GLP-1 agonists: what are they and who are they for?
GLP-1 agonists are a class of pharmaceuticals, a weight loss drug in Canada, like semaglutide (marketed as Ozempic or Wegovy) and liraglutide (marketed as Saxenda), designed to replicate the hormone glucagon-like peptide-1 (GLP-1), which is produced in the gut and plays a key role in glucose metabolism, appetite regulation, and satiety. These medications work by enhancing insulin secretion from the pancreas in response to elevated blood glucose levels, reducing glucagon secretion to decrease hepatic glucose production, and slowing gastric emptying, which contributes to a prolonged feeling of fullness after eating and influencing the central nervous system to reduce hunger. For the treatment of obesity, particularly in patients with a body mass index (BMI) of 30 or greater, or those with a BMI of 27 or greater who have at least one obesity-related comorbidity such as type 2 diabetes, hypertension, dyslipidemia, or sleep apnea, GLP-1 agonists like liraglutide (marketed as Saxenda) and semaglutide (marketed as Wegovy) are considered when other weight loss strategies such as dietary changes, increased physical activity, and behavioral modifications have not led to adequate weight loss. They are recommended as part of a comprehensive weight management program, which includes ongoing nutritional counseling, physical activity, and behavior therapy, and are typically prescribed under close medical supervision due to potential side effects and the need for monitoring. The decision to use GLP-1 agonists for obesity treatment should be personalized, taking into account the patient’s overall health, potential benefits, and risks, as well as their commitment to lifestyle changes.
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When is the right time to start the GLP-1 program?
GLP-1 agonists like weight loss with Ozempic in Canada are typically considered for individuals who are overweight or obese, particularly when other weight loss methods like diet and exercise have not been effective, or when weight-related health conditions are present. The appropriate BMI (Body Mass Index) for starting Ozempic generally aligns with clinical guidelines for obesity management (try the BMI calculator on this page):
- BMI of 30 or greater: This indicates obesity, and Ozempic might be considered without the necessity of additional health conditions.
- BMI of 27 to 29.9 (overweight): Here, Ozempic could be an option if there’s at least one weight-related comorbidity like type 2 diabetes, hypertension, dyslipidemia, or cardiovascular disease.
The decision to start treatment of weight loss with Ozempic in Canada should not solely depend on BMI but should consider overall health, the presence of related health issues, and lifestyle factors. It’s crucial to have this conversation with a qualified physician who can assess your full medical history, your readiness for potential side effects, and the lifestyle changes you’re willing to commit to for sustainable weight management. The timing also involves considering psychological readiness, as the treatment requires ongoing monitoring and adjustments.
How are GLP-1 agonists taken in the course of the program?
GLP-1 agonists are typically taken with prepackaged needles under the skin at various frequencies. Saxenda Semaglutide, known as Wegovy for weight loss in Canada, is administered as a weekly subcutaneous injection, typically into the abdomen, thigh, or upper arm, using a prefilled pen designed for ease of use. The dosing usually starts at the lower dose and then increases, based on tolerance and effectiveness. Patients are trained by healthcare providers on proper injection techniques. Always follow the specific instructions provided with your prescription or as advised by your doctor for personalized guidance on timing and managing any side effects.
If a dose is missed, it should be taken as soon as remembered, provided it’s not close to the time for the next dose, avoiding double dosing; common side effects like nausea might be mitigated by taking the injection after a meal or at a different time of day if advised by you doctor.
Who should avoid GLP-1 agonists?
Individuals who should avoid these medications include those with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2) due to the risk of thyroid C-cell tumors. Additionally, those with a history of pancreatitis or conditions predisposing them to pancreatitis might want to avoid GLP-1 agonists due to the increased risk associated with its use. People with severe gastrointestinal disease, particularly conditions like gastroparesis, should also be cautious or avoid it due to its effect on slowing gastric emptying. These medications are not recommended during pregnancy unless the benefits clearly outweigh the risks, as there’s limited data on its safety in pregnancy. Moreover, anyone who has experienced a serious hypersensitivity reaction to any components of the medications should not use them. Lastly, individuals without significant weight-related health issues or those looking for weight loss without medical necessity might not benefit from its risks, especially considering potential side effects like severe gastrointestinal issues or rare but serious conditions like bowel obstruction or pancreatitis. Always consult with a healthcare provider for personalized advice.
How long should I be on semaglutide?
The duration for which you should be on GLP-1 agonist for weight management, such as Semaglutide varies based on individual health goals, response to the medication, and medical advice. Typically, a treatment course might start with an initial phase aimed at achieving significant weight loss, which could last from 12 to 24 months. During this period, many experience substantial weight reduction, with clinical trials like the STEP program showing significant weight loss over 68 weeks when combined with lifestyle changes. After this initial phase, if weight loss goals are met, you might transition into a maintenance phase where you could continue semaglutide at the same dose or potentially reduce the frequency or dosage, depending on how well you maintain your weight loss. However, if after 3 to 6 months at the full dose, you haven’t lost at least 5% of your initial body weight, your healthcare provider might reconsider the treatment strategy. Long-term or even indefinite use might be necessary for some, particularly if lifestyle changes alone are insufficient to prevent weight regain or if there are additional health benefits like improved glycemic control or cardiovascular outcomes. Always consult with your healthcare provider for a personalized treatment plan, considering not just weight loss but overall health improvements, side effects, and your commitment to lifestyle changes.
Is there something stronger than GLP-1 agonists?
Actually there is. GLP-1/GIP dual agonists are innovative treatments for obesity and type 2 diabetes that employ an additional action to just GLP-agonists like Ozempic. In terms of potency, these newer medications such as tirzepatide (Marjouna for weight loss) have shown superior efficacy in reducing body weight compared to standalone GLP-1 agonists like semaglutide (Ozempic or Wegovy). For instance, clinical trials have demonstrated that tirzepatide leads to significant weight loss, with patients losing up to 24.2% of their body weight, approaching outcomes seen with bariatric surgery. This level of weight reduction surpasses that typically achieved with GLP-1 agonists at up to 17% of body weight. However, regarding side effects, while GLP-1 agonists are often associated with gastrointestinal issues like nausea, vomiting, and diarrhea, the dual agonists might exhibit a slightly intensified side effect profile due to their enhanced pharmacological activity. The enthusiasm around these dual agonists stems from their potential for greater metabolic improvements, although their long-term side effects and safety profile continue to be studied, especially considering the concerns around muscle mass loss and the risk of more severe gastrointestinal issues noted with GLP-1 therapies.
Are there other medications that can be used?
When comparing GLP-1 agonists (and dual agonists) to other weight loss medications like orlistat (which inhibits fat absorption), naltrexone-bupropion (which works on the brain’s appetite regulation), or phentermine-topiramate (which combines an appetite suppressant with a medication that makes food less appealing), GLP-1 agonists and dual agonists generally show superior weight loss outcomes. The efficacy of these other medications typically results in a 5-10% total body weight loss, which, while significant, is less than what has been observed with the newer GLP-1-based therapies. Moreover, GLP-1 agonists and dual agonists have shown potential cardiovascular benefits. However, they come with gastrointestinal side effects like nausea, vomiting, and diarrhea, which are less pronounced or different in mechanism from other weight loss drugs in Canada. The choice between these medications often depends on individual health profiles, the presence of comorbidities like diabetes, and the desired balance between efficacy and tolerance of side effects, as well as the costs of the respective medications.
If there are psychological causes of overeating that can be diagnosed, your physician may consider other medications that can help achieve and’or maintain weight loss. Medications for addressing psychological causes of weight gain often target underlying psychiatric conditions that contribute to weight issues, like depression, anxiety, or binge eating disorder. Antidepressants such as fluoxetine (Prozac) and sertraline (Zoloft) can aid in managing depression and potentially lead to weight loss or prevent further gain by improving mood and reducing emotional eating. For the binge eating disorder, lisdexamfetamine (Vyvanse) has been approved, directly tackling the compulsion to binge eat. Topiramate, an anticonvulsant, has also been used for its off-label benefit in weight management, particularly in cases linked with psychological eating disorders. Lastly, patients exhibiting food addiction, can be treated with contrave (bupropion/naltrexone combination), wellbutrin or naltrexone alone, or other medications to treat the underlying mental health conditions. You can read further about these conditions under our other services.
