GLP-1s for Weight Loss: Wonder Drug or risky option?
What are GLP-1s, and are they effective for weight loss?
Wonder drug or risky option? It depends.
GLP-1 (or GLP-1RA) is short for “glucagon-like peptide 1 receptor agonist”. This group of medications, originally designed for patients with Type 2 Diabetes to help control blood sugar, are now being used for weight loss in overweight or obese patients. They are injectable medications that help reduce blood sugars by increasing insulin secretion and decreasing glucagon secretion. Insulin is released by the pancreas to lower blood sugar levels and help bring the sugar into the cells where it is needed for energy. Glucagon is released by the pancreas and triggers the liver to release more glucose into the bloodstream when the body is stressed. GLP-1s also slow gastric emptying and decrease the amount of food a person eats by suppressing their appetite. Sounds pretty good, right? (4.)
UptoDate, an evidence-based online resource for medical practitioners, suggests some people may benefit from using GLP-1s for weight loss. They base their criteria on international WHO guidelines and FDA recommendations. First, three to six months of lifestyle interventions are suggested. I do not think most family practice doctors would have the time to effectively counsel patients on lifestyle changes for three to six months. Perhaps weight-loss specialty clinics could do this, but now I diverge. Then, if the patients do not lose at least 5% of their weight in that time and are obese (Obesity is defined as a body mass index (BMI) ≥30 kg/m2), it may be appropriate to take GLP-1 medications. Other candidates for GLP-1 medications are unhealthy people who are overweight (BMI of 27 to 29.9 kg/m2) and have one or more weight-related health issues/diseases or people who have an elevated waist circumference and one or more weight-related health concerns. (6.)
What’s the downside to these “wonder drugs”?
These medications cause fat AND muscle loss that can lead to sarcopenia (degenerative loss of muscle mass, quality and strength). So, it is essential to do weight-bearing exercise as soon as you start to take them, and continually. If a person is looking for a “quick fix” then look some more. Studies show that many people, in particular older adults over 65, stop using the GLP-1s within less than a year for reasons that include cost, and side effects. Speaking of side effects, these medications commonly cause gastroparesis (slowing of digestion of food, which may also slow detoxification in the body) GERD (heartburn), nausea, diarrhea, constipation, vomiting and hair loss. More severe and rarer side effects include increased risk of pancreatitis, thyroid cancer, and problems with eyesight. Mental health side effects may include increased depression and suicidal risk. (1.-9. Except not 3.)
According to Casey and Callie Means, MD, in their book Good Energy, (5.), metabolism and weight control is a complicated system directed by many different hormones. Their main premise is that food can be medicine and the number one path to health is through eating more whole foods. They further explain that you can change your metabolism and likely lose weight without medications. For instance, by eating more dark leafy greens and other vegetables high in thylakoids, people can naturally increase both cholecystokinin (CCK) and their bodies’ own naturally occurring GLP1s! This can slow the release of lipase and the digestion of fats in the body and help people feel more satiated or less hungry sooner. Later, they go on to say that cravings are partly caused by our physiology: our gut health, microbiome, and the foods we are already eating. (5.)
I first heard about GLP-1s almost a decade ago as a PA working in a private, doctor-owned family practice near Denver. At that time, GLP-1s were being promoted to treat Diabetic patients. I prescribed them to a couple of patients, with mixed results. At the time, I was still learning in my new career. I was influenced by the other providers, my colleagues who were using them enthusiastically and by the drug reps who gave us the free samples for our patients to start. I always wondered if it was ethical to prescribe medications given to our office. It is a fine line I still walk with many questions. In their book, Casey and Callie Means list the companies and people who make money on marketing GLP-1s very heavily to patients in the USA for weight loss.(5.)
I am concerned by the heavy marketing of GLP-1s. They are suddenly the “wonder drug” that everyone needs to be taking. I have received texts from an unknown sender telling me my GLP-1s (that I never ordered) are ready. WHAT!? When I was in PA school 12 years ago, I was taught the danger of prescribing opioids. 10 years earlier, pharmaceutical companies were pushing doctors to prescribe them to everyone. Now we have an opioid crisis in our country.
Many studies of GLP-1s were funded by the pharmaceutical companies that make them. This is common since they have the money and incentive to fund studies, however, there is a conflict of interest when the authors/scientists doing the studies also work for the pharmaceutical companies and will benefit from increased sales of the medications/drugs. (3.,4.,9)
One of my biggest concerns about these medications is the perceived need to continue using them for life once you start them. Several studies show that if a person stops taking them after successfully losing weight with them, they will rapidly regain the lost weight unless they also make life-style changes. (8.,9.)
One Danish study showed that people fared much better with a structured exercise program or the exercise program in addition to the GLP-1 medication, than with the medication alone. In their study, Jensen, et al, initially recruited overweight participants ages 18-65 to an 8-week low calorie diet. Participants who lost at least 13 kilograms (28.6 pounds) were then randomly assigned to one of 4 treatment groups for one year: (1) supervised exercise, (2) GLP-1, (3) exercise plus GLP-1, (4) placebo (injection without medicine). 166 Participants completed the weight loss maintenance phase.
The study authors did a follow up interview and analysis of many of the participants a year after the end of treatment to determine if they maintained their results. More of the participants in the groups with exercise or GLP-1 plus exercise kept off 10% of weight even one year later. Those who just took the GLP-1s gained back most of the weight in the following year. The placebo group also experienced weight gain a year after the treatment period. It is not surprising that assistance in changing lifestyle patterns of eating, sleeping, de-stressing and moving will help people to lose weight and maintain that weight loss longer term. (3.)
Rather than take a wonder drug for weight loss, why not focus on lifestyle changes that support your physical, emotional and spiritual health? It is beneficial to take the lifetime approach to your well-being. Start small and young to establish routines for optimal health. OR, if you are already in a difficult state, begin to slowly claim back your life. We can guide you with recommendations for stress reduction, movement, dietary changes, optimization of thyroid and other hormones for success in thriving in your life instead of just surviving. There might be a place for prescription medications and/or supplements to assist you initially.
© January 2026. Deborah Lieberman, MMS, PA-C
References :
1. Dai, H., Li, Y., Lee, Y. A., Lu, Y., George, T. J., Donahoo, W. T., Lee, K. P., Harikrishna Nakshatri, Allen, J., Guo, Y., Sun, R. C., Guo, J., & Bian, J. (2025). GLP-1 Receptor Agonists and Cancer Risk in Adults With Obesity. JAMA Oncology. https://doi.org/10.1001/jamaoncol.2025.2681
2. Hira, T., Pinyo, J., & Hara, H. (2019). What Is GLP-1 Really Doing in Obesity? Trends in Endocrinology & Metabolism, 31(2). https://doi.org/10.1016/j.tem.2019.09.003
3. Jensen SBK, Blond MB, Sandsdal RM, et al. Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial. EClinicalMedicine. 2024;69:102475. Published 2024 Feb 19. doi: 10.1016/j.eclinm.2024.102475
4. Liu, L., Chen, J., Wang, L., Chen, C., & Chen, L. (2022). Association between different GLP-1 receptor agonists and gastrointestinal adverse reactions: A real-world disproportionality study based on FDA adverse event reporting system database. Frontiers in Endocrinology, 13. https://doi.org/10.3389/fendo.2022.1043789
5. Means, C., & Means, C. (2024). Good Energy. Penguin.
6. Perreault, L., MD, L. and Reid, TJ MD, and section editor Pi-Sunyer, X., MD, MPH, Obesity in Adults: Drug therapy. Accessed online UptoDate January 6, 2026.
7. Rodriguez, P. J., Zhang, V., Gratzl, S., Do, D., Cartwright, B. G., Baker, C., Gluckman, T. J., Stucky, N., & Emanuel, E. J. (2025). Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults With Overweight or Obesity. JAMA Network Open, 8(1), e2457349–e2457349. https://doi.org/10.1001/jamanetworkopen.2024.57349
8. Span, Paula (2025) the new old age: Older Americans Quit Weight-Loss Drugs in Droves, The New York Times December 21, 2025. https://www.nytimes.com/2025/12/21/health/older-people-glp1-weight.html
9. Vosoughi, K., Salman Roghani, R., & Camilleri, M. (2022). Effects of GLP-1 agonists on proportion of weight loss in obesity with or without diabetes: Systematic review and meta-analysis. Obesity Medicine, 35, 100456. https://doi.org/10.1016/j.obmed.2022.100456