The Transition of GLP-1 agonists from Weight Loss Drugs to Powerful Metabolic and Hormonal Medications

The introduction of GLP-1 agonists (Ozempic et al.) has completely changed the course of treating metabolic disorders. Even though the marketing of this new class of drugs has focused on weight loss—I believe, cynically, for increased profit, medications that correct metabolic hormonal dysfunction are the future of treating many illnesses, perhaps eating disorders included.

As of now, our knowledge about the broader effects GLP-1’s have on the hormonal system is very limited. Utilization of energy, hunger/fullness awareness, speed of digestion and normalization of blood sugar levels are all clear effects and match our current knowledge of the hormones affected.

But then why are so many people having other powerful effects? The list thus far includes decreased alcohol cravings, curbing compulsive behaviors, lowered systemic inflammation, broader regulation of other non-metabolic hormones and even augmentation in treating depression.

Clearly, there are broader implications of adjusting the gastrointestinal hormone levels which we know regulate metabolism. So the potential risks of taking these medications, and the risk of taking high doses simply to lose weight, are enormous and vastly unknown.

The collective fallacy about the GLP-1’s is that they are very safe and that we know the long-term effects. Through this lens, many people are taking these medications and our knowledge about them will grow quickly.

Over the last couple of years, many doctors have slowed down the dose increase greatly from the original suggestions of the pharmaceutical companies. For people on these drugs longer than three years, side effects appear to become more severe and sometimes lead to needed time off the medications, something that will be shocking for people taking them solely for weight loss. Sudden cessation of the drugs typically leads to weight gain.

The reason people need to stop the drugs is paralysis of the gastrointestinal system. Taking too high of a dose for too long can slow down the digestive system so much that it ceases to function normally. Stopping the drugs helps reverse this side effect, but the jury is out whether long-term use is possible again after suffering such severe side effects.

A few things about the GLP-1’s are becoming clearer. First, the broader effects of this class of medication are still unknown as is the systemic implications of altering metabolic hormonal levels. Second, it’s better to be a lot more careful with dosing and remain on as low a dose as possible. Third, the long-term use of these medications is in question. We don’t know enough yet to see if this is truly possible.

As the hysteria of the GLP-1’s dies down, medicine, and the culture at large, needs to respect the power of this new pharmaceutical step. Rather than kowtowing to the blatant disregard of our well being that weight loss marketing achieved, medicine can instead thoughtfully figure out how and when these medications are best used.