The brand names have become familiar via the advertisements that follow us around in our media consumption. Whatever you’re watching, it’s likely an ad will tell you about the potential benefits of a GLP-1 medication.
Wegovy, Ozempic, Mounjaro and Rybelsus are just some of the increasingly well-known examples. In the clinical world they are known as glucagon-like peptide 1 agonists, gastric inhibitory polypeptide (GIP) and glucagon-like peptide 1 receptor agonists. Collectively they are drugs that can improve blood-sugar levels, support weight loss and lower blood pressure.
In so doing, the medications can help treat type 2 diabetes and obesity, and improve cardiovascular health.
How do they work? Who can benefit from taking them? What about side effects? Because it is a relatively new class of medications – the FDA approved the first GLP-1 in 2005 as a treatment option for diabetes – researchers continue to learn more about what they can do and what they can’t.
A new tool in treatment
In 2021, the FDA approved the GLP-1 receptor agonist, semaglutide, known most commonly as Wegovy, as an aid in weight management. In the spring of 2024, Wegovy was approved as an aid in reducing cardiovascular deaths, strokes and heart attacks in adults with cardiovascular disease with obesity.
“These medications have shown to reduce what we call MACE – major adverse cardiac events – in patients with obesity. They have also been shown to be helpful in patients with heart failure and a preserved ejection fraction,” said Aaron A.H. Smith, M.D., a cardiologist at Sanford Heart and Vascular Clinic in Fargo, North Dakota.
MACE most often refers to fatal and non-fatal heart attacks and strokes.
A person’s cardiometabolic profile assesses risk factors for cardiovascular disease and metabolic conditions like diabetes. It includes measurements such as blood pressure, cholesterol, triglycerides, glucose and waist circumference. It evaluates these overall health markers that can then guide providers in addressing preventative measures and treatment for heart issues.
“GLP-1 medications change a person’s cardiometabolic profile by helping address the obesity problem at its starting point,” Dr. Smith said. “By decreasing a patient’s appetite, it can assist in making a lot of favorable cardiometabolic effects.”
Much better numbers
Researchers found that people with obesity who take semaglutide had a 20% reduction in heart attack, stroke, and cardiovascular death when the medicine is combined with standard care.
There are potential side effects. Nausea, vomiting and diarrhea are the most common, though they can often be addressed separately with other medications. Dr. Smith does not prescribe GLP-1 medication to those who have been diagnosed with pancreatitis. He also does not recommend it for those who have a genetic predisposition for thyroid cancer.
Dr. Smith stressed that GLP-1 medications work best when coupled with all the things cardiologists have recommended for decades for those with cardiovascular risks.
“It’s not a one-size-fits-all medication that fixes all cardiometabolic problems,” he said. “It’s intended to be used in conjunction with other therapies, as well as exercise and eating appropriately. You need to keep working on lowering alcohol intake and quitting smoking.”
Addressing a common issue
GLP-1 medications do not make weight less of a factor in improving or sustaining cardiovascular health. Rather, they serve as an aid in losing the weight that contributes to problems. Cardiovascular health has been closely linked to weight for decades. That is not changing.
More than 70% of American adults are overweight or living with obesity. In many respects the rampant popularity of GLP-1 medications as a weight loss aid is indicative of what a societal problem weight has become.
Jennifer Schriever, M.D., is a Sanford Health family physician who specializes in obesity medicine at the Sanford Weight Management Center in Sioux Falls, South Dakota. She helps people confront challenges with their weight every day.
Dr. Schriever has seen the benefits for her patients, not just in the way it helps them lose weight, but also in the way the benefits often extend beyond what their scale is telling them.
First, the basics:
GLP-1 is a hormone made in the small intestine. Its role in the body includes insulin release from the pancreas, helping regulate blood sugar, slowing digestion and increasing how full you feel. The GLP-1 agonist medications like Wegovy and Ozempic mimic the real GLP-1.
It is the medication’s role in slowing digestion and increasing how full you feel that can lead to weight loss.
Why GLP-1s can be effective
Weight loss drugs have been around for a long time, but the GLP-1 medications influence the metabolism of blood sugars and fat stores, as well as your appetite. Conventionally with weight loss you will become hungrier. GLP-1 medications reduce that hunger. When combined with exercise and good nutrition, they can assist in achieving better health.
“They help us feel satisfied and full,” Dr. Schriever said. “With the medication you feel fuller sooner and for much longer. They also have an effect on the brain to help with food thoughts and food noise.”
Weight loss begins with burning more calories than you take in. Our bodies and brains, once alerted to what is going on, can complicate that process, however.
Success in losing weight and keeping it off are possible but the numbers are not inspiring. Working diligently at diet and exercise is effective long-term for a small percentage of people, but for a large majority, one’s own system can become what can seem an insurmountable obstacle to targeted goals.
“Obesity is a disease,” Dr. Schriever said. “There is a lot going on physiologically that is out of one’s control. At some point our bodies see this weight coming off and they don’t recognize that we’re getting healthier by losing it.”
Your system may go into survival mode, which can impede the positive effects of reducing calories. Weight gets more difficult to lose.
“The people with the disease of obesity often need some additional assistance,” Dr. Schriever said. “Like anyone else with a disease, they should be offered medication to help. In this case, we’re talking about medications that have been really effective in helping people lose 20% or more of their body weight.”
Medicine is one part
When people stop taking a GLP-1, weight can return. In most cases, the worst that happens is that patients are back to where they started. To avoid that, it’s important to combine weight-loss strategies with qualified health providers like Dr. Schriever, who can help with dieting, exercise and managing possible side effects.
“When you talk to patients who have experienced this medicine, a lot of them have never felt so good in their lives,” Dr. Schriever said. “They never realized how much they thought about food and thinking, ‘What am I going to eat next?’ They will tell you about how stressful it is if you’re thinking about food all the time when you’re trying to work on your health.”
The “food noise” that can take up space in a person’s brain can be difficult to combat. A GLP-1, combined with exercise and good nutrition, can turn the volume down, however. With obesity trending in the wrong direction – worldwide, obesity has more than doubled since 1990 – GLP-1 meds can offer hope.
“We’ve never had such a great tool that is effective for so many people,” Dr. Schriever said. “We’re going to see significant improvement in medical complications associated with excess weight. In addition to cardiovascular disease, there are ongoing studies involving sleep apnea, kidney disease, liver disease, and even addiction. It will be interesting where this type of medication can go to improve the health of our population.”
With an eye on continued research aimed at sustained long-term benefits, GLP-1 medications may also help in avoiding some health issues altogether.
“There is a lot of potential in the preventative space in cardiology to really take this on and prescribe it more aggressively,” Dr. Smith said. “For those who have modified all their risk factors as best they can – but they are struggling with the weight loss and dietary piece – there are a lot of promising benefits.”
Learn more
- Four pillars of weight management, defined
- Heart & vascular screenings: What’s the difference?
- How weight loss surgery improves overall health
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Posted In Family Medicine, Fargo, Heart, Sioux Falls, Weight Loss
