What Are GLP-1 Medications?

• GLP-1 stands for glucagon-like peptide-1, which is a hormone naturally made by our body.
• When you eat, your body releases this hormone, which helps:
-Control blood sugar by telling your pancreas to release insulin.
-Slow down how fast food leaves your stomach, making you feel full longer.
-Tell your brain you’re full, reducing appetite and cravings.

GLP-1 medications mimic this natural hormone, giving your body a little extra help.

• These medications help you feel full longer and reduce your appetite, so you’re less likely to overeat.
• They also help control your blood sugar levels, which can prevent cravings and energy crashes.
• By slowing down the emptying of your stomach, they help you eat smaller portions but still feel satisfied.

• Tirzepatide is a new medication that works on two hormones instead of just one.
-It acts on GLP-1 (like the medications I just mentioned).
-It also targets another hormone called GIP (gastric inhibitory polypeptide), which helps with insulin production and appetite control.

• Obesity often comes with insulin resistance and hormonal imbalances, which make it harder to lose weight with just diet and exercise.
• People with obesity may have dysregulated hunger signals, meaning their bodies don’t send the right “I’m full” signals after eating.
• These medications help correct those signals, making it easier to:
-Feel satisfied with less food.
-Stick to a healthy diet without constant cravings.
-Control blood sugar, which can improve overall energy and reduce fat storage.

Tirzepatide may work even better than traditional GLP-1 medications because it targets two
hormones, giving more complete appetite control and better blood sugar regulation.

• Feel fuller longer with smaller meals.
• Eat less without feeling deprived.
• Reduce cravings, making it easier to make healthier choices.
• Improved blood sugar control, which helps prevent fat storage and maintain energy levels.

These medications can be a powerful tool to help you reach and maintain a healthy weight, especially if diet and exercise alone haven’t worked well for you.

By keeping the focus on how these medications align with natural body processes, you can help your patients understand why they work and how they can support their weight loss goals.

GLP-1 receptor agonists (like semaglutide, liraglutide, etc.) are effective treatments for type 2 diabetes and obesity. However, they are generally recommended for patients who meet certain criteria, especially when lifestyle changes alone (diet, exercise, etc.) have not been sufficient. Here’s a breakdown of which types of patients should consider using GLP-1 medications versus relying solely on lifestyle changes:

1. Patients with Type 2 Diabetes:

• When Lifestyle Changes Are Not Enough: Patients with type 2 diabetes who cannot achieve their target blood sugar levels through diet, exercise, and oral medications may benefit from GLP-1 receptor agonists. These medications help lower blood sugar by increasing insulin secretion, reducing glucagon, and slowing gastric emptying.

• Benefits Beyond Blood Sugar Control: GLP-1s also promote weight loss, which can be particularly helpful for overweight or obese patients with diabetes, improving their overall metabolic health.

2. Patients with Obesity (BMI ≥ 30):

• Obesity Treatment: For patients who have a BMI of 30 or higher, and especially for those who have struggled with diet and exercise alone, GLP-1 medications can significantly aid in weight loss. These drugs reduce appetite, increase feelings of fullness, and help with long-term weight management.

• Risk Factor Reduction: Patients with obesity often have other related conditions like high blood pressure, dyslipidemia, and sleep apnea. Weight loss from GLP-1 medications can help reduce these risks, improving overall health.

3. Overweight Patients with Comorbidities (BMI ≥27):

• For Patients with a BMI ≥ 27 and Obesity-Related Conditions: GLP-1 medications are also appropriate for overweight patients (BMI of 27-29.9) who have obesity- related comorbidities, such as:

• Type 2 diabetes
• Hypertension
• Dyslipidemia (high cholesterol)
• Cardiovascular disease
• Obstructive sleep apnea

• These patients may not qualify as “obese,” but their health risks make weight loss essential, and GLP-1 medications can be effective for this group.

4. Patients Who Have Tried Lifestyle Changes Without Success:

• Failure of Diet and Exercise Alone: GLP-1 medications are often considered for patients who have already attempted comprehensive lifestyle interventions (like improved diet and regular physical activity) for at least 3 to 6 months but have not achieved meaningful results (i.e., 5% or more weight loss).

• Behavioral and Metabolic Factors: Some people may find it difficult to lose weight due to metabolic or behavioral factors (like hunger and cravings), and GLP-1 medications help by modulating appetite and improving satiety.

5. Patients with Cardiovascular Disease:

• Cardioprotective Benefits: GLP-1 receptor agonists like liraglutide and semaglutide have shown cardiovascular benefits in patients with type 2 diabetes and established cardiovascular disease. These drugs can reduce the risk of major adverse cardiovascular events (heart attack, stroke), making them a good option for diabetic patients with heart disease.

1. Patients with Minimal Excess Weight (BMI <27):

• Mild Overweight: Patients who are mildly overweight (BMI under 27) and do not have significant obesity-related health conditions should focus primarily on lifestyle changes, such as adopting a healthy diet, increasing physical activity, and managing stress.

• For these individuals, weight loss can often be effectively achieved through non-pharmacological methods, and medications like GLP-1 receptor agonists are usually not necessary.

2. Patients Who Are Motivated and Capable of Long-Term Lifestyle Changes:

• Good Candidates for Behavioral Therapy: Some patients are highly motivated and capable of making long-term behavioral changes, and for these individuals, comprehensive programs involving diet, exercise, and behavioral therapy may be sufficient for achieving significant weight loss.

• GLP-1 medications should generally be reserved for patients who have tried but struggled to maintain lifestyle changes on their own.

3. Patients with a History of Certain Thyroid or Pancreatic Conditions:

• Medullary Thyroid Carcinoma (MTC) or Multiple Endocrine Neoplasia Syndrome Type 2 (MEN2): GLP-1 receptor agonists are contraindicated in individuals with a personal or family history of MTC or MEN2 due to the potential risk of thyroid tumors, as seen in animal studies.

• Pancreatitis: Patients with a history of pancreatitis should be cautious, as GLP-1 medications have been associated with an increased risk of this condition in some cases.

• Lifestyle First: The first-line treatment for weight loss and type 2 diabetes management should always be lifestyle changes, including a balanced diet (like a low- calorie or Mediterranean diet) and regular physical activity. For most people, these approaches can be effective in improving metabolic health and reducing body weight.

• When to Add Medications: If, after 3-6 months, a patient is not seeing meaningful results (e.g., less than 5% weight loss or uncontrolled blood sugar), adding a GLP-1 receptor agonist may be appropriate. This is especially true for patients with diabetes, obesity- related conditions, or cardiovascular risks.

• Patient Suitability: Not all patients are candidates for GLP-1 medications. A thorough assessment by a healthcare provider is essential to evaluate the patient’s medical history, current health status, and personal preferences before prescribing these medications.

GLP-1 receptor agonists are an effective option for patients with type 2 diabetes, obesity, or overweight individuals with comorbid conditions, especially when lifestyle changes alone are insufficient. Patients with a BMI ≥ 30, or those with a BMI ≥ 27 and additional risk factors like cardiovascular disease or high blood pressure, are ideal candidates for these medications. However, for individuals with mild weight issues or who can achieve results through diet and exercise alone, lifestyle changes should remain the primary approach.