirzepatide to semaglutide, a selective GLP-1 RA. Furthermore, semaglutide showed a higher incidence of gastrointestinal side effects in the STEP-3 trial (82.8%) compared to placebo (63.2%) . In the STEP-2 trial , adverse events were more commonly observed in patients treated with semaglutide 2.4 mg (353 87.6% out of 403 patients) and 1.0 mg (329 81.8% out of 402 patients) compared to those receiving placebo (309 76.9% out of 402 patients). There is strong clinical proof that tirzepatide is also beneficial for people with type 2 diabetes and related issues. But the data up until now shows that stopping GLP-1 medications, regardless of which drug in the class is being used, often leads to the patient eventually gaining back much of the weight they’ve lost even if they maintain a healthy diet and lifestyle. Additionally, GLP-1 medications have not been routinely studied in pregnant people or for their effects on fetuses. GLP-1 RAs are currently used in treating patients with T2D and consistently result in weight loss, in addition to lowering blood glucose levels. Three long-acting drugs in the market represent this approach which are liraglutide, semaglutide, and tirzepatide. Patients with T2D who require better glycemic control, want to lose weight, and are not interested in injectable medication may find oral semaglutide to be an appealing alternative . Maladaptive reactions that occur after weight loss are also significant components of the pathophysiology of obesity. Nutrition insecurity was more common among adults with younger age, lower income, lower educational attainment, and identifying as Black, Hispanic, or Native American/indigenous compared with White backgrounds.246 Adjusting for age, sex, race/ethnicity, income, education, and food security status, individuals experiencing nutrition insecurity were 40-60% more likely to have obesity as well as type 2 diabetes, heart disease, hypertension, and hypercholesterolemia. Findings were more mixed for pharmacologic obesity interventions, with inconsistent or no differences observed by race/ethnicity.241 In trials, medication treatments may be more standardized and less influenced by sociocultural variables than lifestyle and surgical interventions. Disparities in access to GLP-1s have been documented by race/ethnicity and socioeconomic status.236 In a study of ∼1.2 million commercially insured U.S. individuals with diabetes from 2015 to 2019, lower GLP-1 use was seen among Asian, Black, and Hispanic, compared with White, individuals and among those living in lower vs higher income households.237 Using electronic health record data from 6 U.S. care delivery systems from 2014 to 2022, American Indian/Alaska Native, Asian, Black, Hawaiian or Pacific Islander, and Hispanic individuals were less likely to be prescribed a GLP-1 than White individuals.238 For example, one cohort study used United Kingdom claims data to examine body weight changes among 589 patients with T2D initiating a GLP-1 agonist.22 In that sample, 33% achieved weight loss ≥5% at 12 months. In addition, our results are also in line with the mean 1.6% to 4.6% differential weight loss demonstrated in placebo-controlled cardiovascular outcome trials for liraglutide 1.8mg (LEADER),17 semaglutide 1.0mg (SUSTAIN-6)18 and dulaglutide 1.5mg (REWIND).19 One-third of patients achieved clinically significant weight loss, defined as ≥5% change from baseline. Weight loss achieved with standard doses of GLP-1 agonists (GLP-1a) among real-world patients with type 2 diabetes has not been determined. Hitting a plateau on GLP 1 medications like semaglutide, tirzepatide, or retatrutide is common, but not the end of progress. Moreover, significant 11%–12% relative risk reductions for all‐cause mortality and for heart failure hospitalisations have also been shown (Sattar et al., 2021). Amongst people 65 years of age or older, the T2D prevalence is high in many societies and in the US specifically, 25% of the people in this age group is estimated to have diabetes with even more having prediabetes (Rooney et al., 2021). Tolerability concerns related mainly to gastrointestinal side effects can be mitigated for most using dose‐escalation regimens. The GLP‐1 receptor agonist (RA) semaglutide is shown bound to the GLP‐1 receptor (GLP‐1R). This was much better compared to the placebo group. In this study, people who took the highest dosage lost around 52 pounds in 72 weeks, which is attributed to an improved metabolism. These effects are like what happens naturally after you eat. It is uncertain whether a large enough clinical trial addressing this question will ever be conducted. The effects of combining GLP-1 RAs with SGLT-2 inhibitors were corroborated in a meta-analysis by Castellana et al. , confirming this combination's potential. However, if the risk of congestive heart failure complications is considered the primary problem, SGLT-2 inhibitors are the better choice. Therefore, if a patient seems to be at risk of ischemic events (e.g., because of previous events), GLP-1 RAs appear to be the better option. It can become a serious risk if you take GLP-1s with other medications that lower blood sugar, like sulfonylureas or insulin. These side effects are more likely to happen when you start the medication or if you’re taking an increased dose. If you have obesity or overweight, talk to your healthcare provider to see if a GLP-1 agonist is right for you. These professionals are dedicated to providing personalized support and guidance tailored to your unique health needs. With your monthly subscription, you gain access to a comprehensive suite of services designed to support your health and wellness journey. History of organ transplant on anti-rejection medication9. Your health and well-being are our top priorities, and we're dedicated to making the process as smooth and stress-free as possible for you. No, on your initial visit with your licensed provider, in addition to reviewing your health history and goals, your clinician will order any necessary lab work. The FDA does not currently have guidelines on microdosing GLP-1 medications and it’s clear that more study is needed to understand the risks, benefits, and efficacy of doses that are lower than those recommended by current prescription guidelines. Depending on the severity, those side effects are enough to make some people resist taking the medications or stop taking them completely. Examples of GLP-1 meds that are FDA-approved for weight loss include Zepbound (tirzepatide) and Wegovy (semaglutide). No class of medication has gotten more buzz in recent years than the glucagon-like peptide-1 (GLP-1) receptor agonist, better known by the brand names Ozempic, Wegovy, Zepbound or the generic name semaglutide or tirzepatide. For example, some patients who plateau on semaglutide find success by switching to tirzepatide. Even on GLP-1s, which help regulate insulin and blood sugar levels, your body will eventually adapt to the medication and your new, lower body weight. If you have missed several doses or need to pause your treatment for any reason, it's best to contact your healthcare provider. GLP-1 medications can cause temporary side effects like nausea, abdominal pain, or diarrhea. Since tirzepatide has a dual action on GLP-1 and GIP receptors, doctors often start with the lowest dose and gradually increase it to help the body adjust. Some people switch because tirzepatide may be more effective for blood sugar control or weight loss. This includes stopping semaglutide at the right time, starting tirzepatide at an appropriate dose, and closely monitoring how your body responds. Patients need to be cautious and understand microdosing is not evidence-based — it has not been studied in clinical trials, McGowan says. “As such, microdosing of Zepbound and Mounjaro may increase the risk of contamination and therefore pose patient safety risks,” Eli Lilly says in a statement. “It’s important to understand that for Wegovy, only the marked doses on the single-use, fixed-dose pens … are approved for use and represent an authentic FDA-approved medicine.” Understanding these differences can help patients and healthcare providers decide whether making the switch is the right choice. Since the dosing schedules are not identical, switching from semaglutide to tirzepatide requires careful planning to avoid complications. Both medications are available as once-weekly injections that must be taken at the same time each week. However, many doctors prescribe it “off-label” for weight loss. There are currently seven approved GLP-1 receptor agonists (Table 1); exenatide twice daily, lixisenatide once daily, liraglutide once daily, exenatide once weekly, dulaglutide once weekly, semaglutide once weekly, and oral semaglutide once daily. Recent studies indicate that semaglutide does not increase suicide risk , but caution is still advised for patients with significant mental health conditions. Patients may privately obtain these medications, so it’s important to enquire non-judgmentally (e.g., “To ensure safe prescribing, are you taking any weight loss medications you buy online?”). The dramatic results patients show off in countless before-and-after photos have made them wildly popular. If you have any concerns, your healthcare provider is always available to offer support and reassurance. Hold the vial upside down, insert the syringe, and draw the prescribed amount of medication, being careful to avoid air bubbles. These side effects are usually mild to moderate in severity and tend to diminish over time as the body adjusts to the medication. While GLP-1 medications are generally safe and well-tolerated, it's essential to be aware of potential side effects that some individuals may experience. While side effects can occur, most are mild and tend to subside as the body adjusts to the medication. If you have Type 2 diabetes, the medications help manage your blood sugar by triggering your pancreas to release more insulin. GLP-1 agonists alone can’t treat Type 2 diabetes or obesity. GLP-1 agonists are most often injectable medications, meaning you inject a liquid medication with a needle and syringe. And they’re just one part of your treatment plan if you have Type 2 diabetes or obesity. Medications containing semaglutide marketed for type 2 diabetes or weight loss. FDA Fast Track designation for tirzepatide for the treatment of adults with obesity, or overweight with weight-related comorbidities. RDs also can advocate for the safe and proper use of weight management medications in tandem with promoting the critical roles of healthful eating, lifestyle modifications, and medication adherence. Dietitians can embrace weight management medications as a helpful element of successful short- and long-term management of type 2 diabetes, excess weight, CVD, and potentially other comorbidities. Membership plans include up to four consultations with a board-certified medical provider specializing in weight loss in the first month and up to two consultations per month in the following months. Once you sign up for a membership, with or without the optional meal delivery service, you’ll get ongoing support from a weight loss physician, one-on-one dietitian coaching, and daily nutrition education in the app. When you join Form Health, it will ship a scale to your home so you can keep track of your weight loss. From there, users will have monthly follow-ups with their physician and registered dietitian to track goals and adjust the weight loss plan accordingly. Despite the promising efficacy of these agents, it is essential to consider their safety profiles, particularly regarding gastrointestinal adverse effects, which are common but generally transient and manageable. The wide array of available GLP-1RAs, from short-acting to long-acting formulations, provide clinicians with various options to tailor treatment to individual patient needs. 4, we present a proposed algorithm for the management of patients, which reflects this personalized approach. Of interest are the results of questionnaires indicating that obese subjects had fewer food cravings and could better resist food cravings while treated with semaglutide . Human studies have confirmed the ability of GLP-1 RAs to influence food choices (toward a selection of less energy-dense healthier foods) 66,78. (A) Evidence also suggests that GLP-1 receptors in the hepatoportal region (B) and on afferent parasympathetic nerve endings in the intestinal mucosa (C) may generate central nervous system signals influencing insulin secretion and metabolism. It still remains unclear why albiglutide has a weaker weight-lowering efficacy than other GLP-1 RAs (Figure 4). Scientists have figured out ways to make them stick around longer and have different effects.” But beyond the hype, what do patients actually need to know? Prescribing a GLP-1 agonist may be appropriate for these patients. We can also redirect the conversation toward health-promoting behaviors. Adverse effects can include nausea, vomiting, diarrhea, and bloating due to gastroparesis (tolerability). EQW treatment also led to weight loss, similar to MET, and a decreased risk of hypoglycemia. EQW treatment also led to sustained weight loss, improved glycemic control, and a decreased risk of hypoglycemia after 84 weeks . Therefore, Lixisenatide as an add-on to basal insulin may become a preferred treatment intensification option, achieving significant glycemic targets with fewer hypoglycemic events without weight gain compared to basal-plus or basal-bolus in inadequately controlled insulin-treated patients 133,134. Running out of medication can quickly derail your routine, and with the current nationwide shortages of GLP-1 medications, it’s more important than ever to plan ahead.Since the primary indication for using GLP-1 RAs is type 2 diabetes, dose selection has mainly addressed glycemic control (HbA1c reduction).Hence, identifying HbA1c reduction as a potential mediator of CV benefits induced by GLP-1 RAs leaves a number of open questions, especially since it has been difficult to establish a relationship of HbA1c reduction with cardiovascular benefits in other glucose-lowering medications .The satiety effect of GLP1-agonists reduces your food intake, appetite and hunger.Gilden is very involved in education in obesity medicine, lecturing in one of the obesity medicine board review courses and serving as the lead author on the Annals of Internal Medicine article "In the Clinic" on obesity.Clinicians started to observe the weight management benefits of GLP-1s in addressing metabolic syndrome in patients with diabetes and in treating patients with cardiovascular disease and conditions that can be exacerbated by overweight and obesity.While GLP-1 medications are generally safe and well-tolerated, it's essential to be aware of potential side effects that some individuals may experience.This time frame is important relative to the duration of exposure to antidiabetes drugs that might have a potential to accelerate the progression of malignant disease. This step-by-step increase allows the body to adjust and reduces the chance of strong side effects like nausea and vomiting. After starting tirzepatide, the dose is usually increased over several weeks. This allows the body time to recover before adjusting to the new medication. This schedule helps prevent overlapping side effects while avoiding a gap in treatment that could cause high blood sugar. The effect was primarily observed during ad libitum lunch (35% reduction with semaglutide versus placebo) (8). Semaglutide produced substantial, albeit smaller, weight reduction that was also predominantly explained by fat mass loss. At week 28, energy intake significantly reduced from baseline with tirzepatide and semaglutide, but not with placebo. The absorption of concomitant oral medications may be reduced or delayed when tirzepatide therapy is initiated; this effect is explained by the delay of gastric emptying observed under tirzepatide administration (61). The pharmacokinetics of tirzepatide are not significantly changed by age, gender, race, ethnicity, body weight, or renal or hepatic function (61). Clinical studies showed an improvement in glycemic parameters and a substantial and dose-dependent loss of body weight. Therefore, both agonists and antagonists of the GIP receptor may be useful for the therapy of obesity (46). Not all insurance plans cover both medications equally. Some may lose weight faster on tirzepatide, while others may take longer to see results. The starting dose of tirzepatide is also an important decision. Switching from semaglutide to tirzepatide needs to be done carefully to avoid side effects, keep blood sugar stable, and ensure the new medication works properly. The transition from semaglutide to tirzepatide should be carefully timed to avoid withdrawal effects or overlapping doses. If semaglutide is not leading to the desired weight loss or blood sugar control, a switch to tirzepatide could be beneficial. Semaglutide and tirzepatide are both effective treatments for type 2 diabetes and weight management. With these precautions, in principle, quantitatively similar effects can be achieved with respect to glycemic control and lowering body weight .Nausea and vomiting were the main side effects that Pickford and Lynn-Pullman experienced in the early days of treatment.It’s possible microdosing could lead to weight loss or help maintain previous weight loss, but that’s never been studied, she adds.This typically shows up as increased appetite, the return of food cravings, and reduced feelings of fullness that the medication had been helping to manage.Timing your injection around your preferred downtime can reduce the impact of early side effects.Your body is starting something new, and that deserves credit.Safety outcomes were published (3); the overall pattern of adverse events was consistent with incretin class molecules and comparable between treatment groups. He stressed the importance of changing my habits or the weight would come right back once I stopped taking Wegovy.Tirzepatide may take a few weeks to start working fully, just like semaglutide.Daytryp’s online GLP-1 weight loss program connects you with providers who guide the whole journey.Use lowest effective dose, prioritise lean mass protection.Comprehensive guide How to taper off semaglutide and stop GLP-1 medications after reaching your weight loss goals.It's crucial to acknowledge these systemic barriers and advocate for equitable access to weight-loss treatments, empowering individuals of all backgrounds to prioritize their health.No foods are strictly “off-limits” while taking Semaglutide or Tirzepatide, but some foods are more likely to cause side effects, especially early on.For example, they may have read or heard about a newer treatment or may have a preference for one delivery device or route over another. For the once-weekly GLP-1 receptor agonists subcutaneous semaglutide and dulaglutide, gradual escalation to the recommended therapeutic dose is recommended (11,12). For patients who have experienced GI adverse events, consider withholding medications in a stepwise manner to determine the causative agent or facilitate tolerance of the GLP-1 receptor agonist. Practitioners should try to become knowledgeable about formulary coverage and the relevant pre-authorization processes in their area to ensure that patients who need these medications can obtain them as part of their health insurance benefits. All GLP-1 receptor agonists delay gastric emptying, which may affect the absorption of other oral medications (7–13). Furthermore, in rodents like mice and rats, stimulating the GLP-1 receptor raises cAMP in thyroid C cells, initiates the release of calcitonin, and upon longer-term exposure, is accompanied by C-cell proliferation and the formation of C-cell adenomas and (medullary thyroid) carcinomas (6). “Working closely and communicating effectively with your provider is necessary for your treatment success,” she tells us. That said, Dr. Ngo-Hamilton explains it’s important to stay on the current dose for at least four weeks to build tolerance. Semaglutide dosing varies by individual and should only be determined by your healthcare provider. Don’t try to lose weight faster by eating too little, as this can cause muscle loss and nutritional deficiencies. While no foods replicate Ozempic’s effects, certain foods can support similar processes. You can boost natural GLP-1 production by eating foods rich in healthy fats like avocados, nuts, and olive oil. Success comes from understanding how different foods interact with your treatment. Some for-profit companies, like GoodRx, can also help you compare prices and find discounts on prescription medications. If your insurance doesn’t cover GLP-1 drugs, you still have options to help lower the cost of these medications. If your insurance company denies coverage for GLP-1 medications, you have the right to appeal the decision. Food and Drug Administration (FDA) approved semaglutide sold under the brand name Ozempic mainly for treating type 2 diabetes, so it’s more likely to be covered when prescribed for that reason. Comparison of approved GLP-1 RAs with respect to their effectiveness in reducing HbA1C (A), fasting plasma glucose (B), and body weight (C). Thus, the time–action profile changes between periods (lasting a few hours) during which patients are exposed to effective circulating drug concentrations, and “resting” periods, during which GLP-1 receptors are not activated. Less than optimal up-titration regimens may lead to (avoidable) side effects and will most likely limit the upper dose range that is considered to have a beneficial efficacy-side effect relationship. Choosing the appropriate initial dose escalation schedule can have consequences for dose selection in phase 2 of clinical development programs, since doses carried on into phase 3 and suggested for approval have to be effective as well as tolerable and safe. Since then, recommendations have been developed for such an up-titration (dose escalation) approach to induce tolerance before patients are exposed to higher doses of GLP-1 RAs (Figure 2). The Truth About Switching Medications The report further distinguished clinical obesity, defined as excess adiposity with significant tissue or organ dysfunction that can lead to severe complications, from preclinical obesity, defined as excess adiposity without immediate organ dysfunction but with an increased risk of progression to clinical obesity and other non-communicable diseases. A recent expert group reviewed the utility of BMI-based measures for assessing individual health and concluded that these can misclassify (both underestimate and overestimate) adiposity—and thus undermine effective clinical care and policy development.271 To address this, the report proposed a new definition of clinical obesity—a chronic, systemic illness resulting from excess adiposity and characterized by alterations in tissue and organ function. Others tolerate the drug but, once meaningful weight reduction is achieved, do not wish to stay on the medication for life. As a result, recommendations prioritize GLP-1 RA treatment for individuals with atherosclerotic vascular disease (such as previous CV events) . However, in addition to the direct effects of GLP-1 on the CNS, the incretin more likely exerts its actions on the brain through indirect pathways, that is, through vagal afferents originating in the gut and portal circulation 59,60. GLP-1 secretion from the gut seems to be impaired in obese subjects, suggesting a role in the pathophysiology of obesity . Working with a clinician helps you use GLP-1s safely, manage side effects, and stay accountable. We believe that a personalized approach is the key to achieving and maintaining your health goals safely and effectively. Partnering with experienced health care professionals ensures you have the support and expertise you need for success. Your provider will help you evaluate the benefits and risks of each. Semaglutide is still a highly effective option that has helped millions of people achieve their goals. These findings point to a role of the arcuate nucleus within the hypothalamus, area postrema (AP), and nucleus tractus solitarii (NTS) for the influence of systemically administered GLP-1 RAs on appetite, satiety, calorie intake, and body weight as schematically summarized in Figure 6. It is obvious that appetite-and weight-reducing effects involve uptake into specific brain regions and interaction with CNS neural circuits involved in the homeostatic or hedonic regulation of energy household and food intake. In addition, the risk of hypoglycemic episodes and gastrointestinal side effects was slightly, but significantly lower with long-acting GLP-1 RAs . GLP-1 RAs that are usually injected once daily (liraglutide or lixisenatide) were combined with basal insulin designed for once-daily injection (insulin degludec or insulin glargine), resulting in the fixed-dose combinations iDegLira 28,59 and iGlarLixi 60,61. When a GLP-1 RA is added to (basal) insulin, the combination is as effective as an intensified (basal bolus) insulin regime in terms of HbA1c control, but with a much lower risk of hypoglycemia and weight gain . Innovations in Medicine: 2024 Lineup of New and Approved Specialty Drugs (Pharmacy Technician Credit) It is currently used as a second-line drug for diabetes, similar to other GLP-1 drugs like semaglutide, and may also be used off-label to treat obesity. However, it is important to note that tirzepatide has not been studied in individuals with pancreatitis and is not approved for the treatment of type 1 diabetes. The percentage of participants who had a weight loss of 5% or more was 85% with 5 mg, 89% with 10 mg, and 91% with 15 mg of tirzepatide, whereas only 35% of participants experienced this weight loss with a placebo. At week 72, the mean percent change in weight was −15.0% with weekly doses of 5 mg tirzepatide, −19.5% with doses of 10 mg, −20.9% with doses of 15 mg, and −3.1% with placebo. Furthermore, the mean change in body weight from baseline was −5.4 kg with 5 mg of tirzepatide, −7.5 kg with 10 mg, −8.8 kg with 15 mg, and 1.6 kg with placebo in the SURPASS 5 study . While GLP-1s can be more effective than lifestyle changes alone, including changes to your diet and increasing physical activity, it’s worth noting that the best approach to using GLP-1s is to combine them with those healthy habits. Because there haven’t been studies done on smaller doses of GLP-1s, it’s hard to say for sure how they stack up. Using semaglutide has shut down the "food noise" I’ve lived with most of my life. I'm gaining my confidence back in my ability to lose weight, and I've lost 3 lbs. Several for-profit telehealth and digital companies are now engaging with health systems, aiming to provide more efficient and less costly obesity management. Pharmacists can also play a role, as an accessible healthcare professional who is also dispensing the medication. Other lifestyle interventions are essential to support individuals using GLP-1s as part of the recommended multicomponent lifestyle programs that are the foundation of obesity treatment.94,179,180 These include improving sleep quality, managing mental stress, minimizing substance use, and nurturing positive social connections.181,182 The cultural fear of weight gain and larger body size has insidious origins. Lark’s digital coach is available 24/7 on your smartphone to give you personalized tips, recommendations, and motivation to lose weight and prevent chronic conditions like diabetes. Your Lark coach is available 24/7 for food logging and feedback, support taking your medications, and coaching around supportive behaviors like managing stress and being physically active. Lark can help with personalized coaching for weight loss and side effect management. Your healthcare provider may change your GLP-1 dose occasionally, too. This helps you see how your body changes during treatment. Initial health metrics provide a clear starting point before using tirzepatide. Healthcare providers need to check your body weight, BMI, blood pressure, and medical history. Weight loss also leads to a decrease in GLP-1 and changes other appetite-related hormones, which can prompt you to eat to get back up to your baseline weight. In that way, the body’s natural GLP-1 “doesn’t have its same oomph,” Undeberg says. The body releases it when you’re eating “to help slow us down and eventually put the brakes on food so we stop eating,” Rao says. “The medicine hits some receptors in various parts of the brain that then have downstream effects,” says Dr. Nadolsky. These receptor agonists are designed so our bodies can’t break them down. We must also empathize with patients experiencing weight-based marginalization. These medications are expensive (price), and injections are more complex than oral medications (simplicity). Given the sociopolitical origins of our weight-focused culture, how should we address our patients' desires to achieve a certain weight, even if there is no strict medical need to do so? Rotating sites prevents skin irritation and ensures you get the full dose. For vomiting or diarrhea, make rehydration a priority (consider electrolyte drinks) and ask your doctor about temporary dose adjustments if needed. The good news is they often lessen over time as your body adjusts. Focus on lean proteins, vegetables, whole grains, and healthy fats, and try to avoid ultra-processed foods. The Mayo Clinic emphasizes that drugs like semaglutide should be combined with a nutritious diet and regular physical activity. Risk of nonarteritic anterior ischemic optic neuropathy in patients prescribed semaglutide. Role of glucagon-like peptide-1 receptor agonists in Alzheimer’s disease and Parkinson’s disease. Recommendations from the eastern and southern Europe diabetes and obesity expert group. Additionally, further research is needed to clarify the mechanisms underlying adverse events and to identify which patients may be at higher risk (27). Educating patients about the importance of lifestyle modification, as well as the potential risks of pharmacotherapy, will remain essential. Table 1 Effects of GIP receptor agonism or antagonism on glycemic control, body weight, and energy balance in animal models of obesity and diabetes (modified according to Campbell and Nauck) (47, 49). The GLP-1RA liraglutide has also been approved for the treatment of obesity at a higher standard dose (3 mg once daily) compared to the standard dose used for T2D treatment (1.2 mg once daily) due to the results of the SCALE study program (37, 38). Dual- and triple-receptor agonists acting via different receptors and postreceptor pathways seem attractive in view of potentially additive or synergistic effects in the treatment of T2D and obesity. While many studies have demonstrated efficacy in patients with diabetes and obesity, a worrying trend is interest in Ozempic for cosmetic weight loss popularized by social media and celebrity influences . GLP-1 Semaglutide can be a game-changer in managing weight. The magnitude of effect on A1C, weight, and GI AEs should be considered when selecting a specific agent within the GLP-1 RA class. The short-acting agents have less impact on A1C and weight and high rates of GI AEs, and thus should not routinely be considered first-line agents. Support Your Body with Nutrients (B12, NAD⁺, etc.) Kaplan-Meier analysis of persistence among patients switching from a previous GLP-1 receptor agonist to dulaglutide once weekly, exenatide twice daily or once weekly, or liraglutide once daily. Several patient surveys indicate a preference for less frequent dosing with GLP-1 receptor agonists, specifically for once-weekly over once-daily dosing, in both injection-naive and injection-experienced patients (49,50). Dissatisfaction with treatment frequency may be a reason for patients not to adhere fully to their prescribed regimen and may be ameliorated by a switch from a once- or twice-daily to a once-weekly GLP-1 receptor agonist. It is important to emphasize to patients that glycemic efficacy and weight loss are not necessarily mutually exclusive. Your healthcare provider can help you decide if they’re right for you. This should include an emphasis on healthful eating, physical activity, and resistance training; screening and management around substance use disorders, eating disorders, mental health, and sleep; and micronutrient or protein supplementation as needed. Careful attention to evidence-based nutritional and behavior modification can help mitigate the adverse effects of these challenges. This isn’t a standard treatment; it’s one made just for you. Talk to your healthcare provider to see if a GLP-1 agonist is right for you. Every person is unique and so is each treatment plan. You should have regular appointments with your healthcare provider when taking a GLP-1 agonist to assess how well it’s working. Without proper treatment, severe hypoglycemia can be life-threatening. In 2016, 650 million people were obese and in 2020, 39 million children under the age of 5 were already overweight or obese (18). Obesity, defined as a body mass index above 30 kg/m2, is also increasingly prevalent worldwide and has become a challenge to the various healthcare systems and societies. Randomized prospective studies have demonstrated a significant reduction in microvascular and macrovascular complications in patients with T2D when plasma glucose, blood pressure, and plasma lipid concentrations are lowered towards a normal level (3–15). • Show patients how to use the injectables. The second incretin, GIP, whose receptors reside in adipose tissue, increases insulin secretion and suppresses glucagon release. GLP-1 agonists also stimulate pancreatic beta cells to secrete insulin and tamp down glucagon secretion from the pancreatic alpha cells. How and Why They WorkGLP-1 has several actions, whether secreted endogenously from the intestine or used as a medication. "If they're on the maximum dose for a couple of months and they really haven't seen a significant weight loss, like 5% or more of their total body weight, then it's really time to think about getting some labs," Dr. Meghan advises. You've seen the headlines about dramatic weight loss results with GLP-1 medications. If restarting, patients usually return to a lower dose to avoid side effects and ensure a gradual reacclimation, allowing the medication to reach therapeutic levels safely once again. The dosing schedule for semaglutide also involves gradually increasing the dose over several weeks to help minimize side effects and allow the body to adjust. The dosing schedule for tirzepatide involves a gradual increase in dose to help the body adjust and minimize side effects. Obesity was defined as an ICD-9-CM or ICD-10-CM diagnostic code of obesity or a calculated BMI ≥30 kg/m2. When there was more than one weight measurement in a given 8-week interval, we randomly selected a weight measurement for that window. Always proceed with clinician-guided protocols, close monitoring, and attention to side effects. Rather than immediately jumping to higher doses, a multifaceted approach combining time on dose, adjunct therapies, nutrition, exercise, and stress management will often yield better sustained results. Chronic stress and poor sleep raise cortisol, impair insulin sensitivity, and blunt weight-loss signaling. That is also often the case when patients stop taking full doses of GLP-1 drugs. Pharmaceutical companies spend years running tightly regulated clinical trials to determine the safest and most effective doses. It’s possible microdosing could lead to weight loss or help maintain previous weight loss, but that’s never been studied, she adds. It’s unpredictable whether microdosing would have a similar effect since some patients feel almost nothing on the lower doses, McGowan notes. Wegovy and Zepbound are FDA-approved for patients with a BMI of 30 or greater; or a BMI of 27 or more if they have a weight-related complication.