In the realm of medical treatments, the truth often lies in the nuances. This is particularly true for GLP-1 (Glucagon Like Peptide-1), the molecule found in medications like Mounjaro and Wegovy.
GLP-1 hormones, known as “incretins,” are naturally released after eating. They play a crucial role in increasing insulin production and sensitivity, slowing gastric emptying, and promoting a feeling of fullness. The synthetic version of GLP-1 was first introduced in 2005 with Byetta, a daily injection for diabetes management.
The introduction of weekly Semaglutide (GLP-1) marked a significant advancement. It not only improved glycemic control in diabetes but also reduced the risk of heart attacks, strokes, kidney function decline, and promoted weight loss—achievements unmatched by other diabetes medications.
The primary GLP-1 medications include Semaglutide for diabetes and Wegovy for weight loss, and Tirzepatide (Mounjaro), which combines GLP-1 with another incretin, GIP.
Recent large-scale trials have explored the benefits of these drugs in individuals without diabetes. The SELECT trial showed that Semaglutide reduced cardiovascular events by 20% in people with obesity, while the SUMMIT trial found that Tirzepatide decreased cardiovascular death or disease progression in heart failure (HFpEF) by 38%, a condition previously lacking effective treatments.
Beyond diabetes and cardiovascular health, GLP-1s have shown promise in treating liver conditions (MASLD), PCOS, arthritis, OSA, binge eating disorder, and more. They offer a safe and effective option for obesity treatment, complementing lifestyle changes. Many of my patients have experienced significant health improvements with GLP-1 therapy.
However, there is a downside. The resurgence of extreme thinness as a trend, fueled by these medications, threatens the progress made in the body positivity movement.
For patients with overweight but without obesity-related health complications, I approach GLP-1 prescriptions with caution. This balance is crucial, as it involves navigating the fine line between supporting diet culture and addressing weight stigma. My goal is to have thorough discussions with patients to determine the best approach for their mental and physical health.