Over the last few years, there has been near non-stop media and social media coverage of the "new weight loss drugs," GLP-1 receptor agonists such as semaglutide (Ozempic and Wegovy) and GLP-1 and GIP receptor agonist tirzepatide (Mounjaro and Zepbound). In reality, GLP-1 receptor agonists have been available for many years for the treatment of type 2 diabetes (Victoza, Trulicity, etc) and for weight loss (Saxenda), while tirzepatide is new in the last few years. These medications have powerful effects in the treatment of diabetes and reduction of risk for cardiovascular disease, but they are best known now for their ability to result in significant weight loss. As a result, they are in high demand by everyone from celebrities to the general public. They do have known potential side effects ranging from mild nausea and constipation to severe gastroparesis with vomiting, intestinal obstruction, and pancreatitis. There are other side effects that we are still learning about- effects on the brain such as on mood and addiction behaviors, potential for malnutrition, etc. They are also costly and subject to variable insurance coverage, leading many med spas and compounding pharmacies to offer compounded versions of these FDA-approved medications with varying degrees of safety. There is a lot of information and a lot of marketing out there creating a lot of confusion.
As a primary care physician, I am asked about these medications at least once a day, either by a patient, a colleague, a family member, friend, or acquaintance. I have spent a great deal of time reviewing the data available about these medications, discussing the risks and benefits with patients, and observing and monitoring the effects of these medications on my patients who are using them. In that time, I have developed what I believe is a unique and nuanced perspective on the use of these medications in comparison to the discussion being had in the media.
As most of you know, I follow a Health at Every Size® approach to the care of my patients. This means that I recognize that there is weight diversity amongst people, that a person's weight does not define their health status, and that it is possible to pursue health-promoting activities at any weight. I recognize the harms that often accompany attempts at intentional weight loss, and that intentional weight loss is rarely sustained long term. I care for many patients in recovery from eating disorders, and I have personal experience with eating disorders in myself and loved ones. I am acutely aware of the harmful effects of weight bias and stigma in medical care and society at large. Therefore, it is my practice not to prescribe intentional weight loss and instead focus on improving each patient's health with an individualized approach- by addressing underlying health conditions, social, and lifestyle factors affecting health- regardless of weight. I do not prescribe "weight loss" medication for the sole purpose of reducing the number on the scale.
That said, throughout my training I have witnessed and become experienced in treating the health consequences associated with metabolic syndrome. Diabetes, cardiovascular disease, and metabolic associated fatty liver disease all have the potential to cause life-altering complications and premature death. The factors contributing to these conditions are complex- a combination of genetics, lifestyle, social connection, socioeconomic status, racism, access to food, education, and healthcare, etc. Sometimes these conditions can be controlled with lifestyle changes alone, but not all of these risk factors are under our control. Often medication is useful to better control these conditions and help reduce these risks. In my residency training at a community hospital in an underresourced area of Washington, DC, I frequently treated patients who were suffering severe consequences of these conditions that could have been prevented with earlier treatment. We should not demonize the use of medications that have the potential to profoundly benefit patients. Sometimes, for some patients, the GLP-1 receptor agonists may be the best choice.
So when patients ask me about these medications, I do the same thing I do when considering any other medical intervention. I provide information about the risks, side effects, costs, and potential benefits. We discuss the patient's goals and expectations. We review all of this in the context of the patient's personal history, family history, lifestyle, environment, and current health status. Then together, we come to a decision that is right for them. Once the decision is made, we come up with a plan for ongoing monitoring to ensure the treatment plan continues to be safe and effective. This approach is not one-size-fits-all and it takes time. It is not a quick fix, it is not flashy, and it does not sell well on a MedSpa billboard. But it is in my opinion the ethical and medically appropriate approach.
If you are my patient and are considering a GLP-1 receptor agonist- I strongly encourage you to schedule an appointment with me so we can discuss your individual situation. If you are not my patient and are considering it- please do so with caution. Choose a physician to discuss this with who will take the time to help you decide whether it is truly right for you- someone who will review your health in detail, who understands the data and can explain it well, and who will monitor you appropriately while you are taking the medication. If you are receiving the medication from someone inexperienced, with inadequate training, or who is not appropriately monitoring your care- you are at risk of severe consequences.