GLP-1 For Weight Loss: Is It Safe?

If drug names like Ozempic and Wegovy ring any bells for you, it may be because you've heard about their role in promoting weight loss. These drugs are part of a class of medications known as glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists or GLP-1 RAs).

If you're interested in learning more about them, you've come to the right place. Before we discuss these drugs further, a quick reminder that it's always best to seek medical advice from healthcare providers about what may or may not be right for you.

Read on for a closer look at the science behind these drugs and the different opinions surrounding their increasingly popular role in weight loss.

What is GLP-1?

GLP-1, or glucagon-like peptide-1, is a peptide hormone made by the small intestine and helps reduce glucose levels by stimulating insulin and reducing glucagon secretion. It’s a natural hormone that we all have! This hormone slows stomach emptying and allows glucose from food to enter the bloodstream more slowly. Weight loss drugs like GLP-1s mimic the action of this natural hormone. As a result, people taking this drug may see lower blood sugar levels. GLP-1 may also affect hunger centers in the brain, which impacts appetite regulation and reduces hunger.

Types of GLP-1 Agonist Medications

Due to how they interact with glucose and insulin function in the body, GLP-1 RAs (Receptor Agonists, which are chemical substances that bind to and activate specific receptors. They mimic the action of the natural hormone GLP-1) are a class of prescription drugs often used for type 2 diabetes medication treatment.

In addition to antidiabetic medications, some may also be prescribed by medical professionals for the treatment and management of obesity.

Ozempic may be used as a colloquial catchall for ‘weight loss drugs,’ but that’s a brand name semaglutide which is just one of the available GLP-1 medications on the market.  There are actually many more! The seven drugs that are currently considered GLP-1 receptor agonists include:

• Dulaglutide (Trulicity)
• Tirzepatide (Mounjaro, Zepbound)
• Exenatide extended-release (Bydureon)
• Exenatide (Byetta)
• Semaglutide injection (Ozempic, Wegovy)
• Semaglutide tablet (Rybelsus)
• Liraglutide (Victoza, Saxenda)
• Lixisenatide (Adlyxin)

If all of these drugs influence GLP-1 in similar ways, what makes each of them unique? 

• Small variations in chemical structure, as well as different dosage and delivery methods, may affect how they are approved for use.
  Some are taken twice daily, some extended-release (ER) weekly, and others once daily.
  Except for oral semaglutide, they’re typically subcutaneous injections (administered into the fatty tissue just under the skin).

How Do GLP-1 Agonists Work?

Though the different dosages and types may impact the body in a variety of ways, generally, GLP-1 agonist medications may:

• Delay gastric emptying and slow the speed at which food leaves the stomach, and glucose may enter the blood. This can potentially reduce post-meal glucose levels
• Suppress your appetite and improve satiety
• Suppresses the release of glucagon, which can help reduce excess glucose production by the liver. 
• Promote the proliferation or increase the reproduction of pancreatic beta cells, which produce insulin
• GLP-1 receptor agonists may also restore the body's insulin-secretion function in the pancreas, which can contribute to improvements in glucose regulation and body weight reduction in those with diabetes.
• Studies have also shown that these drugs interact with other parts of the body, potentially reducing the risk of health conditions such as kidney disease, cardiovascular diseases, and heart attacks. This means it could also potentially positively impact heart disease risk factors such as high blood pressure and high cholesterol.

What’s the Difference Between Ozempic and Wegovy?

The name “GLP-1 receptor agonist” may feel like a mouthful, so it’s not surprising everyone’s taken to calling everything Ozempic. It’s much easier! But they’re not all the same, so let’s break it down a little.

This class of drugs, manufactured by Novo Nordisk and more commonly masquerading under the names Ozempic or Wegovy, influence a specific hormone in your body called GLP-1.

What is Ozempic?

Ozempic (semaglutide) is an injectable drug (typically, you’d be given weekly injections) that is FDA-approved for diabetes treatment and management in adults. However, it’s not yet FDA-approved for weight loss. So, if you've been prescribed Ozempic for weight loss outside of diabetes care, it’s considered off-label use.

What is Wegovy?

Wegovy is also a semaglutide injection, though typically a higher-dose version (compared to Ozempic). The FDA has approved this one for weight loss (you should see the drug label for weight loss management on the packaging). Even though semaglutide is the active drug in both cases, Wegovy is not approved to treat patients with type 2 diabetes.

This is simply because Ozempic drug trials focused on how it impacted blood sugar (like metformin does), while Wegovy drug trials focused on how it impacted weight. However, due to recent shortages of Wegovy access, many people who are interested in using this drug for weight loss have turned to Ozempic.

Wegovy is available at a higher dosage than Ozempic, and in clinical trials, it has been more common for people to report side effects while using it.

Is Ozempic Good for Weight Loss? 

Whether you're looking to lose those few stubborn pounds and tone your body or tackle a bigger weight loss goal, there are many reasons you may feel stuck on your weight loss journey.

Obesity rates have almost tripled since 1975, which researchers say is due to a combination of factors, including:

• Increased access to energy-dense food coupled with reduced physical activity
• Sleep deprivation
• Circadian desynchronization
• Chronic stress
• A rise in the use of certain medications known to result in weight gain, including some anti-epileptic and psychotropic drugs
• Other genetic and environmental factors

As a result, prescription drug companies have sought their own way to target the treatment of obesity. When it comes to prescription drug interventions, however, many weight loss medications have led to their fair share of controversy over the years.

It's not uncommon, for example, to see some weight loss drugs negatively impact blood pressure and hypertension. Other times, weight loss is not long-term, as weight gain quickly resumes after people stop taking the medication.

While semaglutide, the active compound found in many of these drugs, is shown to be effective for short-term weight loss, Ozempic is not currently authorized for use as a weight loss aid. Wegovy, on the other hand, is approved by the FDA for weight loss.

During clinical trials, adults taking Wegovy lost an average of nearly 15 percent of their starting body weight. In a separate trial, adolescents lost an average of about 16 percent of their starting body weight.

According to weight loss research, it may take about five months to reach the target dosage. During this time, adults taking a weight loss drug in clinical trials lost an average of about 10 percent of their starting body weight, and they lost an additional eight percent within 15 months.

While this research suggests that drugs like Ozempic and Wegovy do appear to be effective when it comes to shedding a few extra pounds in the short term, what effect can they have over a longer period of time? Let's discuss some of the potential safety concerns of these drugs.

Are Ozempic and Wegovy Safe for Weight Loss?

Although some healthcare providers may prescribe these drugs for extended periods, not many research studies have looked at how safe and effective they are for long-term use.

In addition to some safety concerns, weight regain is one of the biggest issues critics voice in using drugs like Ozempic and Wegovy for weight loss. Some researchers have highlighted post-treatment study findings that have shown that people tend to suffer from a high risk of weight regain after stopping these drugs. However, research has also shown that if people integrate lifestyle habits while taking the medication and maintain those lifestyle habits, they are less likely to regain weight when they get off. Working 1:1 with a credentialed expert like a registered dietitian or nutritionist can help you set, maintain, and adjust your health goals for the best weight loss success here. 

Earlier versions of GLP-1 drugs, such as exenatide (Byetta), increased the risk for pancreatic cancer or certain types of thyroid cancer and even instances of autoimmunity. Research on this topic is still ongoing, however, and it may take time to determine the long-term effects of these drugs.

Dosage for Weight Loss

The dosage of weight loss drugs differs from those used in the treatment of type 2 diabetes or prediabetes. The insulin levels in people with type 2 diabetes are known to be lower than those in people without diabetes, and the GLP-1 drugs help balance them. Depending on your personal health conditions and health goals, your healthcare provider can help determine the best dosage for you.

What are the Dangers of Taking Ozempic or Wegovy?

According to the FDA, Wegovy is indicated for chronic weight management in patients with a body mass index (BMI) of 27 kg/m2 or greater who have at least one weight-related ailment or in patients with a BMI of 30 kg/m2 or greater.

Some researchers believe those who have a goal for more significant weight loss may be relatively better candidates for prescription weight loss drugs compared to those with more modest weight loss goals. But what about the side effects of using drugs like Ozempic or Wegovy?

Since GLP-1 medications mimic the action of a peptide produced in the GI tract, most reported mild side effects are associated with the digestive tract. There is also the risk of losing muscle and decreased exercise output. It’s another reason to incorporate muscle-building activities and exercises (like strength training) into your routine and combine them with lifestyle changes and expert support. 

According to the manufacturers of Ozempic and Wegovy, the main common side effects may include:

• Nausea, vomiting, and diarrhea that could lead to an acute kidney injury
• Dizziness
• Rapid heart rate
• Headaches
• Hypoglycemia
• Allergic reactions to the medication
• Abdominal pain
• Shortness of breath
• Severe hypoglycemia
• Blurred vision
• Severe rash
• Slurred speech
• Hoarse voice

Other minor side effects to watch out for include a rise in resting heart rate, a decrease in heart rate variability, and mood changes (like anxiety and depression). Besides these side effects, you should be mindful of two other primary medical conditions.

1) Cancer and Thyroid Concerns

Semaglutide is also not recommended for people with a family or medical history of medullary thyroid carcinoma (MTC), medullary thyroid cancer, and thyroid tumors or those with Multiple Endocrine Neoplasia syndrome type 2. This is because, in animal studies, higher doses of semaglutide were found to increase the risk of developing thyroid C-cell tumors.

Some researchers are raising additional concerns about pancreatic cancer potential risk and GLP-1 RAs. This is because clinical trials have not been long enough to assess pancreatic cancer risk, and the risk may still be present. As a result, those with endocrine system conditions are not advised to take Ozempic or Wegovy.

2) Pancreatitis Concerns

Acute pancreatitis, including potentially fatal hemorrhagic and necrotizing types of pancreatitis, has been documented in those taking some GLP-1 RAs. The reason for this reaction is not fully known at this time, but it has led licensed healthcare professionals to avoid prescribing these drugs to those with a health history of pancreatitis.

Additionally, experts say those with more severe gastrointestinal diseases, such as gastroparesis and inflammatory bowel disease (IBD), should avoid these medications. Although it is rare, death in adults resulting from gastrointestinal complications has occurred in the past. Research is ongoing to understand the full potential of side effects and implications of taking GLP-1 RAs in these particular populations.

Are There Other Metabolic Effects of Taking GLP-1?

Some researchers have pointed out that the common digestive adverse reactions of the drug (diarrhea, vomiting, loss of appetite) may be contributing to their supposed weight loss “success” and are not ideal ways to support metabolic health at its foundation.

According to some scientists, people can reduce their risk of metabolic disorders by 29 to 45 percent with more foundational dietary and lifestyle changes. On the other hand, with drugs such as Wegovy, some of the underlying metabolic imbalances may persist.

Others may argue that for people who have a large percentage of weight to lose and struggle getting started with a more foundational approach to weight loss, drugs like Wegovy can give them a “jump start” or help get their foot in the door on healthier habits by helping them control their appetite in the beginning.

Regardless, researchers and manufacturers of Ozempic and Wegovy do say that these drugs are most successful when they're incorporated into a treatment plan in conjunction with healthier diet and lifestyle changes.

If you are trying to lose weight and looking for a long-term solution with a low risk of adverse effects, working 1:1 with a personal dietitian can help.

What Foods Increase GLP-1 Levels Naturally?

Is there any way you can naturally support your body's production of GLP-1? Some clinical studies have shown that boosting protein during food intake may be helpful. 

Consuming adequate healthy fats, fermented foods, probiotics, and protein is important for weight loss for many reasons, and this is one more.

Encouraging a healthy microbiome might be another promising way to support your own production of GLP-1. One preliminary study showed that probiotics may enhance the release of incretin hormones like GLP-1. More studies are needed to understand this effect fully.

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