How do GLP-1s help obesity?

Curious about GLP-1s and how they’re changing the game for obesity? Maybe you know them as brand-name drugs like Ozempic® or Wegovy®. Either way, you’re in the right place. Let’s start by breaking down what GLP-1 receptor agonists are. Glucagon-like peptide 1 receptor agonists (a mouthful, we know), or GLP-1s, are a group of medications used to treat type 2 diabetes and obesity. They mimic GLP-1, a peptide hormone your body naturally makes in your small intestines and colon. GLP-1 plays an essential role: it helps regulate blood sugar, tells your brain when you’re full, and slows down gastric emptying (digestion). 

Most GLP-1 receptor agonists are approved by the Food and Drug Administration (FDA) to treat type 2 diabetes. But one of the GLP-1 medications, semaglutide—produced by Novo Nordisk under the brand name Ozempic for treating diabetes—is also FDA-approved to treat obesity under the brand name Wegovy. Other GLP-1 receptor agonists are Trulicity®, Victoza® (liraglutide approved for type 2 diabetes), and Saxenda® (liraglutide approved for weight loss). Healthcare providers may prescribe medications like GLP-1s off-label to help treat obesity. Off-label prescribing is when a physician prescribes an FDA-approved drug at different doses or for a condition other than what the med was approved to treat. This off-label use is based on a strong body of research showing a medication’s benefit in treating a condition or disease for which the drug is not indicated. It’s a legal and common practice for physicians across the country.

Why GLP-1s are so groundbreaking for the treatment of obesity

Many experts agree that GLP-1s are a game changer for people with obesity, including Rekha Kumar, MD, Found’s Chief Medical Officer and the former medical director of the American Board of Obesity Medicine. According to Dr. Kumar, GLP-1s, like semaglutide,  are as effective in helping people lose body weight as bariatric surgery, which is a pretty big deal. “GLP-1 medications have a good safety profile and are well tolerated,” she explains. “And for people who do lose weight on these medications, staying on them long term can help with sustainable weight management.” 

Dr. Kumar also notes that while GLP-1s were first approved as type 2 diabetes medications, researchers discovered they also resulted in weight loss. That’s why they were later studied in clinical trials for weight loss and later approved. And clinical trials also showed that glucagon-like peptide 1 receptor agonists are superior in improving blood sugar regulation and reducing cardiovascular disease risk for patients with type 2 diabetes without the risk of hypoglycemia (low blood sugar) compared to other medications that lower blood sugar. 

This new movement of using GLP-1s that manipulate the gut hormone receptors to achieve weight loss helps us understand the role these hormones play in obesity. People with obesity may have GLP-1 impairment—when the body doesn’t respond to its natural GLP-1—and they may find success with these medications. GLP-1s can also be a groundbreaking treatment option for people with obesity who don’t qualify for bariatric surgery or don’t respond well to other weight-loss drugs. And unlike traditional treatments for obesity, like diets or increased exercise, these medications are shown to be extremely effective. 

How GLP-1s work for weight loss

As we mentioned earlier, your body naturally makes the GLP-1 peptide hormone. But some people with obesity may have an impaired release or potency of their own GLP-1, even in those with a normal response to glucose. To understand the nitty-gritty of GLP-1: It’s a type of incretin hormone our body naturally produces and these hormones—or gut peptides—are responsible for regulating blood sugar levels by stimulating insulin secretion after we eat. 

Unlike our natural GLP-1, the GLP-1 receptor agonists are resistant to an enzyme called dipeptidyl peptidase 4. This enzyme quickly breaks down your natural GLP-1, which means that GLP-1 receptor agonists can be more powerful and last longer in your body. Specifically, they: 

• Help your body make more insulin. GLP-1s restore insulin secretion and decrease the release of glucagon, another hormone your body makes to control blood sugar levels. 
• Delay gastric emptying. In other words, they help slow digestion, so nutrients from food are absorbed more slowly,  which helps prevent blood sugar spikes after a meal.
• Decrease appetite. By binding to GLP-1 receptors in the central nervous system and gastrointestinal tract, hunger is decreased, which can lead to a decrease in the amount of food you eat. 
• Restore insulin secretory functions. This leads to body weight loss and better control over blood glucose levels in people with diabetes. 

Why are GLP-1s so different from the previous treatment of obesity in health care?

Not only are GLP-1s often superior in efficacy, but they also target a different pathway—that of the natural GLP-1 hormone—than other weight-loss medications. As a result, people taking GLP-1 medications see their appetite decrease, and they eat less food, which leads to long-term weight loss. The benefits of GLP-1 receptor agonists go beyond blood glucose regulation and weight loss. For instance, they’ve also been shown in studies to improve insulin sensitivity in people with obesity and reduce blood pressure.

How GLP-1s could change the obesity crisis in the US

According to Dr. Kumar, if pricing and access to  GLP-1 receptor agonists improves, it could truly impact the obesity crisis—both in the US and globally. “Not only do these medicines reduce body weight, but they also improve the common comorbidities associated with obesity, such as type 2 diabetes, high blood pressure, and high cholesterol,” she says. “If anyone who needed this medicine could get a version of it as easily as we can for blood pressure and cholesterol medicine, we could improve health on the population level.” And for people with obesity who have tried it all without success—possibly because of GLP-1 impairment—they may finally have an effective treatment option. GLP-1 medications could mean more positive weight loss journeys for individuals with obesity because, well, they work.

GLP-1*

GLP-1 prescriptions, filled through your local pharmacy, are now available as part of Found's weight-loss toolkit. While GLP-1s are effective for weight loss, they are not clinically appropriate for everyone. Eligibility for a GLP-1 is based on a thorough evaluation of your medical history, eating behavior, lab work, and insurance coverage. If a GLP-1 is not appropriate for you, our providers will work with you to determine an effective medication for your health profile.

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