Dietitian Review: GLP-1 Weight Loss Drugs and What NO ONE is Telling You

Ever wondered about weight loss drugs, particularly the massively popular GLP-1 drugs like Ozempic, Wegovy, and Mounjaro? Curious about what they are, how they work, and if they're effective? This episode aims to answer all your questions, review the research, and offer up my honest insights.

Special shoutout to @Dr_Idz for taking the time to help me prepare for this episode. Check out his school for deep dives into all the latest nutrition fads. I highly recommend it for anyone interested in nutrition and health,  especially if you are a healthcare professional who advises others on nutrition.

Read the article associated with this episode here

TOPICS COVERED 👇 

• [2:19] What are GLP-1 Drugs and how do they work?
• [4:02] What is the difference between the Semaglutides Ozempic, and Wegovy?
• [5:30]  Liraglutides, Dulaglutides, and Tirzepatides... uh, what?
• [6:17] How Mounjaro works
• [7:11] Difference between Mounjaro and Ozempic / Wegovy
• [7:47] What the research says about Semaglutides (Ozempic & Wegovy) and Tirzepatides (Mounjaro)
• [12:20] The red flag that no one is talking about with these drugs 🚩 
• [15:17] Side effects of GLP-1 drugs
• [16:33] How much do they cost?
• [17:45] Ethical considerations and concerns about these drugs
• [18:39] My overall thoughts on using GLP-1 drugs for weight loss
• [20:57] Recap

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Transcript

Michelle: 0:00

Welcome back to the Nourished and Free Podcast. I'm your host, michelle Yates, and I'm a registered dietitian that loves talking about how to heal our relationship with food, but also do so in a really evidence-based way. And today I'm talking about probably the hottest topic I could possibly talk about because I get asked about it all the time and I'm constantly seeing it in headlines which is weight loss drugs, specifically the GLP-1 drugs, which I'm going to explain what that means soon. But basically, if you've heard of Ozempic, Wegovy, Mounjaro, there's a few others. That's what I'm talking about today and I'm super excited to dig into it. But first I want to give credit where credit is due, because, in order to prep for this episode, i wanted to be sure I fully understood how these medications work, the risks, benefits, what the research is saying. I wanted to be sure I fully understood everything there is to understand about these drugs before I presented the information here from, obviously, a dietitian's perspective. So credit where credit is due. Thank you to Dr Idz for collaborating with me on this and teaching me what I didn't know about these drugs and also just filling me in on what the research is saying and also the risks and benefits of these drugs.

Michelle: 1:09

If you're not already following him on social media, i really recommend it. I'll drop his social channels in the show notes. He's a really great resource for debunking all of the ridiculous stuff that we see about nutrition these days, and so he goes through all of the evidence, basically showing why a lot of the stuff we hear is not true. I'm also going to put a link to his membership site. I don't get like a kickback on that or anything, i just really love it. It is where he does longer form content, going into all the nuances behind these hot topics and like a full data review. So it's great. If you're a healthcare professional or somebody who's just interested in nutrition in general, you're definitely going to want to be involved with that because, especially for the healthcare professionals out there, we have a duty to be up to date on the research and be providing accurate information. Otherwise it's straight up harmful. Anyway, i really appreciate him for his collaboration on this specific topic so that I could bring it to you guys and actually have accurate information for you. So I'm excited to dig in.

Michelle: 2:08

Let's talk about the drugs. As we dig into this topic, i think it's important that we just explain what GLP-1 drugs even are, and what GLP-1 stands for. So GLP-1 drugs were initially used for diabetes management but have since grown and popularity for weight loss, which is, of course, why we're talking about it today. GLP-1 stands for glucagon like peptide one, which is a hormone naturally produced in the intestines. GLP-1 drugs are receptor agonist, which means that they bind to and they activate the receptors GLP-1 GLP. So basically they're making GLP-1 that glucagon like peptide one, which is found in the intestines is making that activate.

Michelle: 3:02

And what this does is it leads to several effects in the body. Number one it increases our insulin secretion by stimulating the release of insulin from pancreatic beta cells, which helps to lower blood sugar levels. Of course, insulin helps to lower blood sugar. The next thing is it inhibits the release of glucagon. Glucagon is a hormone that raises blood sugar, so this, of course, is another thing that helps to lower overall blood sugar levels. It should be making sense now why this is typically used for diabetes. And the last thing is that it slows down gastric emptying. So what I mean by gastric emptying is it basically slows down the rate that food is processed and leaves the stomach, and it does this by relaxing the stomach muscles and preventing that movement or motility from happening, which essentially means that food is staying in the stomach longer. That means that people are full or longer as well, and so naturally they're just going to end up eating less food.

Michelle: 4:02

So one of the most confusing parts of these drugs to me, before I really learned about them, was just all the different names, and I didn't understand if they were different drugs or if it was just different brands or what. So, just in case that's something that you're curious about, i'm going to go ahead and share with you the lowdown on all the different drugs that fall under the GLP-1 drug class, and then the brand names as well that they're being sold as. So agglutides i think, are one of the most popular that we hear about right now, and this is Ozempic and Wegovy. Ozempic and Wegovy are both semag lutides. Just to clarify, they are both sema glutides and they are both underneath the GLP-1 drug class. Ozempic is just the brand name for this drug after it was approved by the FDA for diabetes specifically. Then, once the FDA approved sema glutides for weight loss, it started being sold under the name Wegovy. Wegovy is the same drug as Ozempic. The difference is just that it was finally approved by the FDA for weight loss, so they had to start a new brand name in order to have it be the FDA approved for weight loss drug. I don't know why that is, but that's just how it is. So Wegovy and Ozempic are the same exact thing Ozempic FDA approved for diabetes, Wegovy FDA approved for weight loss. They are both sema glutides, both GLP-1 drugs. Similarly, we have Liraglutides, which are sold as Victoza, which is the FDA approved for diabetes, and Saxenda, which is the same drug but sold under a different name because it was FDA approved for weight loss. So, liraglutides, we've got Victoza and Saxenda. Dulaglutides, another type of GLP-1 drug, is sold as Trulicity I feel like I see Trulicity commercials a lot and this is the FDA approved one for diabetes. At this point there is no FDA approved version of Dulaglutides for weight loss, so there's only Trulicity. And then Tirzapetide is sold as Mounjaro. This is the one that we always hear about And so that presently is only FDA approved for diabetes. Once we have an FDA approved one for weight loss, then there will be a new brand name that comes out.

Michelle: 6:17

Tirzapetide is a little bit different of GLP-1 GLP drug, because not only does it activate the GLP-1 receptors, but it also activates GIP. So quick review of the GLP-1 receptors When we activate those, we have effects like slowed gastric emptying, in other words, food stays in your stomach longer, we have increased insulin secretion from the pancreatic beta cells, and then we also have an inhibition for the release of Glucagon, which is a hormone that raises blood sugar. So all of that is happening with drugs like Mounjaro, plus the GIP. Gip stands for Glucose Dependent Insulinotropic Polypeptide, but of a mouthful, which is why they call it GIP. Gip stimulates insulin to release after a meal, specifically after a meal. It depends on there being glucose in the bloodstream. So insulin is, of course, key in regulating our blood glucose, and so the difference between drugs like Mounjaro and Wegovy or Ozempic is that there's this extra layer of the GIP One stimulation which is aiding in some extra insulin being released after a meal. Therefore, the difference between Terzapetide, otherwise known as Mounjaro, and some aglutides otherwise known as Ozempic or Wegovy, is that there's another agent working to secrete insulin. Okay, so you probably didn't need to know all of that, but just in case you wanted to know, like I did, there you have it. Let's stick into what the literature is telling us about these drugs, and you might be surprised. Now, keep in mind there are other drugs used for weight loss, like phentermine, naltrexone, orlistat. There's other weight loss drugs besides GLP-1, but for the sake of this episode and the research review, we're going to just be looking GLP-1 drugs like Mounjaro and Ozempic slash Wegovy.

Michelle: 8:09

The first study that really put sem aglutides on the map was in 2021, published in the New England Journal of Medicine, and this was a really interesting study. So researchers had nearly 2,000 participants who were in the obese category of BMI, and they were actually spanned across 16 countries from 129 different places. So I think that's really unique to this study is that there were so many participants and they were really spread across the globe, which is really rare to see in a study and actually super valuable. And everybody had 68 weeks of lifestyle interventions. But the participants were randomly assigned to either being a part of the placebo group or the intervention group. So placebo just means they got an injection, but there is not actually any drugs in there, and then the intervention group got the injections of semaglutide. So remember this was going on for 68 weeks.

Michelle: 9:05

This is a very long term study, which is also a unique part of this study, and so they found that the group who was receiving this amalgamate in their injections lost more than 33 pounds on average over the 68 weeks, whereas the placebo group, who were doing injections but it didn't actually have semaglutide in it, just lost five pounds. Now, remember, these groups are both doing lifestyle interventions as well. Which the lifestyle interventions was a 500 calorie, a deficit, paired with increased physical activity, about 150 minutes per week of physical activity like walking or whatever really any physical activity And then both their diet intake and activity were recorded in a diary daily, which they could do on their smartphone if they wanted. So I think that's really interesting that the group who was undergoing lifestyle interventions but got the placebo, they only lost five pounds on average over the span of over a year, which is really interesting to me. Something else that's interesting is that in the intervention group, almost double the amount of people normalized or hemoglobin A1c versus the group who was not receiving semaglutide, and this is, of course, for those who were pre diabetic. Now, none of their participants had diabetes, but some of them were pre diabetic And so they were seeing. The researchers were seeing that the participants who were pre diabetic and received semaglutide had double the amount of normalization in the hemoglobin A1c versus the other group. More than 69% of people who were receiving semaglutide lost more than 10% of their weight, compared to only 12% of people from the placebo group. So this is really interesting And it's definitely a well designed study. We're looking at a lot of different locations all across the world And it was well designed. It was a double blind. They didn't know if they were getting the semaglutide or not. The lifestyle interventions were controlled, for everybody was having a lifestyle intervention And so I think this was a very well designed study. I can see why it was so groundbreaking.

Michelle: 11:16

And then another study that was really similar showed similar results over the course of 72 weeks, and this study was using tirzepetide specifically, which, if you remember me explaining from earlier, that's the Mounjaro of the drugs and the semaglutides are the ozempics and Weogvy of the drugs. So both of those, whether it's semaglutide or tirzepetide, were showing similar results over the course of a long period of time that generally the drug those who actually received the drug did much, much better than those who did not, with the goal, of course, of weight loss. Now, something that I would have liked to have seen controlled for was just disordered eating behaviors and some psychological assessments on their relationship with food and with their body and everything, but that's not really what the researchers were interested in. They were just interested in how effective is this drug as a weight loss drug with obese populations who are not diabetic? So, when it comes to the goals they had, they certainly did get the data they were looking for with those specific goals in mind. Now here's the interesting thing, and here's where we really need to pay attention. The benefits were only seen as long as the participants were taking the drugs.

Michelle: 12:35

There was a follow up study published in 2022 to the study done specifically for semaglutides, in other words, ozempic and wegovy, and what they found was that, after one year of stopping the semaglutides, participants regained two thirds of the weight they had lost, and most of the cardiometabolic improvements that they had seen, like the hemoglobin C and there were some other things like cholesterol, i believe were starting to revert towards the baseline levels as well. Also interesting, though, is that the people in the placebo group also gained back the weight. Now, remember they didn't even have that much weight to gain back in the first place because they didn't lose nearly as much, but they were still trending back. And so what's interesting is that, regardless of what happened during the study whether they got the placebo or they got the drug they were doing lifestyle interventions, and once the study was over, everybody started to regain their weight, no matter what group they were in. And then, when it comes to those who did take the smagotides, we're talking about a ton of weight, an average of 33 pounds. They had regained two-thirds of that, so over 20 pounds within a year. I would be curious to see, a year after that, how much weight they had regained. Maybe they end up regaining all of it, maybe they end up gaining more than they lost. I'm not sure There's no follow-up to the follow-up study, but I think that's a really that's a very teachable moment that these drugs only work for as long as you take them.

Michelle: 14:14

Once you go off, the weight comes back And any changes in cardiometabolic indicators also go back. An easy argument to this, then, is like well, then I'll just keep taking the drug, right? Like I want to lose weight, so I'm going to take this drug, and if you're telling me that, as soon as I go off of it, the weight comes back. Then I'm just going to keep taking it, which is a totally natural reaction. However, now we need to start to consider some other things. Is this something that we can actually maintain for the rest of our life? And the way that we figure that out is by looking at side effects and by looking at the cost. There's a few other things we can look at too, such as just like the general unpleasantness of having to stick yourself with a shot, but I think the most helpful thing to look at here is side effects and the cost of this medication, because those are going to be the biggest things that we'll decide how long somebody can actually take this drug for, and or if they can take it the rest of their life.

Michelle: 15:17

Some reported side effects that we're seeing is one study showing that 84% of people taking smagolotides experienced gastrointestinal issues such as diarrhea, which absolutely nobody wants to experience, and part of its interaction is to reduce glucose absorption from the gut. So it makes sense that there might be some GI distress if there's more sugar and water in the intestines. Therefore diarrhea. Other side effects in more than 10% of people is nausea and hypoglycemia. And then rarer side effects, in less than 10% of people, include constipation, vomiting and digestion, bloating, abdominal pain, fatigue, decreased appetite, obviously, and an increased heart rate. And then there are some super rare side effects, including an increased risk of gallstones or pancreatitis. Now we're not 100% sure if this is due to the medication or if it's just because people are losing weight quickly, and anybody who loses weight quickly is at an increased risk for these conditions anyway. So in terms of longevity, we're looking at 84%, if people at least experiencing diarrhea. So I don't know, do you want to be experiencing that the rest of your life? For some people, maybe it's worth it.

Michelle: 16:33

Now let's talk about the cost of these drugs. Of course, if your insurance covers it, it's potentially free or partially covered. However, there is a growing concern of a massive shortage on these drugs. So if everybody is getting their insurance to cover these, i'm not even sure that that's not helpful if there's going to be a global shortage on these drugs, especially for those who really need it for their diabetes. As far as I can tell, the only way that insurance will cover these drugs is if that person has a body mass index of 30 or greater. There's also potential for those who have a BMI of 27 or greater to have insurance approved coverage if they are experiencing other conditions like high blood pressure or sleep apnea. Now, in terms of out-of-pocket cost for these drugs, there's a lot of different references, a lot of different resources citing a lot of different prices, but as far as I can tell, we're looking at anywhere from between $800 to $1400 a month for these drugs. So I don't know many people that are willing to pay that price for the rest of their life. If you are good on you.

Michelle: 17:44

But when we're thinking about the longevity of these drugs, does it really make sense to start something that literature is showing us? the research is showing us the results only last as long as you take it. Does it make sense to start it if you know you're not going to be able to upkeep with the expenses of it? This also raises an ethical concern. If providers are prescribing these medications knowing the risk that, as soon as the drug is removed from the equation, that the weight is just going to be regained and all of the symptoms that improved with the drug are just going to go back to how they were at baseline, i feel like that's a bit of an ethical concern, at least for me, that this is being prescribed so frequently, because I can't imagine that the majority of people are going to be able to continue taking this drug, whether it's because of the side effects, the cost, insurance not covering it anymore, or because it just simply runs out because there's a shortage of it. So, when it comes to my overall thoughts and opinions on these GLP-1 drugs, i will be honest and say that there is some solid research supporting that it does what it's supposed to do, which is to help individuals living in a larger body lose weight. That's just kind of a fact based on the studies that were pretty well designed.

Michelle: 19:01

But when it comes to all of the nuances which, of course, we have to look at the nuances of this, like real life circumstances is somebody going to actually be able to continue to take this the rest of their life? Are they going to be able to do it without side effects? Are they going to be able to do it without some huge dent in their bank account? Are they going to want to continue to poke themselves? Is there going to be enough supply for them? There's a lot of factors that go into the longevity of this thing.

Michelle: 19:30

And then I think one of the most important things to analyze about a situation where somebody might be considering doing the GLP-1 drugs is what led to the excess amount of body weight in the first place that they feel like they have to get rid of. Was it binge eating or was it, i don't know, like something that is underneath all of this, and can we just address that instead? Because if we address the cause of the problem, then the problem goes away, especially if we address it in a way that's sustainable. It makes way more sense to address the root issues behind why somebody is seeing an imbalance in their weight. And something else I want to mention as well is that if somebody is in a body that is technically obese according to the BMI, but everything else about them is healthy, then I don't see this blaring need to do anything about their body size personally, because if everything else looks good their lab work, their cardiometric, balic health, they are exercising frequently and challenging themselves and they have a well-balanced diet and they're stressed as well-managed and they're sleeping Like if they're doing all of the right things, but they just happen to be in a larger body then I don't think that that's fair to just tell them they have to lose weight. I'm not a big fan of that type of health care, which is unfortunately pretty common.

Michelle: 20:57

So more all of the story is these GLP-1 drugs. There is some really solid research behind them being effective at what they're supposed to be effective for, which is just straight-up weight loss. However, it doesn't make sense for somebody to use these drugs if they have underlying issues in their behaviors and lifestyle choices that are causing the excess weight, because as soon as the drug is removed, then all of the weight comes back. So we might as well just go ahead and address the underlying issues that are happening, if possible. Also, there is some concern about gastrointestinal distress, like diarrhea. In terms of side effects, there's some other side effects as well, but that's the most common one. And in terms of just costs, this can be a quite costly drug And it's so popular right now that there are issues with shortages. So with a drug like this that is shown by research to only work as long as you're taking it and then as soon as you get off of it, you're going to regain two-thirds of the weight within a year, and then who knows how much in the year after that. You better hope that you're going to be able to take it the rest of your life, and if you can't, then why even start it?

Michelle: 22:10

I hope you enjoyed this episode about these weight loss drugs that are getting more and more popular. If you enjoyed it, please share it with a friend and be sure you follow the show so that you never miss an episode. And if you resonate with the concept of getting to the root issues and healing your relationship with food, then please feel free to reach out to me and I will put my information in the show notes. Especially if you struggle with something like binge eating or chronic dieting or you feel really stressed out about food, you might be the perfect candidate for my signature program, nourished and free. So definitely look in the show notes for more information on that. And, as always, you can connect with me on Instagram and I'm happy to chat with you and even just hear feedback on the show.