Each month North American doctors write more than three million prescriptions for the new weight-loss medications called GLP-1 agonists. Examples include semaglutide in Ozempic and Wegovy and tirzepatide, the drug in Mounjaro and Zepbound. Also each year, these doctors perform more than 200,000 stomach surgeries to help people lose weight (Surg Obes Relat Dis, Sept 2022;18(9):1134-1140).
Lost Weight is Usually Regained
Most people have regained two-thirds of their lost weight within one year after they stop taking these drugs (Diabetes Obes Metab, 2022 Aug;24(8):1553-1564), and more than 76 percent of bariatric surgery patients regain significant weight six years after weight-loss surgery (Obes Surg, 2016;26(6):1326-1334). Before people even think of taking the new weight-loss drugs or having weight-loss surgery, they should be schooled on lifestyle changes needed to keep the weight off, and see if they can follow the permanent changes of habits that will be necessary. They need to exercise regularly and eat the correct amounts of healthful foods, and these need to be permanent lifestyle changes, not a short-term diet.
Why People Stop Taking These Weight Loss Drugs
Half of the people who take these new GLP-1 agonist weight-loss drugs stop taking them within the first year because:
• They often cost more than $1000 per month. In 2022, about 60 percent of the new weight-loss drugs were approved by insurers, but today fewer than 25 percent are covered by insurance.
• Side effects of these drugs include loss of appetite, nausea, vomiting and diarrhea. Other less common side effects include dizziness, fast heart rate, infections, headaches, itching and redness in the skin at the injection site. More serious and less common side effects include low blood sugar and allergic reactions.
How GLP-1 Agonists Work
These drugs mimic two hormones called GLP-1 and GIP that our bodies release naturally after a meal to help regulate appetite and food intake by making us feel full. They slow down stomach emptying so your stomach remains full longer. You eat less, and people who take the drug often find that when they eat too much food, the food comes back up. This can lead to the most common side effects: nausea, vomiting, diarrhea and stomach cramps. They stimulate the body to secrete more insulin and less glucagon, which helps to lower blood sugar levels, and they help to send fullness signals from the gut to the brain. When you stop Ozempic, your full appetite may return within a week, increasing your calorie intake and leading to weight regain. In addition, your blood sugar levels may spike, worsening the effects of type 2 diabetes on your blood vessels, which can affect the heart, nerves and eyes.
My Recommendations
Diets and food restrictions usually fail miserably to control obesity. Recent studies show that GLP-1 agonists and bariatric surgery may help with weight loss, but the excess weight usually returns soon after you stop taking the drugs or have the surgery. Before you take GLP-1 agonist weight-loss drugs or have bariatric surgery, be ready to follow the lifestyle changes necessary for long-term weight loss:
• eat a plant-based diet with a wide variety of vegetables, fruits, beans, nuts and other seeds
• avoid all sugared drinks and severely restrict sugar-added foods and other refined carbohydrates
• restrict fried foods
• avoid mammal meat (blocks insulin receptors)
• avoid processed meats
• The least healthful time to eat is just before you go to bed, and the most healthful times to eat are before you exercise or within an hour after you finish exercising (Appetite, 2013 Jan;60(1):246-251). Exercising after eating causes contracting muscles to pull sugar from the bloodstream, which helps to prevent high rises in blood sugar.
• check with your doctor and then get instructions on an exercise program and join an appropriate exercise group.
Names of the GLP-1 agonist weight-loss drugs include Dulaglutide (Trulicity®), Exenatide (Byetta®), Exenatide extended-release (Bydureon®), Liraglutide (Victoza®), Lixisenatide (Adlyxin®), Semaglutide injection (Ozempic®) and Semaglutide tablets (Rybelsus®).
